Fluctuations in milk yield are heritable and can be used as a resilience indicator to breed healthy cows.

Automatic milking systems record an enormous amount of data on milk yield and the cow itself. These type of big data are expected to contain indicators for health and resilience of cows. In this study, the aim was to define and estimate heritabilities for traits related with fluctuations in daily milk yield and to estimate genetic correlations with existing functional traits, such as udder health, fertility, claw health, ketosis, and longevity. We used daily milk yield records from automatic milking systems of 67,025 lactations in the first parity from 498 herds in the Netherlands. We defined 3 traits related to the number of drops in milk yield using Student t-tests based on either a rolling average (drop rolling average) or a regression (drop regression) and the natural logarithm of the within-cow variance of milk yield (LnVar). Average milk yield was added to investigate the relationships between milk yield and these new traits. ASReml was used to estimate heritabilities, breeding values (EBV), and genetic correlations among these new traits and average milk yield. Approximate genetic correlations were calculated using correlations between EBV of the new traits and existing EBV for health and functional traits correcting for nonunity reliabilities using the Calo method. Partial genetic correlations controlling for persistency and average milk yield and relative contributions to reliability were calculated to investigate whether the new traits add new information to predict fertility, health, and longevity. Heritabilities were 0.08 for drop rolling average, 0.06 for drop regression, and 0.10 for LnVar. Approximate genetic correlations between the new traits and the existing health traits differed quite a bit, with the strongest correlations (-0.29 to -0.52) between LnVar and udder health, ketosis, persistency, and longevity. This study shows that fluctuations in daily milk yield are heritable and that the variance of milk production is best among the 3 fluctuations traits tested to predict udder health, ketosis, and longevity. Using the residual variance of milk production instead of the raw variance is expected to further improve the trait to breed healthy, resilient, and long-lasting dairy cows.

An open, prospective trial investigating the pharmacokinetics and safety, and the tolerability of escalating infusion rates of a 10% human normal immunoglobulin for intravenous infusion (IVIg), BT090, in patients with primary immunodeficiency disease.

BACKGROUND AND OBJECTIVES: Pharmacokinetics, safety and tolerability of escalating infusion rates of BT090, a 10% intravenous immunoglobulin (IVIg), were studied in patients with primary immunodeficiency disease. MATERIALS AND METHODS: In Part A, patients (n = 30) received 3 infusions of BT090 at their pretrial dose and dosing interval; the infusion rate of BT090 was increased from 0·3 to 1·4 to 2·0 ml/kg/h for each infusion in each patient initially at 30-min intervals. Pharmacokinetics was evaluated at the 3rd infusion (n = 24). At the 4th infusion, infusion rates were to be gradually escalated from 0·3 to 1·4 to 4·0 to a maximum of 8·0 ml/kg/h initially at 30-min intervals to establish the maximum tolerated infusion rate per patient. RESULTS: The pharmacokinetic characteristics and safety profile of BT090 were comparable with those of other IVIgs, including Intratect(®) . Escalation of infusion rates was well tolerated, allowing identification of individual patient's maximum tolerated infusion rate. At subsequent infusions, all patients tolerated their individually defined maximum infusion rate: 17 patients (68·0%) tolerated infusion rates of 6·0 or 8·0 ml/kg/h and four patients (16%) had maximum tolerated infusion rates of <4·0 ml/kg/h at subsequent infusions. Escalation of infusion rates shortened infusion time from a median of around 2·5 h to around 1·6 h. SAEs were reported in three patients, but none was related to BT090 treatment. CONCLUSIONS: Shortening infusion time may reduce overall healthcare spending, for example nursing time needed, and also minimize disruption of patients' daily routine, especially for those patients in work or school settings.

Pregnancy complications in HIV-positive women: 11-year data from the Frankfurt HIV Cohort.

