Machine Learning Enabled Photoacoustic Spectroscopy for Noninvasive Assessment of Breast Tumor Progression In Vivo: A Preclinical Study.

Breast cancer is a dreaded disease affecting women the most in cancer-related deaths over other cancers. However, early diagnosis of the disease can help increase survival rates. The existing breast cancer diagnosis tools do not support the early diagnosis of the disease. Therefore, there is a great need to develop early diagnostic tools for this cancer. Photoacoustic spectroscopy (PAS), being very sensitive to biochemical changes, can be relied upon for its application in detecting breast tumors in vivo. With this motivation, in the current study, an aseptic chamber integrated photoacoustic (PA) probe was designed and developed to monitor breast tumor progression in vivo, established in nude mice. The device served the dual purpose of transporting tumor-bearing animals to the laboratory from the animal house and performing PA experiments in the same chamber, maintaining sterility. In the current study, breast tumor was induced in the nude mice by MCF-7 cells injection and the corresponding PA spectra at different time points (day 0, 5, 10, 15, and 20) of tumor progression in vivo in the same animals. The recorded photoacoustic spectra were subsequently preprocessed, wavelet-transformed, and subjected to filter-based feature selection algorithm. The selected top 20 features, by minimum redundancy maximum relevance (mRMR) algorithm, were then used to build an input feature matrix for machine learning (ML)-based classification of the data. The performance of classification models demonstrated 100% specificity, whereas the sensitivity of 95, 100, 92.5, and 85% for the time points, day 5, 10, 15, and 20, respectively. These results suggest the potential of PA signal-based classification of breast tumor progression in a preclinical model. The PA signal contains information on the biochemical changes associated with disease progression, emphasizing its translational strength toward early disease diagnosis.

An artificial intelligence framework and its bias for brain tumor segmentation: A narrative review.

BACKGROUND: Artificial intelligence (AI) has become a prominent technique for medical diagnosis and represents an essential role in detecting brain tumors. Although AI-based models are widely used in brain lesion segmentation (BLS), understanding their effectiveness is challenging due to their complexity and diversity. Several reviews on brain tumor segmentation are available, but none of them describe a link between the threats due to risk-of-bias (RoB) in AI and its architectures. In our review, we focused on linking RoB and different AI-based architectural Cluster in popular DL framework. Further, due to variance in these designs and input data types in medical imaging, it is necessary to present a narrative review considering all facets of BLS. APPROACH: The proposed study uses a PRISMA strategy based on 75 relevant studies found by searching PubMed, Scopus, and Google Scholar. Based on the architectural evolution, DL studies were subsequently categorized into four classes: convolutional neural network (CNN)-based, encoder-decoder (ED)-based, transfer learning (TL)-based, and hybrid DL (HDL)-based architectures. These studies were then analyzed considering 32 AI attributes, with clusters including AI architecture, imaging modalities, hyper-parameters, performance evaluation metrics, and clinical evaluation. Then, after these studies were scored for all attributes, a composite score was computed, normalized, and ranked. Thereafter, a bias cutoff (AP(ai)Bias 1.0, AtheroPoint, Roseville, CA, USA) was established to detect low-, moderate- and high-bias studies. CONCLUSION: The four classes of architectures, from best-to worst-performing, are TL > ED > CNN > HDL. ED-based models had the lowest AI bias for BLS. This study presents a set of three primary and six secondary recommendations for lowering the RoB.

Duration of stenting with Montgomery T-tubes in severe laryngotracheal stenosis: does it matter?

OBJECTIVE: Laryngotracheal stenosis management remains largely discretionary in surgical practice. Duration of stenting remains variable following open reconstruction procedures in absence of clearly established differences. The current study evaluates successful decannulation after short-term periods compared with longer periods. METHOD: A comparative study over 18 months evaluated differences in successful decannulation between short- and long-term stent groups. Patients with grade II, III or IV laryngotracheal stenosis were placed on Montgomery T-tube for a short-term period (n = 15), and decannulation rates were compared with age-, sex- and diagnosis-matched patients (n = 15) from historical cases with long-term stent placement. RESULTS: Thirty patients were included. There was no difference between the two groups at baseline. Nine patients (30 per cent) were successfully decannulated, and there was no difference in rates of decannulation between the two groups (p = 0.8). Granulations at the proximal end of tube (38.7 per cent), superior migration of tube (16.1 per cent) and dysphonia (12.9 per cent) were common complications. CONCLUSION: Decannulation was not more successful after placing Montgomery T-tubes for longer periods of time when compared with removal within the first three months. Early removal after proper case selection and planning may be considered for a successful outcome in laryngotracheal stenosis.

