Uptake and virological outcomes of single- versus multi-tablet antiretroviral regimens among treatment-naïve youth in the HIV Research Network.

OBJECTIVES: Several single-tablet regimens (STRs) are now available and are recommended for first-line antiretroviral therapy (ART); however, STR use for youth with HIV (YHIV) has not been systematically studied. We examined the characteristics associated with initiation of STRs versus multi-tablet regimens (MTRs) and the virological outcomes for youth with nonperinatally acquired HIV (nPHIV). METHODS: A retrospective cohort study of nPHIV youth aged 13-24 years initiating ART between 2006 and 2014 at 18 US HIV clinical sites in the HIV Research Network was performed. The outcomes measured were initiation of STRs versus MTRs, virological suppression (VS) at 12 months, and time to VS. Demographic and clinical factors associated with initiation of STR versus MTR ART and VS (< 400 HIV-1 RNA copies/mL) at 12 months after initiation were assessed using multivariable logistic regression. Cox proportional hazards regression was used to assess VS within the first year. RESULTS: Of 987 youth, 67% initiated STRs. Of the 589 who had viral load data at 1 year, 84% of those on STRs versus 67% of those on MTRs achieved VS (P < 0.01). VS was associated with STR use [adjusted odds ratio (AOR) 1.61; 95% confidence interval (CI) 1.01-2.58], white (AOR 2.41; 95% CI 1.13-5.13) or Hispanic (AOR 2.38; 95% CI 1.32-4.27) race/ethnicity, and baseline CD4 count 351-500 cells/µL (AOR 1.94; 95% CI 1.18-3.19) and > 500 cells/µL (AOR 1.76; 95% CI 1.0-3.10). STR use was not associated with a shorter time to VS compared with MTR use [hazard ratio (HR) 1.07; 95% CI 0.90-1.28]. CONCLUSIONS: Use of STR was associated with a greater likelihood of sustained VS 12 months after ART initiation in YHIV.

Surgical anatomy of the nose.

Knowing the details of nasal anatomy is absolutely necessary when undertaking the responsibility of rhinoplasty surgery. It is the essential first step. Careful study of these details makes for a more confident, prepared practitioner.

Diagnosis of silicone gel breast implant rupture by ultrasonography.

To prospectively evaluate the efficacy of ultrasonography in the diagnosis of ruptured silicone gel breast implants, 98 patients (192 implants) underwent preoperative breast ultrasonography prior to silicone gel breast implant removal. The prevalence of implant rupture confirmed at surgery in this group of patients was 62 of the 192 implants (32 percent). Of the 60 implants diagnosed as ruptured by ultrasonography, 46 were confirmed as having visible defects at surgery (true positive) for a positive predictive value of 77 percent. Of the 132 implants diagnosed as intact by ultrasonography, 116 were confirmed as intact at surgery (true negative) for a negative predictive value of 88 percent. Overall, the sensitivity of ultrasonography for implant rupture was 74 percent, and the specificity was 89 percent. These findings demonstrate that ultrasonography is an effective imaging modality for the diagnosis of silicone gel breast implant rupture. Compared with mammography, ultrasonography appears to offer superior sensitivity and specificity without radiation exposure or discomfort. Although magnetic resonance imaging has shown considerable promise in the diagnosis of implant rupture, ultrasonography provides comparable sensitivity at a fraction of MRI's cost.

Effects of sympathetic denervation and oxygen free radicals on neovascularization in skin flaps.

An island skin flap, with its sole blood supply based on the inferior epigastric vessels, in Sprague-Dawley rats (female, 220 to 250 gm) was used as a model for the investigation of neovascularization. Flap survival after pedicle ligation was considered an indicator of neovascularization. Vascular pedicles were ligated on days 2 to 5 after flap elevation, and the time course of neovascularization in the innervated and denervated flaps was determined by measurements of survival on day 7 after pedicle ligation (on days 9 to 12 postoperatively). Neovascularization sufficient to maintain viability was established at 4 and 5 days after flap elevation in the innervated and denervated flaps, respectively. The effects of various scavengers of oxygen free radicals on neovascularization were evaluated in the innervated and denervated flaps. The pedicles were ligated 3 days after flap elevation. Flap survival was assessed on day 7 after pedicle ligation (on day 10 postoperatively). Treatment with a single dose of deferoxamine (50 mg/kg) increased the viability from 48 to 69 percent of flap area in the denervated flaps (p < 0.01) but produced little effect on viability in the innervated flaps. In the denervated flaps, treatments with a single dose of superoxide dismutase, intravenously and intraarterially, also substantially increased the survival rates from 29 to 86 percent (marginally significant) and 100 percent (p < 0.05), respectively. Allopurinol improved the survival from 43 to 88 percent; the difference was not statistically significant. The results suggest that denervation resulted in a delay of neovascularization and that severe sympathetic denervation contributes to the production of oxygen free radicals, which may exert their inhibitory effects on neovascularization.

Synthesis of polypeptides by the cervix of the baboon (Papio anubis).

Administration of oestradiol to ovariectomized baboons caused the epithelium of the cervix to differentiate into tall columnar cells that were ciliated or secretory. Administration of progesterone in the presence or absence of oestradiol altered the appearance of the lining epithelium, suggesting a decrease in secretory activity. Fluorographs of media from cultures of tissue from steroid-treated animals reflected changes in polypeptide biosynthesis which correlated with the morphological observations: 6 polypeptides (Mr 88,000-37,000; pI 5.5-6.0) were observed in all treatment groups and, except for relative changes in intensity, these polypeptides were electrophoretically similar to those synthesized by the endometrium. A new group of low molecular weight polypeptides (Mr 23,000-20,000, pI greater than 8.0-5.5) and a basic protein (Mr 160,000) were synthesized and released in the oestradiol-dominated animal. These polypeptides were distinct to the cervical mucosa since they were not observed in the endometrium or oviduct. Progesterone suppressed the synthesis of the low molecular weight acidic polypeptides (Mr 23,000-20,000; pI 6.1-5.5) but maintained the synthesis of the basic polypeptides (Mr 23,000-20,000; pI greater than 8). Treatment with progesterone +/- oestradiol did not appear to induce the synthesis of any new major polypeptides in the cervical epithelium. These results suggest that oestradiol induces the synthesis of a group of cervix-specific polypeptides and progesterone antagonizes the action of oestradiol in the baboon cervix.

Nuclear decondensation of mammalian spermatozoa: changes during maturation and in vitro storage.

Swelling of the spermatozoan nucleus and decondensation of the chromatim occur soon after penetration of spermatozoa into the egg cytoplasm. This decondensation was duplicated in vitro by incubating pre-ejaculatory ram, rabbit and bovine spermatozoa and also stored post-ejaculatory bovine spermatozoa in 1% sodium dodecyl sulfate and 2.0 mM dithiothreitol. Spermatozoa obtained from the testis and epididymal caput, corpus and cauda showed a progressive resistance to nuclear decondensation, while no change was evident in the decondensation time of spermatozoa obtained from the epididymal cauda, vas deferens and ejaculated semen. There was also a significant increase in decondensation time after the spermatozoa had been stored in vitro at 25 degrees C. This increased resistance to nuclear decondensation in the in vitro stored spermatozoa, reflecting an increase in cross-linking within the spermatozoan histones by formation of disulfide bonds, may account for part of the increased embryonic mortality observed when spermatozoa are stored in vitro prior to insemination.