OBJECTIVES: The aim of the study was to assess pregnancy complications in HIV-positive women and changes in the rates of such complications over 11 years in the Frankfurt HIV Cohort. METHODS: There were 330 pregnancies in HIV-positive women between 1 January 2002 and 31 December 2012. The rate of pregnancy-related complications, such as gestational diabetes mellitus (GDM), pre-eclampsia and preterm delivery, the mode of delivery and obstetric history were analysed. Maternal and neonatal morbidity/mortality as well as HIV mother-to-child transmission (MTCT) were evaluated. RESULTS: In our cohort, GDM was diagnosed in 38 of 330 women (11.4%). Five women (1.5%) developed pre-eclamspia or hypertension. In 16 women (4.8%), premature rupture of membranes (PROM) occurred and 46 women (13.7%) were admitted with preterm contractions. The preterm delivery rate was 36.5% (n = 122), and 26.9% of deliveries (n = 90) were between 34+0 and 36+6 weeks of gestation. Over the observation period, the percentage of women with undetectable HIV viral load (VL) increased significantly (P < 0.001), from 26.1% to 75%, leading to obstetric changes, including an increase in the rate of vaginal deliveries (P < 0.001), from no vaginal births to 50%. The preterm delivery rate decreased significantly (P < 0.001), from 79.2% to 8.3%. There were no significant changes in the rate of GDM, pre-eclampsia, PROM or preterm contractions. CONCLUSIONS: In the 11 years of our analysis, there was a significant reduction in the rate of preterm deliveries and an increase in the vaginal delivery rate, possibly reflecting changes in treatment policies in the same period and the availability of more effective antiretroviral therapy options. The rates of complications such as GDM, pre-eclampsia, preterm contractions, PROM and postnatal complications were stable over the 11 years, but were still increased compared with the general population.

The influence of stevia glycosides on the growth of Lactobacillus reuteri strains.

UNLABELLED: Use of stevia-derived sweeteners was recently officially approved by the European Commission, and their application in the food industry has increased, especially in functional foods. However, there are scarce data about the influence of stevia on probiotic bacteria, which are important both as an inhabitant of the human gut and as a functional food additive. Taking into consideration the broad application of Lactobacillus reuteri in functional foods, the aim of the research was to evaluate the influence of stevia glycosides on its growth. Six Lact. reuteri strains were tested for their ability to grow in the presence of stevioside and rebaudioside A (0·2-2·6 g l(-1) ). The effect of stevia glycosides on biomass concentration, cell count, pH and lactic and acetic acid synthesis was analysed. Both glycosides impaired the growth of analysed strains. However, the inhibitory effect was strain specific, and the concentration-dependent effect was not observed for all parameters. The most pronounced concentration-dependent effect was on lactic and acetic acid production. Taking into account the observed strain-specific inhibitory effect of stevia glycosides, it could be suggested to evaluate the influence of them on each strain employed before their simultaneous application in functional foods. SIGNIFICANCE AND IMPACT OF THE STUDY: The study showed that the growth of Lactobacillus reuteri strains was inhibited in the presence of stevia sweeteners stevioside and rebaudioside A. Probiotics, for example Lact. reuteri strains, are often used as functional additives in health foods and are an important natural inhabitant of the human gastrointestinal tract. Stevia glycosides application in food is increasing; yet, there are no data about the influence of stevia glycosides on Lact. reuteri growth and very few data on growth of other lactobacilli, either in probiotic foods or in the gastrointestinal tract. This research shows that it is necessary to evaluate the influence of stevia glycosides on other groups of micro-organisms in further research.

The German national registry for primary immunodeficiencies (PID).

In 2009, a federally funded clinical and research consortium (PID-NET, http://www.pid-net.org) established the first national registry for primary immunodeficiencies (PID) in Germany. The registry contains clinical and genetic information on PID patients and is set up within the framework of the existing European Database for Primary Immunodeficiencies, run by the European Society for Primary Immunodeficiencies. Following the example of other national registries, a central data entry clerk has been employed to support data entry at the participating centres. Regulations for ethics approvals have presented a major challenge for participation of individual centres and have led to a delay in data entry in some cases. Data on 630 patients, entered into the European registry between 2004 and 2009, were incorporated into the national registry. From April 2009 to March 2012, the number of contributing centres increased from seven to 21 and 738 additional patients were reported, leading to a total number of 1368 patients, of whom 1232 were alive. The age distribution of living patients differs significantly by gender, with twice as many males than females among children, but 15% more women than men in the age group 30 years and older. The diagnostic delay between onset of symptoms and diagnosis has decreased for some PID over the past 20 years, but remains particularly high at a median of 4 years in common variable immunodeficiency (CVID), the most prevalent PID.

