bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of dyslipidaemia in an HIV‐positive cohort
Authors: Loy A , Townsend L , O'Dea S , Mulcahy F
Published: November 2012

Background

Dyslipidaemia, secondary to both HIV and the use of antiretroviral therapy (ART) is well recognised, with HIV replication and immune status also thought to contribute to the risk. Traditionally the HIV physician has looked after HIV with primary care physicians (GP) managing non‐HIV‐related medical issues. However with the ageing population and the effectiveness of ART the HIV physician is diversifying to focus management strategies on preventative measures also.

Method

127 subjects were recruited. All subjects were HIV‐positive males without any traditional cardiovascular disease symptoms or history. Details of patients demographics, family history, statin therapy, and primary care physician contact were collected. Baseline parameters were recorded and fasting bloods taken.

Results

127 asymptomatic HIV‐positive males were recruited. 74/127 (58.3%) met the EACS criteria for statin prescription. 33/74 (44.6%) were on a statin. There was no significant difference between the class of antiretroviral prescribed, (NNRTI v PI) and lipid abnormalities (p=0.628). Hypertension and increased waist:hip ratio significantly increased the chances of the patient being hyperlipidaemic. Patients were more likely to be prescribed a statin if they were older, had hypertension, an increased waist circumference, increased Framingham risk, increased brain natriuretic peptide (BNP), or were diagnosed HIV‐positive for longer (p<0.05). Pravastatin (21/33 [63.6%]), was most commonly prescribed statin. 24.2% received their statin prescription from their HIV physician, with 75.8% receiving their prescription from their GP. 5/21 (23.8%) on pravastatin met the target verses 7/7 (100%) on atorvastatin verses 2/2 (100%) on simvastatin versus 1/3 (33.3%) on rosuvastatin (p=0.02). Meeting lipid targets was less successful in the protease inhibitor group (1/9) 11.1% versus 11/21 (52.4%) in the NNRTI group (p=0.16).

Conclusion

The majority met criteria for lipid management but less than half of those were prescribed it. Of those, most received treatment from their GP. Nearly half of those on statins did not meet lipid targets. HIV physicians were most likely to prescribe pravastatin and those on pravastatin were the least likely to achieve lipid targets when compared to the other statins. HIV physicians need to diversify their knowledge base and have clearly defined management strategies for the management of dyslipidaemia.
Gender differences in cardiovascular risk factors in HIV‐infected patients on antiretroviral therapy: data from the Spanish Coronator study
Authors: Santos J , Olalla J , Pérez Elías M , Miralles C , Lozano F , Iribarren J , Masiá M , Domingo P , Bernardino J , Estrada V
Published: November 2012

Purpose

HIV‐infected patients present an increased cardiovascular risk (CVR) of multifactorial origin, usually lower in women than in men. Information by gender about prevalence of modifiable risk factors is scarce.

Methods

Coronator is a cross‐sectional survey of a representative sample of HIV‐infected patients on ART within 10 hospitals across Spain in 2011. Variables include sociodemographics, CVR factors and 10‐year CV disease risk estimation (Regicor: Framingham score adapted to the Spanish population).

Results

We included 860 patients (76.3% male) with no history of CVD. Median age 45.6 years; 84.1% were Spaniards; 29.9% women were IDUs. Median time since HIV diagnosis for men and women was 10 and 13 years (p=0.001), 28% had an AIDS diagnosis. Median CD4 cell count was 596 cells/mm3, 88% had undetectable viral load. Median time on ART was 91 and 108 months (p=0.017). There was a family history of early CVD in 113 men (17.9%) and 41 women (20.6%). Classical CVR factors are described in the table. Median (IQR) Regicor Score was 3% (2‐5) for men and 2% (1–3) for women (p=0.000), and the proportion of subjects with mid‐high risk (>5%) was 26.1% for men and 9.4% for women (p=0.000).

Conclusions

In this population of HIV‐infected patients, women have lower cardiovascular risk than men, partly due to higher levels of HDL cholesterol. Of note is the high frequency of smoking, abdominal obesity and sedentary lifestyle in our population.

