Long-Term Benefits from Early Antiretroviral Therapy Initiation in HIV Infection.

BACKGROUND: For people with HIV and CD4+ counts >500 cells/mm3, early initiation of antiretroviral therapy (ART) reduces serious AIDS and serious non-AIDS (SNA) risk compared with deferral of treatment until CD4+ counts are <350 cells/mm3. Whether excess risk of AIDS and SNA persists once ART is initiated for those who defer treatment is uncertain. METHODS: The Strategic Timing of AntiRetroviral Treatment (START) trial, as previously reported, randomly assigned 4684 ART-naive HIV-positive adults with CD4+ counts .500 cells/mm3 to immediate treatment initiation after random assignment (n = 2325) or deferred treatment (n= 2359). In 2015, a 57% lower risk of the primary end point (AIDS, SNA, or death) for the immediate group was reported, and the deferred group was offered ART. This article reports the follow-up that continued to December 31, 2021. Cox proportional-hazards models were used to compare hazard ratios for the primary end point from randomization through December 31, 2015, versus January 1, 2016, through December 31, 2021. RESULTS: Through December 31, 2015, approximately 7 months after the cutoff date from the previous report, the median CD4+ count was 648 and 460 cells/mm3 in the immediate and deferred groups, respectively, at treatment initiation. The percentage of follow-up time spent taking ART was 95% and 36% for the immediate and deferred groups, respectively, and the time-averaged CD4+ difference was 199 cells/mm3. After January 1, 2016, the percentage of follow-up time on treatment was 97.2% and 94.1% for the immediate and deferred groups, respectively, and the CD4+ count difference was 155 cells/mm3. After January 1, 2016, a total of 89 immediate and 113 deferred group participants experienced a primary end point (hazard ratio of 0.79 [95% confidence interval, 0.60 to 1.04] versus hazard ratio of 0.47 [95% confidence interval, 0.34 to 0.65; P<0.001]) before 2016 (P=0.02 for hazard ratio difference). CONCLUSIONS: Among adults with CD4+ counts >500 cells/mm3, excess risk of AIDS and SNA associated with delaying treatment initiation was diminished after ART initiation, but persistent excess risk remained. (Funded by the National Institute of Allergy and Infectious Diseases and others.).

Scoping Review: Evaluation of Moringa oleifera (Lam.) for Potential Wound Healing in In Vivo Studies.

Wound healing is a natural process to restore damaged tissues due to loss of tissue integrity. Moringa oleifera (locally known as merunggai in Malaysia) has been traditionally used in various ailments, including for wound management. To evaluate the wound healing properties in M. oleifera, publications were searched and selected following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement with predetermined inclusion criteria. The databases searched for primary studies include PubMed, Google Scholar, Science Direct, LILACS, ClinicalTrials.gov, and CENTRAL. In total, 18 in vivo studies were included, which involved the leaves, while the remaining 5 studies involved other plant parts tested on excision, incision, dead space, abrasion, and burn-induced wound models. All studies reported significant wound healing abilities. Most studies used different topical formulations of aqueous leaves extract. The accumulation of collagen content and underlying wound healing mechanism through antimicrobial, antioxidant, and anti-inflammatory activities may be contributed by its bioactive phytochemical content, which has the potential to accelerate the wound contraction, increase the rate of epithelialization, and protect tissues against oxidative damage. In conclusion, M. oleifera showed wound healing potential but further studies are warranted to determine the main bioactive phytocompounds and safety.

Bent, But Not Broken: Locus-of-Hope and Well-Being Among Malaysians Facing Economic Challenges Amidst the COVID-19 Pandemic.

Hope is conceptualized as a cognitive set that has often been studied in the context of adversity. No studies, however, directly examine how locus-of-hope (LOH) influences psychological outcomes among vulnerable populations within collectivist cultural contexts. We address this gap by assessing the relationships between LOH and well-being among Malaysians facing financial struggles during the COVID-19 pandemic. We hypothesized that LOH will predict well-being but that external LOH will more strongly predict well-being than internal LOH. One-hundred and fifty-two (152) Malaysians (63 men, 89 women, average age 29.69 years old) who have (1) experienced loss of employment status (2) decrease in salary earnings or (3) earn below the lower 40% threshold of national household incomes completed a series of questionnaires assessing their LOH and well-being. Results indicate that controlling for age, perceptions of government efforts and trait optimism, LOH significantly predict well-being. Findings also show that internal LOH and LOH-family were the strongest predictors of well-being. Theoretical and practical implications are discussed in light of these findings.

Mental health and psychological resilience during the COVID-19 pandemic: A cross-cultural comparison of Japan, Malaysia, China, and the U.S.