[Guideline for antiretroviral therapy of HIV-infected children and adolescents]. / Leitlinie der Pädiatrische Arbeitsgemeinschaft AIDS (PAAD) e.V. zur antiretroviralen Therapie bei HIV-infizierten Kindern und Jugendlichen (2011).

The HIV-infection in adults or children and adolescent differs substantially. Differences include the mode of infection, viral dynamics facing a developing immune system and the clinical course of the infection. In addition to the virological, immunological and epidemiological aspects the psychosocial situation is also very different. The above aspects and the decreased number of antiretroviral substances underline the need for specific guidelines for HIV-therapy in children and adolescents. The German Pediatric Working group AIDS (PAAD) has formulated this guideline in 2011 based on new study results, changes in international recommendations and newly available drugs.

Differences in clinical presentation between norovirus genotypes in nursing homes.

BACKGROUND: In healthcare settings, norovirus (NoV) outbreaks are predominated by genotype II.4 (GII.4) strains. Periodically, new variants of GII.4 emerge, causing a temporary increase of outbreaks. OBJECTIVES: To study the relationship between symptoms and NoV genotype. STUDY DESIGN: Data of 49 nursing homes which were monitored for NoV outbreaks in the winter seasons of 2005/2006 and/or 2006/2007 were used. RESULTS: Data on symptoms and duration of illness were available for 465 residents and 174 staff members from 28 NoV outbreaks. Genotype GII.4 was responsible for 21 outbreaks. Attack rates for residents seemed to be higher in GII.4 outbreaks compared to other genotypes. In outbreaks caused by GII.4, residents vomited more often than in outbreaks with other genotypes. They also had more often complaints of nausea, abdominal cramps, fever, and mucus in stool. The GII.4 2004 variant outbreaks showed higher percentages of nausea, stomach ache, and fever than outbreaks with the GII.4 2006a variant. Differences in duration of illness were not found. In nursing home staff, no clear differences were found between outbreaks caused by GII.4 and non-GII.4 NoVs. CONCLUSIONS: Genotype GII.4 was found to be related to more symptomatic disease, including more residents vomiting, and to a lesser extent, higher attack rates among residents.

Norovirus outbreaks in nursing homes: the evaluation of infection control measures.

Effective infection control measures during norovirus outbreaks are urgently needed in places where vulnerable individuals gather. In the present study, the effect of a number of measures was investigated in daily practice. Forty-nine Dutch nursing homes were monitored prospectively for norovirus outbreaks during two winter seasons. A total of 37 norovirus outbreaks were registered. Control measures were most effective when implemented within 3 days after onset of disease of the first patient. Measures targeted at reduced transmission between persons, via aerosols, and via contaminated surfaces reduced illness in staff and in residents. Reducing illness in staff results in fewer costs for sick leave and substitution of staff and less disruption in the care of residents. The effect of control measures on outbreak duration was limited. This is the first intervention study examining the effect of control measures. Further research is needed to extend and refine the conclusions.

Inhibitor treatment by rituximab in congenital haemophilia A - Two case reports.