Differentiation of Jugular Foramen Paragangliomas versus Schwannomas Using Golden-Angle Radial Sparse Parallel Dynamic Contrast-Enhanced MRI.

BACKGROUND AND PURPOSE: Accurate differentiation of paragangliomas and schwannomas in the jugular foramen has important clinical implications because treatment strategies may vary but differentiation is not always straightforward with conventional imaging. Our aim was to evaluate the accuracy of both qualitative and quantitative metrics derived from dynamic contrast-enhanced MR imaging using golden-angle radial sparse parallel MR imaging to differentiate paragangliomas and schwannomas in the jugular foramen. MATERIALS AND METHODS: A retrospective study of imaging data was performed on patients (n = 30) undergoing MR imaging for jugular foramen masses with the golden-angle radial sparse parallel MR imaging technique. Imaging data were postprocessed to obtain time-intensity curves and quantitative parameters. Data were normalized to the dural venous sinus for relevant parameters and analyzed for statistical significance using a Student t test. A univariate logistic model was created with a binary output, paraganglioma or schwannoma, using a wash-in rate as a variable. Additionally, lesions were clustered on the basis of the wash-in rate and washout rate using a 3-nearest neighbors method. RESULTS: There were 22 paragangliomas and 8 schwannomas. All paragangliomas demonstrated a type 3 time-intensity curve, and all schwannomas demonstrated a type 1 time-intensity curve. There was a statistically significant difference between paragangliomas and schwannomas when comparing their values for area under the curve, peak enhancement, wash-in rate, and washout rate. A univariate logistic model with a binary output (paraganglioma or schwannoma) using wash-in rate as a variable was able to correctly predict all observed lesions (P < .001). All 30 lesions were classified correctly by using a 3-nearest neighbors method. CONCLUSIONS: Paragangliomas at the jugular foramen can be reliably differentiated from schwannomas using golden-angle radial sparse parallel MR imaging-dynamic contrast-enhanced imaging when imaging characteristics cannot suffice.

Wound complication among different skin closure techniques in the emergency cesarean section: a randomized control trial.

OBJECTIVE: Cesarean section is the most commonly performed obstetrical surgical procedure; however, there are no standard guidelines on appropriate skin closure techniques and materials. Only few comparative studies have been conducted on different skin closure techniques, and they have shown conflicting results. Therefore, we compared different skin closure techniques during emergency cesarean section to identify the best technique with minimal wound complication rates. METHODS: Patients were randomized into 3 groups (group A, n=100; group B, n=102; and group C, n=98). In group A, the skin was closed using staples; in group B, via the subcuticular technique using monocryl 3-0; and in group C, using mattress suture nylon (2-0). The primary outcome was a composite of wound complications, including infection, seroma, gaping, and need for resuturing and antibiotic administration. The secondary outcome included closure time, pain perception, patient satisfaction, and cost. Analyses were performed in accordance with the intention-to-treat principle. RESULTS: The composite wound complication rate in the entire cohort was 16.6% (n=50); the complication rate was significantly higher in group A than in the other groups. Infection was the most common wound complication observed in the entire study group (86%) and was significantly higher in group A than in groups B and C (P≤0.001). CONCLUSION: The use of staples for cesarean section skin closure is associated with an increased risk of wound complications and prolonged hospital stay postoperative visits.

Synthesis, characterization and sorption studies of a zirconium(iv) impregnated highly functionalized mesoporous activated carbons.

This study aimed to develop a highly functionalized adsorbent material for the removal of persistent anionic reactive dye. The modification process was commenced via a wet oxidation method by using zirconium salt as an impregnating material. The process led to an increase in the overall porosity, thermal stability and its oxidative functionality. The newly synthesised material was named ZrAC. The morphological and textural images revealed the irregular and eroded structures with an increase in porosity of the modified adsorbent. The results of chemical and spectral analysis disclosed that the material had successfully gained the oxidative functionality over the surface that will favour the removal of anionic dye. Equilibrium isotherms and adsorption kinetics studies insinuate that the overall process of adsorption follows the Sips isotherm and pseudo-second order kinetic model, respectively. The monolayer adsorption capacity of ZrAC was found to be superior (506 mg g-1) to AC at 500 mg L-1 concentration of persistent reactive dye. Moreover, the desorption capabilities of ZrAC were found to be more prominent, which finally affirms its potential use in a continuous flow system as a reusable adsorbent. Additionally, the stability of zirconium, corroborated from ICP-MS and XPS data, revealed the stability of zirconium after adsorption cycles thus verified its reusability. Thus, the characterization and experimental results of ZrAC strongly advocated its potential as a future adsorbent for removal of reactive dyes.