Men n=656
Women n=204
P value

Age (men >55 y, women >65 y) n (%)
72 (11.0)
8 (3.9)
0.002

Smoking, n (%)
358 (54.9)
110 (53.9)
0.805

Waist >102 cm (men), >88 cm (women), n (%)
84 (12.9)
55 (27.4)
0.000

Hypertension, n (%)
208 (31.8)
45 (22.2)
0.009

Diabetes, n (%)
50 (7.8)
11 (5.4)
0.262

Total cholesterol>240 mg/dL, n (%)
63 (9.8)
24 (11.9)
0.399

HDL‐cholesterol <40 mg/dL, n (%)
239 (37.5)
34 (16.8)
0.000

Total cholesterol/HDL >5, n (%)
197 (30.9)
23 (11.4)
0.000

Physical inactivity, n (%)
324 (56.7)
108 (69.2)
0.005
Non‐communicable diseases among elderly patients with human immunodeficiency virus infection at an urban clinic in a resource‐limited setting
Authors: Katusiime C , Kambugu A
Published: November 2012

Purpose of the study

Following the introduction of highly‐active antiretroviral therapy (HAART), there is improved survival of elderly persons infected with HIV, which may be complicated by multiple co‐morbidities. There is limited data on non‐communicable disease prevalence among HIV‐infected elderly persons in developing countries. The objective of the study was to estimate the prevalence of diabetes mellitus, hypertension and obesity among HIV‐infected elderly persons above 60 years of age attending an urban clinic in Kampala, Uganda.

Methods

We retrospectively reviewed records from a program perspective of HIV‐infected patients aged 60 years of age and above who were attending our clinic. The purpose was to assess prevalence of non‐communicable diseases to improve clinical care.

Summary of results

During the period from April 2011 to March 2012 we reviewed records and identified 154 HIV‐infected patients aged 60 years of age and above. Of these, 26 (16.9%) were aged 70 years and older while 128 (83.1%) were 60–69 years of age. The median age was 63 years (IQR: 61–68 years). Eighty‐five (55.2%) were males while 69 (44.8%) were females. Only 10 participants (6.5%) had been diagnosed with diabetes mellitus while 42 participants (27.3%) had essential hypertension. On the contrary, only 6 patients (4%) had both essential hypertension and diabetes mellitus. There was evidence to show that 58.3% of the female participants with a BMI≥25.00 kg/m2 were significantly different from 38.7% of their male counterparts with a BMI of ≥25.00 kg/m2 (χ2=5.16; 1 df; p=0.02). There was strong evidence that hypertensive patients with BMI <25.00 kg/m2 were significantly different from hypertensive patients with BMI ≥25.00 kg/m2 (χ2=9.55; 1 df; p=0.002).

Conclusion

Three in 10 elderly HIV positive persons aged 60 years and older had a non‐communicable disease‐either diabetes mellitus or essential hypertension. Thirty‐one percent of patients were either overweight or obese. Almost 50% of patients were diabetic, hypertensive, overweight or obese. There is therefore need to incorporate diagnostic tests and management protocols of non‐communicable disease control for elderly HIV‐positive persons aged 60 years and older in resource‐limited settings.
Interest in the ‘Test and Treat’ strategy for HIV prevention among men who have sex with men living in Bangkok
Authors: Maek‐a‐nantawat W , Phanuphak N , Teeratakulpisarn N , Kanteeranon T , Chaiya O , Mansawat T , Ananworanich J , Phanuphak P
Published: November 2012

Background

The current HIV epidemic in Thailand is primarily driven by new cases among men who have sex with men (MSM). HPTN052 study demonstrated 96% efficacy of immediate antiretroviral therapy (ART) to reduce HIV transmission among serodiscordant heterosexual couples. As a result, universal HIV testing and immediate ART has emerged as a strategy to reduce HIV transmission in certain at‐risk populations. The acceptability of this strategy, however, is unknown in MSM.

Methods

From August 2011‐March 2012, we conducted a cross‐sectional study using self‐administered questionnaires to assess attitudes towards universal HIV testing and immediate ART among MSM VCT clients in Bangkok. Participants were asked to complete the questionnaires prior to and after knowing their HIV status. The study was approved by the Institutional Review Board of the Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

Results

Of 342 MSM, the median age (IQR) was 26 (22–31) years, and 34.2% had bachelor's degree or higher. Previous HIV testing was reported by 69.9%, 35.2% of which had HIV testing annually. The most common reasons for previous HIV testing included perceived risk behaviors (63.6%), annual health checkup (26.4%), and partner's request (13.8%). Prior to receiving pre‐test counseling, 74.4% expressed interest to get regular HIV testing. Health benefits from testing (59.6%), free testing (36.5%), and speedy service (35.7%) were the most common persuasive reasons to come for regular HIV testing. Longevity (73.1%) and prevention of HIV transmission to others (58.4%) were reasons for interest in immediate ART (if tested positive) program while costs (37.0%) and life‐long burden (36.7%) were cited as main barriers. Among MSM who tested HIV‐positive (n=45, 13.2%), the interest to participate in immediate ART program was very high both before and after knowing their HIV status (86.7% vs 93.3%, p=0.371). Among HIV‐negative MSM, the interest to participate in regular HIV testing program significantly increased after knowing HIV status (83.4% vs 77.0%, p<0.001).