UNLABELLED: The development of neutralizing alloantibodies (inhibitors) to factor VIII (FVIII) is one of the most serious complications in the treatment of haemophiliacs. Inhibitors occur in approximately 20 to 30% of previously untreated patients (PUPs), predominantly children, with severe haemophilia A within the first 50 exposure days (ED). Immune tolerance induction (ITI) leads to complete elimination of the inhibitor in up to 80% of the patients and offers the possibility to restore regular FVIII prophylaxis. However, patients with high titre inhibitors, in whom standard ITI fails, usually impose with high morbidity and mortality and therefore prompting physicians to alternate therapy regimens. Rituximab, an anti-CD 20 monoclonal antibody has been successfully used in children and adults for the management of B-cell mediated disorders. We report on the use of a new protocol including rituximab in two adolescents with severe haemophilia A and high titre inhibitors, severe bleeding tendency and high clotting factor consumption after failing standard ITI. Both patients received a concomitant treatment with FVIII according to the Bonn protocol, cyclosporine A and immunoglobulin. Treatment with rituximab resulted in a temporary B-cell depletion leading to the disappearance of the inhibitor. FVIII recovery and half-life turned towards normal ranges. In patient 1 the inhibitor reappeared 14 months after the last rituximab administration. In patient 2 complete immune tolerance could be achieved for 60 months. Bleeding frequency diminished significantly and clinical joint status improved in both patients. In patient 1 the treatment course was complicated by aspergillosis and hepatitis B infection. CONCLUSION: Rituximab may be favourable for patients with congenital haemophilia, high-titre inhibitors and a severe clinical course in whom standard ITI has failed. Prospective studies are required to determine safety, efficacy and predictors of success.

[Side effects of antiretroviral treatment for transmission prophylaxis in preterm and near-term infants]. / Unerwünschte Wirkungen der antiretroviralen Prophylaxe der HIV-Transmission bei Frühgeborenen unter 35 Schwangerschaftswochen.

BACKGROUND: The aim of this study was to assess the frequency of side effects of antiretroviral treatment in transmission prophylaxis in preterm and near-term infants with a history of HIV-positive mothers. METHODS: A retrospective single-centre study of all neonates born to HIV-positive mothers between 2001 and 2005 and receiving antiretroviral prophylaxis was performed. Respiratory distress was documented as well as possible side effects from antiretroviral drug treatment, e. g., anaemia, need for transfusion, liver and kidney dysfunction, depression of white blood cell count, feeding problems and nosocomial infections. A comparison was made between a group of preterm infants of less than 35 weeks of gestation with one of near-term neonates of more than 34 weeks. To evaluate the influence of prematurity on the frequency of symptoms, a matched pairs group of 50 preterm infants was established as the control group. RESULTS: Anaemia at birth (24 vs. 27 %), transient signs of liver impairment (24 vs. 16.5 %) or kidney dysfunction (4 vs. 0.8 %) as well as nosocomial infections were not significantly more frequent in the preterm group than in near-term group of HIV-exposed infants. Respiratory distress (56 vs. 13 %), postnatal anaemia (84 vs. 27 %). leucocytopenia (36 vs. 4 %), feeding problems (88 vs. 42 %), and blood transfusion (32 vs. 7 %) were more common in the preterm infants. The frequency of feeding problems remained markedly elevated when preterm HIV-exposed neonates were compared to preterm controls. Respiratory distress in near-term infants was seen in 13 % of the cases and 2.6 % of them had to be ventilated artificially. This was a higher frequency than in babies delivered by elective Caesarean section without maternal HIV history. CONCLUSIONS: Transmission prophylaxis in offspring of HIV-positive mothers may give rise to adverse effects. Their frequency is higher in preterm infants than in near-term infants. However; this may be related to prematurity, and not to the antiretroviral treatment itself.

Need for therapeutic drug monitoring in HIV-1 infected children receiving efavirenz doses according to international guidelines.

BACKGROUND: International guidelines for the treatment of HIV-1 infected children recommend efavirenz plus nucleoside reverse transcriptase inhibitor combination therapy for first line therapy. Until now little is known about the steady state pharmacokinetics of efavirenz in children. METHODS: 11 HIV-1 infected children at the age of 4 to 10 years received efavirenz according to body weight adjusted dose recommendations at 10 -15 mg/kg body weight. All children were non nucleoside reverse transcriptase inhibitor (NNRTI) naive, 5/11 received efavirenz as first line therapy. Efavirenz plasma concentrations were assessed before daily dose and 1, 2, 4, 8, 24 h post-dose after medication by established HPLC. RESULTS: 7 of 11 children exhibited efavirenz plasma concentrations below targeted ranges. Mean (95% CI) minimum concentrations (C subsetmin) was 1293 ng/mL (range: 889 -1697) and maximum concentration (C subsetmax) was 5552 ng/mL (3951 - 7153) and the mean area under the time-concentration curve at steady state (AUCss) was 63608 ng*h/mL (44222 - 82989). The linear regression analysis of bodyweight adjusted efavirenz AUCss showed a close correlation between dose/bodyweight and plasma concentrations (r superset2 = 0.79). Efavirenz doses below 12.5 mg/kg lead to an AUC < 60000 ng*h/mL in 7 of 8 cases. Higher efavirenz doses exhibited an AUC within the recommended therapeutic range of 60000 - 120000 ng*h/mL (n = 3). CONCLUSIONS: The data show insufficient plasma concentrations for some children despite efavirenz dosing according to recommendations. Antiretroviral therapy needs to be carefully adjusted in children. Therapeutic drug monitoring is strongly recommended to meet efavirenz plasma levels within the therapeutic range.

