Tenofovir disoproxil fumarate rescue therapy following failure of both lamivudine and adefovir dipivoxil in chronic hepatitis B.

OBJECTIVE: To determine the efficacy of tenofovir disoproxil fumarate (TDF) in adults with chronic hepatitis B virus (HBV) infection who had previously failed lamivudine (LAM) and had significant viral replication (HBV DNA >105 copies/ml if HBeAg positive, > 104 copies/ml if HBeAg negative) despite at least 24 weeks of treatment with adefovir dipivoxil (ADV). DESIGN: A prospective open-label study of TDF 300 mg daily. Patients receiving combination ADV/LAM prior to baseline were switched to TDF/LAM. SETTING: Multiple tertiary referral centres. METHODS: Sixty patients were enrolled. The median age was 48.5 years (range 21e80), 46 (77%) were male and 40 (67%) were HBeAg positive. Thirty-eight patients (63%) were switched from ADV to TDF, the remainder from ADV/LAM to TDF/LAM. At baseline, substitutions conferring resistance to LAM or ADV were present in 20 patients (33%) and 17 patients (28%), respectively. The median baseline viral load was 5.33 log10 IU/ml (range 2.81-8.04). Patients initially treated with TDF monotherapy with persistent viral replication at or after 24 weeks were switched to TDF/LAM. The main outcome measures were change in HBV viral load from baseline and percentage of patients achieving an undetectable viral load (<15 IU/ml). RESULTS: Results are reported at 96 weeks of treatment. One patient discontinued TDF at 10 days due to rash. The time-weighted change in viral load from baseline to week 12 was -2.19 log10 IU/ml overall. The median change in HBV DNA from baseline to weeks 12, 24, 48 and 96 was -2.86, -3.23, -3.75 and -4.03 log10 IU/ml, respectively. At 48 and 96 weeks, 27/59 (46%) and 38/59 (64%) patients achieved a HBV DNA <15 IU/ml. The response was independent of baseline LAM therapy or mutations conferring ADV resistance. CONCLUSIONS: In heavily pretreated patients with a high rate of genotypic resistance, TDF retains significant activity against HBV although this appears diminished in comparison with studies of naïve patients.

Volume assessment of the bovine hoof.

The size of bovine hooves is one factor that may affect their ability to absorb shock. An increase in size could therefore reduce the risk of lameness associated with excessive digit loading. The hooves of 30 mature cattle were assessed by linear measurements with the objective of predicting digit volume, which was measured separately by water displacement. Claw volume was predicted accurately by regression equations including the top hoof width, toe length and heel angle. Replacing toe length and heel angle with the age and weight of the animal also gave an acceptable prediction and would be more appropriate for on-farm measurement. A reasonable prediction could be obtained from the top hoof width alone. Front hooves were larger and had greater heel depth than hind hooves. In 26 of the cattle either the right fore and left rear hooves, or the left fore and right rear hooves, were larger than the other two hooves, indicating that crossed limb laterality (symmetry in diagonally opposed limbs) may be present to a greater degree than has been previously recognised in quadrupeds.

Messages discriminated from the media about illicit drugs.

The electronic media have been an instrumental tool in the most recent efforts to address the issue of illicit drug abuse in the United States. Messages about illicit drugs appear in three places in the media: advertising content, news content, and entertainment content. Many studies have documented the amount and types of messages that appear on the electronic media, but few have asked the audience how they interpret these messages. The purpose of this study is to investigate how much and what type of information college students receive from the media about drugs. Interviews were conducted with 228 students using the message discrimination protocol. The messages were then content analyzed into theme areas. Results indicate the majority of messages discriminated from advertising content were fear appeals; that the majority of messages discriminated from news content documented the enforcement efforts in the war on drugs; and that messages about drugs in entertainment content were more likely to provide clear accurate information about drugs than the other two content sources. The results are discussed in terms of the audience receiving fear and fight messages from the electronic media rather than clear, accurate information necessary to make informed decisions about drugs.