Conclusions

MSM in Bangkok showed high level of interest in the “Test and Treat” strategy for HIV prevention. Knowing one's HIV status affected the interest to access regular HIV testing program.
Surveillance of transmitted drug resistance in untreated HIV‐infected patients in Cuba
Authors: Machado Zaldivar L , Dubed Echevarría M , Blanco de Armas M , Díaz Torres H , Ruiz Gutierrez N , Romay Franchi D , Váldes de Calzadilla N , Silva Cabrera E
Published: November 2012

Background

Knowledge of transmitted drug resistance (TDR) in untreated HIV‐infected patients is fundamental in the epidemiological surveillance programs, because it is associated with suboptimal virological outcome of first‐line HAART. The aim of this study was to evaluate the epidemiology of TDR in newly diagnosed Cuban patients.

Methods

250 HIV‐1‐infected patients diagnosed between 2009 and 2011 were included in the study. RNA was isolated from plasma and used as target to amplify the pol gen by RT‐nested PCR. PCR products were sequenced and the data generated used to determine the viral subtype by phylogenetic analyses. The TDR were detected by means of Stanford University calibrated population resistance tool, using the 2009 surveillance drug resistance mutations list.

Results

Baseline characteristic were as follows: 78.4% of the cases were males, mean age was 35.5 years, 66.3% of infections were acquired by homosexual transmission and the median viral load was 4.6 log. The 39.2% of the analyzed samples corresponded to the subtype B and 60.8% for non‐B genetic forms, with prevalence of CRF 19_cpx, CRF 20 BG and CRF 23 BG [1]. The overall prevalence of TDR increased in comparison with previous studies (19.2% versus 5.2%) [2]. The majority of mutations were seen within the group of nucleoside reverse transcriptase (NRTI) (8.5%) and non‐NRTI (9.7%). TDR was less common in the group of protease inhibitors (1.7%). The most common mutations were M184V and K103N for the NRTIs and NNRTIs, respectively. The prevalence of TDR in samples of the subtype G was significant (p = 0.005) in comparison with other genetic forms.

Conclusions

This study confirms an increase in the transmission of resistance‐associated mutations, which indicates the importance of maintaining a constant epidemiological surveillance of the TDR in newly diagnosed Cuban patients.
Clinical risk factors on survival among infected children born to HIV‐positive mothers
Authors: Chaimay B , Woradet S , Chantutanon S , Phuntara S , Suwanna K
Published: November 2012

Objective

The aim of this study was to investigate clinical risk factors on survival among infected children born to HIV‐positive mothers in the southern region of Thailand.

Methods

Data from routine prospective cohort studies from 1990–2010 were analyzed. In these studies, totally 1549 infected children born to HIV‐positive mothers were enrolled at birth and followed longitudinally. Information on demographic, clinical manifestation, HIV infection status factors was collected. Survival analysis was used to determine risk factors associated with mortality.

Results

The main result found that one‐quarter of infected children died (434, 28.02%) during the follow‐up period. A total of 135,295 person‐months of follow up was available. The incident rate was 1.03 times per 100 person‐months (95% CI: 0.97 to 1.08). The median survival time among infected children born to HIV‐positive mothers from diagnosis to death was 87.34 months (95% CI: 87.32 to 87.36). Infected children born to HIV‐infected mothers were diagnosed to confirm as AIDS (88.44%) and symptomatic HIV positive (11.56%), respectively. Regarding the clinical risk factor on survival among infected children born to HIV‐positive mothers were found. Infected children born to HIV‐positive mothers were more likely to die, who infected with candidiasis (HR: 1.47, 95% CI: 1.07 to 2.00), Mycobacterium tuberculosis (HR: 1.51, 95% CI: 1.26 to 1.81) and Pneumocystis carinii (HR: 1.50, 95% CI: 1.27 to 1.76), those compared to infected children without clinical manifestation.

Conclusion

Mortality among infected children born to HIV‐positive mothers contributed to high levels in the southern region of Thailand. Consequently, health service system related to prevent mother‐to‐child HIV transmission is needed to improve child survival by lowering HIV infection and mortality in children born to HIV‐positive mothers.
Trends in transmitted HIV drug resistance in Iran from 2010 to 2011
Authors: Jahanbakhsh Sefidi F , Hattori J , Ibe S , Monavari S , Memarnejadian A , Aghasadeghi M , Mostafavi E , Keyvani H , Sugiura W , Azadmanesh K
Published: November 2012

Background

Drug‐resistant (DR) HIV emerges during antiretroviral treatment (ART), creating concern about widespread transmission of DR‐HIV as ART is expanded in resource‐limited countries. The aim of this study was to determine the predominant HIV‐1 subtypes and prevalence of drug‐resistance mutations among antiretroviral‐naïve patients in Iran.