Hidatidosis muscular: 2 casos clínicos / Muscle hydatidosis: two clinical cases

La hidatidosis por equinococcus granolossus es una parasitosis que afecta principalmente a hígado y pulmón y que en una mínima proporción implica de forma primaria al músculo. Presentamos 2 casos de pacientes intervenidos por una masa quística muscular que tras llegar al diagnóstico de hidatidosis fue tratada con antihelmínticos. Se practicó intervención radical resecando en bloque la periquística. en el seguimiento postoperatorio no se apreciaron imágenes quísticas no siendo necesarias nuevas intervenciones. El tratamiento de elección de la hidatidosis en cualquier localización es la resección quirúrgica radical (quistoperiquistectomía), lo que requiere un diagnóstico previo adecuado. Ante una masa quística muscular no se debe olvidar esta lozalización de la hidatidosis, ya que el primer tratamiento que se realice determinará la evolución de una patología benigna que, como en nuestro caso, puede evolucionar con recurrencias múltiples, muy invalidantes y de difícil resolución. La rareza de un caso de hidatosis muscular primaria, incluso en un país endémico como el nuestro, junto con la evolución peculiar, que puede recordar ciertas premisas básicas en el tratamiento de la enfermedad hidatídica, sea cual sea su localización, han motivado la comunicación de estos casos.

Estudio comparativo de cirugía clásica de hernias inguinales y con malla de polipropileno en Hospital de Parral / A comparative study of classical surgery for inguinal hernias with polypropylene mesh in Parral Hospital

La hernioplastía con malla ha tenido gran difusión dados los buenos resultados que se ha obtenido, por lo que fue incorporado a nuestro servicio a fines del 2003. El objetivo del presente trabajo es comparar los resultados de esta técnica versus la técnica tradicional. Se revisó los antecedentes de 392 pacientes sometidos a hernioplastías; 166 mallas y 226 sin malla, edad promedio fue de 55 años y rango de 16 a 86. Hernias derechas fueron 222 (56 por ciento) y 170 izquierdas (44 por ciento). Se aplicó en todos los casos técnica abierta; 343 hernias primarias y 49 recidivas, de las cuales 11 son dentro del período de observación (8 sin malla y 3 con malla). La estadía postoperatoria fue un 88 por ciento menor a 2 días. La recidiva global determinada en el período fue de 12, de la cual es 1 por ciento en malla y 17 por ciento en sin malla, con su seguimiento promedio de 1,3 años (de 1 mes hasta 2,8 años). Las complicaciones más frecuentes fueron el serohematoma (4,6 por ciento), seguido por infección de la herida operatoria (1,6 por ciento). El dolor crónico (más allá de 3 meses se reportó en un 6 por ciento (4 por ciento en con tensión y 2 por ciento en sin tensión). No hubo morbilidad en esta serie.

Effect of first line therapy including efavirenz and two nucleoside reverse transcriptase inhibitors in HIV-infected children.