Wound complication among different skin closure techniques in the emergency cesarean section: a randomized control trial

Initial Performance of NI-RADS to Predict Residual or Recurrent Head and Neck Squamous Cell Carcinoma.

BACKGROUND AND PURPOSE: The Head and Neck Imaging Reporting and Data System (NI-RADS) surveillance template for head and neck cancer includes a numeric assessment of suspicion for recurrence (1-4) for the primary site and neck. Category 1 indicates no evidence of recurrence; category 2, low suspicion of recurrence; category 3, high suspicion of recurrence; and category 4, known recurrence. Our purpose was to evaluate the performance of the NI-RADS scoring system to predict local and regional disease recurrence or persistence. MATERIALS AND METHODS: This study was classified as a quality-improvement project by the institutional review board. A retrospective database search yielded 500 consecutive cases interpreted using the NI-RADS template. Cases without a numeric score, non-squamous cell carcinoma primary tumors, and primary squamous cell carcinoma outside the head and neck were excluded. The electronic medical record was reviewed to determine the subsequent management, pathology results, and outcome of clinical and radiologic follow-up. RESULTS: A total of 318 scans and 618 targets (314 primary targets and 304 nodal targets) met the inclusion criteria. Among the 618 targets, 85.4% were scored NI-RADS 1; 9.4% were scored NI-RADS 2; and 5.2% were scored NI-RADS 3. The rates of positive disease were 3.79%, 17.2%, and 59.4% for each NI-RADS category, respectively. Univariate association analysis demonstrated a strong association between the NI-RADS score and ultimate disease recurrence, with P < .001 for primary and regional sites. CONCLUSIONS: The baseline performance of NI-RADS was good, demonstrating significant discrimination among the categories 1-3 for predicting disease.

Assessment of metal enrichment and their bioavailability in sediment and bioaccumulation by mangrove plant pneumatophores in a tropical (Zuari) estuary, west coast of India.

Sediment collected from the estuarine mangroves of the Zuari estuary and Cumbharjua canal were analyzed to assess the concentration, contamination and bioavailability of metals. Mangrove pneumatophores were also analyzed to understand the metal bioaccumulation in mangrove plants. The results indicated the variation of metal concentrations in sediment along the estuary was attributed to changing hydrodynamic conditions, type of sediment and metal sources. Further, speciation studies revealed that Fe, Cr, Co, Ni, Cu and Zn were mainly of lithogenic origin and less bioavailable while high Mn content in the sediment raised concerns over its potential mobility, bioavailability and subsequent toxicity. The mangrove plants exhibited difference in metal accumulation due to variations in sediment parameters and metal availability, in addition to difference in plant species and tissue physiology that affect metal uptake. Moreover, the mangrove plants reflected the quality of the underlying sediment and can be used as a potential bio-indicator tool.

Geochemistry and bioavailability of mudflats and mangrove sediments and their effect on bioaccumulation in selected organisms within a tropical (Zuari) estuary, Goa, India.

Metals are non-degradable in the aquatic environment and play a vital role in estuarine biogeochemistry but could also be detrimental to associated biota. A comparative evaluation of the trace metal concentrations (Fe, Mn, Zn, Cu, Ni, and Co) was carried out in the Zuari estuary, Goa during the post-monsoon season of 2013 at six locations, each representing three mangrove and three mudflat regions. In addition, fractionation of trace metals in sediments was performed to provide information on the mobility, distribution, bioavailability and toxicity. Special attention was paid to the marine mollusks viz. bivalves and gastropods that are extensively used as bio-indicators in coastal pollution. Considering the percentage of metals in the sequentially extracted fractions, the order of mobility from most to least bioavailable forms was Mn > Zn > Cu > Ni > Co > Fe. Mn maintained high bioavailability (average around 60%) in Fe-Mn oxide and carbonate bound forms indicating that Mn is readily available for biota uptake. The bioavailability of Fe was on an average of around 6% whereas other metals like Cu, Zn, Ni and Co were around 19% to 34%. When the bioavailable values were compared with standard Screening Quick Reference Table (SQUIRT), Zn showed higher toxicity level and bioavailability in the lower estuary. On the basis of calculated Bio Sediment Accumulation Factors (BSAF's), overall trend in bioaccumulation was in the order of Cu > Zn > Mn > Ni > Co > Fe. Metal Pollution Index (MPI) computed was higher for gastropods than bivalves.