BACKGROUND: The current study examined how psychological resilience acted as a buffer against mental health deterioration during the coronavirus disease 2019 (COVID-19) pandemic. We conducted an online survey in four countries (Japan, Malaysia, China, and the U.S.) to examine how psychological resilience functions toward the maintenance of mental health during the COVID-19 pandemic. METHODS: We collected data from 1583 citizens from four countries via an online survey between October 14 and November 2, 2020. We gathered demographic data and measured mental distress (depression, anxiety, and stress) and fear of COVID-19. Data on sense of control, ego-resilience, grit, self-compassion, and resilience indicators were also collected. RESULTS: Sense of control was negatively associated with mental distress in all four countries. Self-compassion was negatively associated with mental distress in the samples from Japan, China, and the U.S. We also found an interaction effect for sense of control: the lower the sense of control, the stronger the deterioration of mental distress when the fear of COVID-19 was high. LIMITATIONS: This study's cross-sectional design precludes causal inferences. Further, lack of data from people who were actually infected with the virus limits comparisons of people who were and were not infected. Finally, as this study only compared data from four countries, comparisons with more countries are needed. CONCLUSIONS: A sense of control and self-compassion may help buffer against mental health deterioration during the COVID-19 pandemic. Sense of control was consistently associated with mental health across cultures.

Loss of CXC-Chemokine Receptor 1 Expression in Chorioamnionitis Is Associated with Adverse Perinatal Outcomes.

Background: Chorioamnionitis complicates about 1−5% of deliveries at term and causes about one-third of stillbirths. CXC-chemokine receptor 1 (CXCR1) binds IL-8 with high affinity and regulates neutrophil recruitment. We aimed to determine the immunoexpression of CXCR1 in placentas with chorioamnionitis, and its association with adverse perinatal outcomes. Methods: A total of 101 cases of chorioamnionitis and 32 cases of non-chorioamnionitis were recruited over a period of 2 years. CXCR1 immunohistochemistry was performed, and its immunoexpression in placentas was evaluated. The adverse perinatal outcomes included intrauterine death, poor APGAR score, early neonatal death, and respiratory complications. Results: Seventeen cases (17/101, 16.8%) with chorioamnionitis presented as preterm deliveries. Lung complications were more common in mothers who were >35 years (p = 0.003) and with a higher stage in the foetal inflammatory response (p = 0.03). Notably, 24 cases (23.8%) of histological chorioamnionitis were not detected clinically. Interestingly, the loss of CXCR1 immunoexpression in the umbilical cord endothelial cells (UCECs) was significantly associated with foetal death (p = 0.009). Conclusion: The loss of CXCR1 expression in UCECs was significantly associated with an increased risk of adverse perinatal outcomes and could be used as a biomarker to predict adverse perinatal outcomes in chorioamnionitis. Further study is warranted to study the pathophysiology involved in the failure of CXCR1 expression in these cells.

RE-COVER project: A survey on resilience, mental health, and fear of Covid-19 in four countries.

OBJECTIVES: The COVID-19 pandemic has impacted the mental health of people worldwide. Psychological resilience has been shown to buffer against the threat of the pandemic (i.e., COVID-19 fear) and sustain mental health. The extent to which psychological resilience factors impact mental health maintenance, however, is unclear, given broad differences in infection rates, prevention approaches, government interventions across different cultures and contexts. Our study examines resilience factors and how they protect individuals from COVID-19-related fear and sustain their mental health. DATA DESCRIPTION: Data were collected from 1583 (Mage = 32.22, SD = 12.90, Range = 19-82) respondents from Japan, China, the United States, and Malaysia between October to November 2020. We collected data across age and sex, marital status, number of children, and occupations. We also accounted for stay-at-home measures, change in income, COVID-19 infection status, place of residence, and subjective social status in the study. Our variables included mental health-related and resilience constructs, namely (i) fear of COVID-19, (ii) depression, anxiety, and stress; (iii) present, past, and future life satisfaction, (iv) sense of control, (v) positive emotions, (vi) ego-resilience, (vii) grit, (viii) self-compassion, (ix) passion, and (x) relational mobility. All questionnaires were assessed for their suitability across the four countries with the necessary translation checks. Results from this study can be instrumental in examining the impact of multiple resilience factors and their interaction with demographic variables in shaping mental health outcomes.

Ameliorative Effects of Aquilaria malaccensis Leaves Aqueous Extract on Reproductive Toxicity Induced by Cyclophosphamide in Male Rats.

BACKGROUND: Cyclophosphamide (CP) is a widely used anti-neoplastic and immunosuppressive agent that is associated with adverse side effects including reproductive toxicity. Aquilaria malaccensis (AM) is a traditional medicinal plant which was reported to exhibit high anti-oxidant and free radical scavenging properties. The present study was aimed to evaluate the protective effects of AM leaves extract on sperm quality following toxic exposure to CP. METHODS: Forty-eight male Sprague Dawley rats were allocated into eight groups of six rats (n = 6): control, CP only (200 mg kg-1), AM only (100 mg kg-1, 300 mg kg-1 and 500 mg kg-1) and CP + AM (100 mg kg-1, 300 mg kg-1 and 500 mg kg-1). Animals were sacrificed after 63 days of treatment and the sperm from the caudal epididymis was taken for sperm analysis. RESULTS: The body and the reproductive organs weight, sperm count and motility did not differ between CP and other groups (P > 0.05). A significant increase (P < 0.05) in percentage of the dead and abnormal sperm were seen in the CP alone treated group compared to the control group. Co-administration of AM to the CP exposed rats significantly reduced the (P < 0.05) percentage of abnormal sperm as compared to the CP only group. CONCLUSION: Overall, the present results represent the potential of AM to protect against CP induced reproductive toxicity.