OBJECTIVE: In an intent-to-treat study, reduction of viral load, increase in CD4 cell count, clinical benefit and adverse reactions were examined in HIV-infected children receiving first line therapy including efavirenz. METHODS: The data of 10 perinatally infected children (median age: 5.8 years) were evaluated during a treatment period of 24 months. Viral load and CD4 cell count were measured every 4 - 8 weeks. Pharmacokinetic evaluations of efavirenz were performed in all patients at study onset. Adverse reactions were reported after obtaining interval history and examination. RESULTS: At base line, median CD4 cell count was 378 cells/microl (21%) and median viral load was 350,000 copies/ml (5.5 log10 copies/ml). After 24 months of treatment, the median viral load reduction was > 3.5 log10 copies/ ml and HIV-1 RNA < 50 copies/ml was found in 8/10 children (80%). Median CD4 cell count increased to 721 cells/microl (24%) after 3 months and was maintained at a level of >1000 cells/microl (> 25%) after 24 months of treatment. Regarding efavirenz levels, C min. values ranged from 845 to 3550 ng/ml (median: 1845 ng/ml) and C max. values from 2380 to 24 200 ng/ ml (median: 3670 ng/ml). The most common adverse effect was a mild skin rash (4/10 children). CNS symptoms were recorded in one patient and no hyperlipidaemia was seen. CONCLUSION: First line therapy with efavirenz and two NRTIs was well tolerated by HIV-1 infected children and the reduction of viral load seems to be similar to single protease inhibitor-containing regimens.

[Management of HIV-positive pregnancies -- results from a retrospective study]. / Geburtshilfliches Management bei HIV-positiven Schwangeren: Ergebnisse einer retrospektiven Analyse an einem integrativen Zentrum.

OBJECTIVE: The management of HIV-positive pregnancies was investigated in conjunction to pre-, peri and postpartal complications and the HIV transmission rate. PATIENTS AND METHODS: Retrospective study of 88 HIV-positive patients who were delivered at the Dept. of Obstetrics and Gynaecology during 1.1.1997-31.12.2001. RESULTS: HIV-positive patients showed significantly more prepartal complications, compared to control group. Low CD4-cell count (< or = 200/microl) or high viral load (> 10 000 HIV-copies/ml) was not associated with increased risk for transmission relevant complications. The overall HIV-transmission rate was 3.4 % (3/89 newborns; with ART 2.5 % [2/85], without ART 33.3 % [1/3]). The transmission rate increased with complications during pregnancy (7.7 % [2/26] vs. 1.6 % [1/61]). Newborns delivered < or = 35 (th) week of gestation showed a transmission rate of 5.3 % compared to 2.9 % of newborns delivered after the 35 (th) week of gestation. 98 % of the patients were delivered by cesarean section (primary: n = 71, prior: n = 15), spontaneously: n = 2). 97 % of patients (85/88) were treated with antiretroviral therapy (ART). No differences were found in the postpartal complication rate of HIV-positive to -negative patients. None of the newborns was breast fed. CONCLUSIONS: Treatment of this risk-pregnancies in HIV experienced centers significantly reduces the risk of HIV transmission.

The outermost atomic layer of thin films of fluorinated polymethacrylates.

In this paper, we investigate the surface properties of a series of copolymers of perfluoroalkyl methacrylate (CH2 = C(CH3)COOCH2CnF(2n + 1), n = 1, 6, or 10) and methyl methacrylate (MMA) and of blends of perfluorooctyl-end-capped poly(methyl methacrylate) (PMMA) and pure PMMA. The introduction of perfluoroalkyl groups significantly lowers the polymer surface energy as determined by the acid-base approach. X-ray photoelectron spectroscopy (XPS) confirms a higher fluorine concentration in the surface region (the outer 3.8 nm) as compared to in the bulk. The fluorine density in the outermost atomic layer is quantitatively determined by low-energy ion scattering (LEIS). A linear relationship is found between the fluorine density in the outermost atomic layer and the surface energy of the partially fluorinated polymethacrylates, irrespective of the length of the perfluoroalkyl chain. This linearity confirms Langmuir's "principle of independent surface action". Deviation from this linear relationship exists for both highly and sparsely fluorinated polymethacrylates and can be ascribed to the local (surface) ordering of the fluorinated tails and MMA units, respectively. This study may offer one further step toward a deeper understanding of the correlations between macroscopic surface properties and microscopic surface chemical composition.

Surface modification of oxidic nanoparticles using 3-methacryloxypropyltrimethoxysilane.