Genetic relationship and population structure of three Indian local chicken populations as revealed by mtDNA D-loop.

The genetic information obtained from the mitochondrial DNA D-loop region has paramount importance in understanding the evolution of closely related individuals, and designing proper breeding or conservation plans. The present study was conducted using partial D-loop sequences of three local poultry populations from Odisha, India. The partial D-loop sequences were found to be highly polymorphic having 164 polymorphic sites with 89 singletons and 75 parsimony informative sites. Furthermore, 25 insertion and deletion sites were observed. High genetic diversity was observed within three local chicken populations. Highest genetic difference was observed between Gujuri and Kalua population (0.2230) followed by Gujuri and Hansli (0.199) and Kalua with Hansli (0.166). The pairwise mismatch distribution showed that all populations are of constant size over time. Phylogenetic tree analysis indicated that the said three populations were close to the referred population of China, Sri Lanka, Indonesia and Japan than Aseel and Kadaknath (Indian native breeds).

Sperm abnormalities induced by pre-pubertal exposure to cyclophosphamide are effectively mitigated by Moringa oleifera leaf extract.

Moringa oleifera L. is a medicinal plant with potential antioxidant property. This study was aimed at investigating the chemoprotective effect of Moringa oleifera leaf extract (MOE) on cyclophosphamide (CP)-induced testicular toxicity. Two-week-old male Swiss albino mice were intraperitoneally injected with phosphate-buffered saline, 50 mg kg(-1) of CP and 25 mg kg(-1) of MOE. In combination treatment, mice were injected with 25 mg kg(-1) of MOE 24 h prior to CP injection, 24 h prior and post-CP injection and 24 h post-CP injection for 5 consecutive days (10 mg kg(-1) ). Six weeks later, mice were sacrificed to assess epididymal sperm parameters. MOE alone did not have any significant effect on sperm parameters. However, acute injection of CP resulted in significant decline in motility (P < 0.001), increase in head abnormality (P < 0.01) and DNA damage (P < 0.05). Combining MOE with CP increased the sperm density, motility and reduced head defect and DNA damage, irrespective of the schedule and dosage of MOE. Administration of MOE prior to CP significantly elevated the level of superoxide dismutase and catalase with concomitant decrease in lipid peroxidation in the testicular tissue. In conclusion, MOE may have potential benefit in reducing the loss of male gonadal function following chemotherapy.

Impact of industrial effluents on geochemical association of metals within intertidal sediments of a creek.

Metal speciation studies were carried out on three intertidal core sediments of the industrially impacted Dudh creek located along west coast of India. Metals indicated a drastic increase in the bioavailable fraction towards the surface of the cores, suggesting an increase in anthropogenic metal input in recent years as compared to the past. Also, when compared with Vaitarna estuary and Khonda creek of Thane district, the speciation of metals in Dudh creek sediments was observed to have been highly modified in recent years. High concentrations of metals associated with bioavailable fractions therefore suggested a risk of toxicity to sediment associated biota of Dudh creek.

Speciation of metals and their distribution in tropical estuarine mudflat sediments, southwest coast of India.