Ameliorative Effects of Aquilaria malaccensis Leaves Aqueous Extract on Reproductive Toxicity Induced by Cyclophosphamide in Male Rats

@#Background: Cyclophosphamide (CP) is a widely used anti-neoplastic and immunosuppressive agent that is associated with adverse side effects including reproductive toxicity. Aquilaria malaccensis (AM) is a traditional medicinal plant which was reported to exhibit high anti-oxidant and free radical scavenging properties. The present study was aimed to evaluate the protective effects of AM leaves extract on sperm quality following toxic exposure to CP. Methods: Forty-eight male Sprague Dawley rats were allocated into eight groups of six rats (n = 6): control, CP only (200 mg kg−1), AM only (100 mg kg−1, 300 mg kg−1 and 500 mg kg−1) and CP + AM (100 mg kg−1, 300 mg kg−1 and 500 mg kg−1). Animals were sacrificed after 63 days of treatment and the sperm from the caudal epididymis was taken for sperm analysis. Results: The body and the reproductive organs weight, sperm count and motility did not differ between CP and other groups (P > 0.05). A significant increase (P < 0.05) in percentage of the dead and abnormal sperm were seen in the CP alone treated group compared to the control group. Co-administration of AM to the CP exposed rats significantly reduced the (P < 0.05) percentage of abnormal sperm as compared to the CP only group. Conclusion: Overall, the present results represent the potential of AM to protect against CP induced reproductive toxicity.

Force System with Vertical V-Bends: A 3D In Vitro Assessment of Elastic and Rigid Rectangular Archwires.

A proper understanding of the force system created by various orthodontic appliances can make treatment of patients efficient and predictable. Reducing the complicated multi-bracket appliances to a simple two-bracket system for the purpose of force system evaluation will be the first step in this direction. However, much of the orthodontic biomechanics in this regard is confined to 2D experimental studies, computer modeling/analysis or theoretical extrapolation of existing models. The objective of this protocol is to design, construct and validate an in vitro 3D model capable of measuring the forces and moments generated by an archwire with a V-bend placed between two brackets. Additional objectives are to compare the force system generated by different types of archwires among themselves and to previous models. For this purpose, a 2 x 4 appliance representing a molar and an incisor has been simulated. An orthodontic wire tester (OWT) is constructed consisting of two multi-axis force transducers or load cells (nanosensors) to which the orthodontic brackets are attached. The load cells are capable of measuring the force system in all the three planes of space. Two types of archwires, stainless-steel and beta-titanium of three different sizes (0.016 x 0.022 inch, 0.017 x 0.025 inch and 0.019 x 0.025 inch), are tested. Each wire receives a single vertical V-bend systematically placed at a specific position with a predefined angle. Similar V-bends are replicated on different archwires at 11 different locations between the molar and incisor attachments. This is the first time an attempt has been made in vitro to simulate an orthodontic appliance utilizing V-bends on different archwires.

Force system generated by elastic archwires with vertical V bends: a three-dimensional analysis.

Background: Our previous understanding of V-bend mechanics is primarily from two-dimensional (2D) analysis of archwire bracket interactions in the second order. These analyses do not take into consideration the three-dimensional (3D) nature of orthodontic appliances involving the third order. Objective: To quantify the force system generated in a 3D two bracket set up involving the molar and incisors with vertical V-bends. Materials and methods: Maxillary molar and incisor brackets were arranged in a dental arch form and attached to load cells capable of measuring forces and moments in all three planes (x, y, and z) of space. Symmetrical V-bends (right and left sides) were placed at 11 different locations along rectangular beta-titanium archwires of various sizes at an angle of 150degrees. Each wire was evaluated for the 11 bend positions. Specifically, the vertical forces (Fz) and anterio-posterior moments (Mx) were analysed. Descriptive statistics were used to interpret the results. Results: With increasing archwire size, Fz and Mx increased at the two brackets (P < 0.05). The vertical forces were linear and symmetric in nature, increasing in magnitude as the bends moved closer to either bracket. The Mx curves were asymmetric and non-linear displaying higher magnitudes for molar bracket. As the bends were moved closer to either bracket a distinct flattening of the incisor Mx curve was noted, implying no change in its magnitude. Conclusions: This article provides critical information on V-bend mechanics involving second order and third order archwire-bracket interactions. A model for determining this force system is described that might allow for easier translation to actual clinical practice.

An efficient biomechanical approach for the management of an impacted maxillary central incisor.

Treatment of an impacted maxillary central incisor poses a unique challenge to the orthodontist because of its position within the esthetic zone, requiring careful management of the soft tissues and an effective biomechanical setup for alignment. This article describes a novel method of extending an extrusion wire from cross tubes attached on the base archwire for forced eruption of impacted central incisors. The effectiveness and versatility of this method are demonstrated with 2 patients.