Effect of gender and race on the week 48 findings in treatment-naïve, HIV-1-infected patients enrolled in the randomized, phase III trials ECHO and THRIVE.

OBJECTIVES: A week 48 efficacy and safety analysis with respect to gender and race was conducted using pooled data from the phase III, double-blind, double-dummy efficacy comparison in treatment-naïve, HIV-infected subjects of TMC278 and efavirenz (ECHO) and TMC278 against HIV, in a once-daily regimen versus efavirenz (THRIVE) trials. METHODS: Treatment-naïve, HIV-1-infected adults were randomized to receive rilpivirine (RPV; TMC278) 25 mg once a day (qd), or efavirenz (EFV) 600 mg qd, plus tenofovir/emtricitabine (ECHO) or tenofovir/emtricitabine, zidovudine/lamivudine or abacavir/lamivudine (THRIVE). RESULTS: A total of 1368 participants (76% male and 61% White, of those with available race data) were randomized and treated. No gender-related differences in response rate (percentage of patients with HIV-1 viral load < 50 HIV-1 RNA copies/mL, using an intent-to-treat, time-to-loss-of-virological-response algorithm) were observed (RPV: men, 85%; women, 83%; EFV: men, 82%; women, 83%). Response rates were lower in Black compared with Asian and White participants (RPV: 75% vs. 95% and 85%, respectively; EFV: 74% vs. 93% and 83%, respectively); this finding was mostly a result of higher discontinuation and virological failure rates in Black patients. Safety findings were generally similar across race and gender subgroups. However, nausea occurred more commonly in women than in men in both treatment groups. In men, diarrhoea was more frequent in the EFV group, and abnormal dreams/nightmares were more frequent in men in both the EFV and RPV groups. CONCLUSIONS: Overall response rates were high for both RPV and EFV. No gender differences were observed. However, response rates were lower among Black patients, regardless of treatment group. Gender appeared to influence the incidence of gastrointestinal adverse events and abnormal dreams/nightmares for both treatments.

Alteration of human tumor cell adhesion by high-strength static magnetic fields.

RATIONALE AND OBJECTIVES: The authors investigated whether the ability of human malignant melanoma cells to increase in cell number or their ability to remain viable was compromised by high-field strength static magnetic fields. Normal human fibroblasts also were studied to determine if any magnetic field-related alterations were unique to tumor populations. METHODS: Human cell lines were grown in monolayer culture in vitro and subjected to a static magnetic field using a 4.7-Tesla superconducting magnetic resonance imaging (MRI) magnet with the gradient coils removed. The number of cells within the total population was determined using an electronic particle counter. Cell viability was estimated by trypan blue exclusion, and the cellular morphology of the attached cells was documented using microscopy. RESULTS: Both the human malignant melanoma cells and the normal human cells were unaffected by the presence of a high-strength magnetic field in terms of increasing their cell numbers or their viability. However, the ability of the malignant melanoma cells to remain attached to the tissue culture surface was impaired. Normal fibroblasts were not affected in this regard. CONCLUSION: High-strength static magnetic fields alter the ability of human malignant melanoma cells to remain adherent to the tissue culture surface, but have no effect on normal human fibroblasts. This may affect the ability of tumor cells to successfully interact with their environment.

Interactions of oxytocin and vasopressin with CRF on the rat colon.

Corticotropin-releasing factor (CRF), a primary mediator of stress responses, produces changes in the gastrointestinal tract identical to those induced by stress. CRF is tenfold more potent in females than in males, but gonadectomy reverses this difference. We postulated that positive modulators of CRF, such as oxytocin (OT) and vasopressin (AVP), may act in females to potentiate effects of CRF and thus could account for the gender-related differences in colonic sensitivity to CRF and stress. Given with CRF, neither OT, peripheral AVP, nor central AVP increased colonic transit any more than CRF alone, suggesting that OT and AVP do not potentiate CRF's actions in the colon. These data indicate that endogenous OT and AVP do not directly affect colonic transit, and that OT and AVP do not account for the gender-related differences in the effects of stress and CRF on colonic transit.

Wrist joint motion simulator.

A computer controlled wrist joint motion simulator has been developed that actively moves forearms from cadavers through cyclic planar flexion-extension motions, planar radial-ulnar deviation motions, and combined motions such as circumduction. Hybrid position-force feedback control algorithms are used to determine the wrist flexor and extensor tendon forces necessary to achieve the desired motions. The simulator was used in a series of 12 fresh cadaver forearms to produce both flexion-extension and radial-ulnar deviation motions and was found to cause repeatable, physiological movements. In these experiments, the extensor tendon forces were greater than those of the flexors, typically by a factor of two.

Four-year study of university athletes' dietary intake.