Two sediment cores collected from a mudflat sedimentary environment of Swarna estuary (S3) and Gurpur estuary (MF6), representing the middle estuarine region, Karnataka, India, were investigated to understand bioavailability of metals and their toxicity. The subsamples were analyzed for sand, silt, clay, organic carbon and total metal concentration of Aluminum (Al), Iron (Fe), Manganese (Mn), Nickel (Ni), Zinc (Zn), Copper (Cu), Cobalt (Co) and Chromium (Cr) at 2 cm intervals. Sediments (average) are relatively coarser in Gurpur estuary whereas silt, clay, organic carbon along with the studied metals (except Mn and Cu) is noted to be higher in the Swarna estuary. Significant correlations were observed of Al, Fe with finer sediments and most of the trace metals in both the cores indicating a mainly lithogenic source. Further, metal speciation analysis carried out for Fe, Mn, Ni, Zn, Cu, Co and Cr on selected samples of both the cores indicated that Fe was largely associated with the residual fraction with 93 ± 0.5% in Gurpur and 84 ± 6% in Swarna estuary. The concentration of studied metals in the residual fraction in the sediments of Gurpur estuary was in the order Mn(90 ± 5%)>Cr(85 ± 1%)>Ni(72 ± 5%)>Zn(69 ± 3%)>Cu(57 ± 5%)>Co(55 ± 2%) and; Cr(80 ± 7%)>Mn(77 ± 10%)>Ni(76 ± 7%)>Zn(67 ± 10%)>Cu(67 ± 10%)>Co(50 ± 7%) in Swarna estuary. When the total (bulk) metals were compared with the Sediment Quality Values (SQV) following Screening Quick Reference Table (SQUIRT), Co values of both the cores fell above Apparent Effect Threshold (AET) values. When the sum of the average bioavailable fractions in sediments was considered, Co values exceeded the AET in core S3 (Swarna estuary). When the variations are viewed with depth, bioavailability of Mn, Ni, Cu and Co in Gurpur estuary indicated anthropogenic addition in recent years whereas in Swarna estuary most of the studied metals showed diagenetic remobilization and diffusion to the water column from surface sediments. Metal speciation study indicated no harm to the aquatic life, except of Co, in Swarna estuary wherein it posed a high risk of toxicity to organisms associated with the sediments.

Effect of climatic variables on production and reproduction traits of colored broiler breeder poultry.

AIM: The present study was conducted to investigate the important climatic variables affecting production and reproduction in a broiler breeder flock. MATERIALS AND METHODS: The experiment was conducted for a period of 1 year on colored synthetic female line male and female poultry birds. 630 female progeny and 194 male progenies from 69 sires and 552 dams produced in four consecutive hatches at an interval of 10 days were used for the present study. Each of the seven, body weight and reproduction traits were regressed with nine environmental variables. Initially, the data were subjected to hatch effect and sire effect corrections through best linear unbiased estimator (BLUE) method and, then, multiple linear regressions of environmental variables on each trait were applied. RESULT: The overall regression was significant (p<0.01) in all traits except 20 week age body weight of females. The R(2) value ranged from 0.12 to 0.90 for the traits. Regression coefficient values (b values) for maximum temperature and minimum temperature were significant (p<0.05) on 5(th) week age body weight of males. Similarly, evaporation and morning relative humidity (RH) was significant (p<0.05) for 5(th) week age body weight of females. Almost all b values were significant (p<0.05) for egg production up to 40 week age. The b values representing rainfall, morning RH, afternoon RH, sunshine hours, and rainy days were significant (p<0.05) on bodyweight at 20 week age. All environmental variables except maximum temperature and minimum temperature were significant (p<0.05) on body weight of females at 20 weeks of age. Age at sexual maturity was regressed significantly (p<0.05) with evaporation, afternoon RH whereas, egg shape index was regressed significantly (p<0.05) with a maximum temperature, evaporation and afternoon RH. CONCLUSION: The result indicated that various environmental variables play a significant role in production and reproduction of breeder broiler poultry. Controlling these variables in adverse weathers may increase production.

Characterizing metal levels and their speciation in intertidal sediments along Mumbai coast, India.

The present study investigated the concentration, distribution and speciation of metals (Fe, Mn, Cu, Pb, Co, Zn and Cr) in sediments of Mumbai region. Pearson's correlation matrix and cluster analyses showed good association of metals with grain size and organic matter. Factor analysis applied to the speciation data helped to identify the role of different sediment fractions in metal retention. The environmental risks of metals, evaluated by sediment quality guidelines, revealed some contamination in the region. However, the Individual and Global Contamination Factors and the Risk Assessment Code, suggested low risk to the aquatic environment, except of Mn in the creek sediments.

Depositional environment and geochemical response of mangrove sediments from creeks of northern Maharashtra coast, India.