Tin oxide, antimony-doped tin oxide (ATO), and silica nanosized particles in aqueous dispersion were reacted with various amounts of 3-methacryloxypropyltrimethoxysilane (MPS). The kinetics were followed by 29Si NMR and the products were analyzed by FTIR and 29Si NMR. The kinetic experiments on ATO and silica revealed that the hydrolysis is the rate-determining step in these reactions. The reaction of MPS with the particles is favored over the homocondensation of MPS. Quantitative analysis using FTIR revealed that the amount of MPS grafted onto the tin oxide and silica particles is limited to the amount needed to fill one monolayer. For ATO the maximum amount of grafted MPS was only 50-70% of the amount that is needed for a closed monolayer. The MPS molecules are for the most part oriented parallel to the oxide surface, and a hydrogen bond between the MPS-carbonyl and the oxide is formed.

Quantification of fluorine density in the outermost atomic layer.

The outermost atomic layer of perfluorinated thiol monolayers on gold and poly(tetrafluoroethylene) (PTFE) is analyzed by low-energy ion scattering. Absolute quantification of fluorine density in this layer was achieved after calibrating the fluorine signal with a freshly cleaved LiF(100) single crystal. The fluorine density of monolayers of a C8F17-thiol on gold was 1.48 x 10(15) F atoms/cm2, whereas for PTFE a value of 1.24 x 1015 F atoms/cm2 was observed. This difference was explained by the different tilt angles of the thiol on gold and PTFE chains with respect to the surface normal. Both a configurational and a molecular interpretation on the perfluorinated thiol monolayer on gold are given.

Effect of antiretroviral triple combinations including the protease inhibitor nelfinavir in heavily pretreated children with HIV-1 infection.

BACKGROUND: In this retrospective study the effect of antiretroviral triple therapy including the protease-inhibitor nelfinavir (NFV) on CD4-cells and viral load (VL) in heavily pretreated HIV-infected children was evaluated. PATIENTS AND METHODS: 20 children (<18 years) were included. Median duration of antiretroviral pretreatment was 27 months (range, 7 65), median initial VL was 4.7 log subset 10 (3.2 6.1) and median relative CD4-cells was 17.5% (3 33). Patients were put on combinations with NFV because of treatment failure (increasing VL), intolerance to prior therapy with PIs or adherence problems with prior indinavir. Viral load (RT-PCR, detection limit 50 copies/ml) and CD4-cells were measured every 4-8 weeks. RESULTS: Median viral load decreased 1.2 log(10) (-1.3 2.5), 0.9 log(10) (-0.8 - 2.5) and 0.4 log(10) (-0.5 - 3.0) after 12, 24 and 36 weeks. The VL of 2 patients was below the detection limit (50 copies/ml) after 24 weeks. The relative CD4-cell count increased from a median of 17.5% to 22%, 23% and 25% after 12, 24 and 36 weeks, respectively. Side effects of NFV were usually mild. WHO grade 1 or 2 diarrhea occurred in 70% and moderate elevations of triglycerides in 40% of the patients. At 48 weeks 18/20 patients had to be switched to other combinations due to virological failure. CONCLUSIONS: In children with intensive prior antiretroviral therapy combination therapy including NFV lead to a modest short-term reduction of the VL and increase in CD4-cells. However, the long-term antiretroviral effect was poor.

Lipids and risk assessment.

Because a standard lipid panel can misrepresent lipoprotein abnormalities that contribute to atherosclerosis, more detailed laboratory analysis should be considered in a patient whose level of risk is unclear. This is especially important for patients who have a family history of premature coronary heart disease of uncertain etiology. Such testing is analogous to performing a more advanced imaging procedure when a plain x-ray lacks the sensitivity to define an anatomic derangement. In selected situations, measuring apolipoprotein B, lipoprotein (a), low-density lipoprotein, or high-density lipoprotein subfractions, or homocysteine can markedly clarify cardiovascular risk. This review describes seven men, themselves cardiologists, who had misinterpreted their own risk based on conventional lipid tests. With further evaluation, one of these men was reassured that he had lower risk than he had feared. Six of the men had greater risk than previously recognized.