Baseline dietary intake data were collected for four years on 10 men's and 6 women's university athletic teams. Caloric intake means for specific teams were higher than those stated in nutrition textbooks (5,270 kcal for football, with a 14,000 kcal per day maximum). Athletes' caloric intakes cannot be grouped, as some athletes (wrestlers and gymnasts) have low intakes (400 kcal per day). Protein intake of all athletes except wrestlers and gymnasts is high (in many cases more than twice any recommendation). The diets of teams with high caloric intakes had a high (more than 50%) fat content. The fat content of the diets of other athletes ranged from 30% to 40%. The wrestling team had more members with poor nutrient intake (less than two-thirds of recommendations) than any other team. Poor vitamin A intakes were noted for all athletic teams studied. Low potassium intakes also were common. Members of women's teams had low iron intakes even though their protein and caloric intakes were high.

Ultrasound catheter placement for deep posterior compartment pressure measurements in chronic compartment syndrome.

Medial shin pain, often referred to as shin splints, is a common but difficult to diagnose entity in many athletes. Chronic deep posterior compartment syndrome as a cause of medial leg pain is still controversial. The problems of deep posterior compartment pressure measurement contribute to this controversy. These problems include safety of catheter insertion and the possibility that the patient has more than one deep posterior compartment. In this paper, we present a new technique for catheter placement in which continuous ultrasound guidance is used. This technique allows for the safe placement of the catheter into the deep posterior compartment and for documentation of catheter tip location.

Analysis of the kinematics of the scaphoid and lunate in the intact wrist joint.

In conclusion, this study combined three different technologies to simultaneously monitor scaphoid, lunate, and global wrist motion in three dimensions and concurrently collect data on the pressure distribution in the radiocarpal and ulnocarpal joints. This information was collected dynamically in real time while the wrist was moved in reproducible, physiologic cycles of motion. The scaphoid and lunate flex and extend as well as pronate and supinate while the wrist moves in the plane of flexion and extension. There is minimal radial and ulnar deviation of these carpal bones during this motion. During wrist radial and ulnar deviation, the scaphoid and lunate both flex and extend as well as deviate radially and ulnarly. The pressures in the wrist also change as the wrist moves. Pressures in the wrist are not evenly distributed and, during some movements, are localized to specific areas. The data also support the concept that there is a hysteresis effect on both the carpal bones and the pressure distribution patterns while the wrist is moving. The results of this study can provide baseline data to compare with other studies that evaluate various pathologic abnormalities of the wrist joint.

Use of a tracer dose of barium for evaluating bowel preparation.

Residual colonic barium can be used to gauge bowel preparation for barium enemas. Because upper gastrointestinal study frequently does not immediately precede the barium enema, we have adopted the technique of administering a tracer dose of barium at the beginning of bowel preparation. This report discusses the method, results, advantages, and disadvantages of this technique.

Arthroscopic repair of radial-sided triangular fibrocartilage complex tears.

Treatment of triangular fibrocartilage complex (TFCC) tears is receiving considerable attention. Repair of peripheral tears of the TFCC has been recommended to restore the important functions of stability and load-bearing. Techniques for the reattachment of the periphery of the TFCC are evolving. Previous reports have mainly dealt with ulnar-sided (Palmer Class I-B) repairs. This report describes an arthroscopic technique for repair of radial-sided (Palmer Class I-D) TFCC tears. The procedure utilizes arthroscopic visualization with direct reattachment of the radial edge of the horizontal disk of the TFCC into the sigmoid notch of the distal radius. Fixation is achieved using sutures driven through the distal radius using long straight meniscal repair needles. Early clinical results following arthroscopic reattachment of radial-sided TFCC tears using this technique have been favorable. The technique is presented as an alternative method for repair of these lesions.

In-house CT service: the next clinical engineering crossroads.

Most acute-care hospitals in the United States own at least one computed tomography scanner. Service contracts offered by scanner manufacturers cost approximately 10% of the equipment's purchase price. Equivalent service support can be provided at a lower cost to scanner owners by a CT scanner service group, in which a program director and a senior biomedical equipment technician in a central office oversee purchase of replacement parts and supervise and train biomedical equipment technicians assigned to each participating hospital. The service group saves money by purchasing replacement parts in quantity from a less expensive source than the CT manufacturer, and by employing a technician at each hospital rather than having one BMET travel between several hospitals. Scanner downtime is significantly reduced because the staff technician is available immediately in the event of equipment failure and routine preventive maintenance tasks can be performed after business hours. By encouraging communication and cooperation the service group enables the technicians to keep abreast of the latest technology.

Ipsilateral supracondylar femur fractures following knee arthroplasty.

A retrospective study was performed to evaluate the treatment of five patients with prosthetic knee arthroplasty who sustained a supracondylar femoral fracture of the ipsilateral side. Four of the patients were initially treated by plaster immobilization or traction. Two of the four showed no signs of healing at three months postfracture and had to have open reduction and internal fixation. The fifth patient had primary open reduction and internal fixation. The three patients who were treated surgically regained their prefracture knee rating score. The two who were treated nonoperatively for their fracture had a significant loss in limb function and failed to regain their prefracture knee rating score. Open reduction and internal fixation of these fractures achieves the best results despite the complicating factors of in situ prosthetic components.