Present study provides results of trace metal distribution in mangrove sediment cores collected from macro-tidal Khonda and Dudh creeks of Northern Maharashtra coast, India. Most of the metals showed significant higher addition in Dudh creek (core DC) as compared to Khonda creek (core KC). However, Khonda creek sediments did show anthropogenic enrichment of Mn, Zn and Ni, while Dudh creek sediments showed anthropogenic enrichment of almost all the studied metals. Large difference in metal concentration between the two creeks was attributed to their proximity to industries. The higher Mn, Zn and Ni content in Khonda creek was mainly attributed to addition from domestic and agricultural wastes. While high deterioration of Dudh creek sediments was the outcome of addition from industrial effluents.

p53 is a major component of the transcriptional and apoptotic program regulated by PI 3-kinase/Akt/GSK3 signaling.

The phosphatidylinositol (PI) 3-kinase/Akt signaling pathway has a prominent role in cell survival and proliferation, in part, by regulating gene expression at the transcriptional level. Previous work using global expression profiling identified FOXOs and the E-box-binding transcription factors MITF and USF1 as key targets of PI 3-kinase signaling that lead to the induction of proapoptotic and cell cycle arrest genes in response to inhibition of PI 3-kinase. In this study, we investigated the role of p53 downstream of PI 3-kinase signaling by analyzing the effects of inhibition of PI 3-kinase in Rat-1 cells, which have wild-type p53, compared with Rat-1 cells expressing a dominant-negative p53 mutant. Expression of dominant-negative p53 conferred partial resistance to apoptosis induced by inhibition of PI 3-kinase. Global gene expression profiling combined with computational and experimental analysis of transcription factor binding sites demonstrated that p53, along with FOXO, MITF and USF1, contributed to gene induction in response to PI 3-kinase inhibition. Activation of p53 was mediated by phosphorylation of the histone acetyltransferase Tip60 by glycogen synthase kinase (GSK) 3, leading to activation of p53 by acetylation. Many of the genes targeted by p53 were also targeted by FOXO and E-box-binding transcription factors, indicating that p53 functions coordinately with these factors to regulate gene expression downstream of PI 3-kinase/Akt/GSK3 signaling.

Doping effect of polyaniline/MWCNT composites on capacitance and cyclic stability of supercapacitors.

Polyaniline doped by Zn2+ ions was synthesized as nanocomposites with multiwalled carbon nanotubes (MWCNT) by in-situ oxidative polymerization and investigated as electrode material for supercapacitors. The uniform coating of polyaniline on MWCNT was characterized by field emission scanning electron microscopy (FESEM) and high resolution transmission electron microscopy (HRTEM). The effect of Zn2+ ions on nanocomposites were characterized by Fourier transform infrared (FTIR) spectroscopy. The electrochemical performances were investigated by cyclic voltammetry (CV), constant current charging/discharging cyclic test (CC) and electrochemical impedance spectroscopy (EIS) using a three-electrode system. The doped polyaniline composites show higher specific capacitance and better cyclic stability.

Longitudinal assessment of cardiac diastolic function in HIV-infected patients.

Asymptomatic isolated diastolic dysfunction (DD), with normal left ventricular systolic function, may be the first indication of underlying cardiac disease in HIV-negative populations. We previously reported a high prevalence (37%) of DD among asymptomatic HIV-infected patients at low risk for AIDS and cardiovascular disease (CVD). We performed a longitudinal assessment of interval echocardiographic changes in this cohort over a four-year period. Repeat transthoracic echocardiograms (TTEs) utilized standard techniques. Sixty (of the original 91) HIV-infected patients, predominately men, underwent repeat TTE (median follow-up 3.7 years, interquartile range [IQR] 3.5, 4.0). Cohort characteristics (median; IQR) include age 42.0 (36.5, 46.0) years, HIV duration 16.4 years (8.1, 18.9), current CD4 count 572.0 cells/mm(3) (436.5, 839.0), antiretroviral therapy (ART) duration 8.1 years (4.8, 13.4) and Framingham risk score 1.0 (0.0, 2.0). DD was observed in 28/60 patients on re-evaluation (47%, 95% confidence interval [CI] 34%, 60%); 31% (11/36) of patients had new onset DD for an overall incidence of 8.2/100 person-years. On follow-up, subjects with DD were older, had a trend towards higher body mass index, hypertension and longer duration of HIV infection compared with subjects without DD. We confirmed a high prevalence of DD (47%) in asymptomatic HIV-infected patients at low risk for AIDS and CVD.