Design and methods

For this HIV DR threshold surveillance study, blood samples were collected from 50 antiretroviral‐naïve HIV‐1‐infected patients. Antiretroviral‐resistant mutations were determined by sequencing HIV‐1 protease (PR), reverse transcriptase (RT) and integrase (INT) regions. The HIV‐1 subtype of each sample was determined by sequencing the p17 and C2‐V5 regions of the gag and env genes, respectively.

Results

The PR, RT and INT regions were successfully sequenced in 47 samples (94.0%). Phylogenetic analyses of these regions revealed that 45 (95.7%) cases were CRF35_AD. The remaining two cases were subtype B (2.1%) and CRF01_AE (2.1%). Consistent results were obtained also by Env and Gag sequences. Regarding prevalence of transmitted drug‐resistant viruses, two cases were found to harbor RT‐inhibitor mutations. In addition, nine amino acid differences compared to that of HXB2 were found in protease region as compared to that of HXB2, though none matched with the mutations shown in the WHO list for surveillance of transmitted mutations. No drug‐resistant mutations were found in the INT region.

Conclusion

Our study clarified that CRF35_AD is the major HIV‐1 subtype among Iranian HIV‐1‐infected patients. According to the WHO surveillance algorithm, the prevalence of transmitted drug resistance in Iran was estimated as moderate (5–15%).
High prevalence of CXCR4‐using viruses in vertically HIV‐1‐infected infants in Thailand
Authors: Samleerat T , Phiayura P , Hongjaisee S , Sirirungsi W , Ngo‐Giang‐Huong N , Barin F
Published: November 2012

Purpose of the study

Previous studies evaluating the frequency of CXCR4‐using strains in HIV‐1 vertically infected children restricted mainly to patients infected with subtype B or C strains. However, the coreceptor use by non‐B or non‐C subtypes remains little known, especially in infants. In this study, we determined the HIV‐1 coreceptor usage in infants with vertically‐acquired HIV‐1 infection in Thailand, where the predominant circulating HIV‐1 strains are CRF01_AE and the minority are subtype B.

Methods

C2‐V3‐C3 gp120 was amplified in a triplicate nested‐PCR and sequenced. Coreceptor usage was predicted using the geno2pheno [coreceptor] algorithm and analyzed with a false positive rate (FRP) of 10%.

Summary of results

A total of 255 sequences were obtained from viral isolates of 85 HIV‐1‐infected infants (34 male and 51 female) participating in the National AIDS Program (NAP) of the National Health Security Office (NHSO) of Thailand. All children were received ARV prophylaxis according to the Thai national guidelines. The median age was 84 days (range: 33–308). Seventy‐four children (87.1%) were infected with CRF01_AE strain and 11 (12.9%) were infected with subtype B strain. Concordance in tropism prediction for the triplicates was observed in all samples. CXCR4 coreceptor‐using strains were found in 44.7% (38 of 85) and CCR5 coreceptor‐using strains were found in 55.3% (47 of 85). No significant difference in age (p=0.34) and clinical signs of AIDS (p=0.47) were observed between these populations. CCR5Delta32 and CCR5m303 mutation genotypes that may contribute to a selective pressure of viruses to alternatively use CXCR4 as a coreceptor were not found.

Conclusions

A high prevalence of HIV‐1 CXCR4‐using variants was found among HIV‐1 vertically infected infants in Thailand, indicating that a direct vertical transmission of CXCR4‐using variants or a rapid switch from CCR5‐using to CXCR4‐using viruses shortly after transmission. These observations may have implications for clinical and therapeutic aspects, especially in the early stage of HIV‐1 infection in infants and may benefits for using of CCR5‐antagonists in this population.
Antiretroviral therapy in HIV‐infected patients with tuberculosis and chronic viral hepatitis
Authors: Kanestri V , Kravchenko A , Deulina M
Published: November 2012

Background

The purpose of the study was to determine the influence of an HIV infection with tuberculosis or chronic viral hepatitis on efficiency and safety during 48 weeks of HAART.

Methods

HAART was received by 327 naïve HIV patients (pts). Clinical symptoms of an HIV infection had 273 pts (83.5%). The 1st group ‐ 59 HIV pts with tuberculosis, the 2nd group ‐ 217 HIV pts with chronic viral hepatitis, the 3rd group ‐ 51 HIV‐monoinfected pts. All pts were treated with 2 NRTI + EFV/PI. Evaluation of HAART efficacy based on the change of amount CD4 cells and RNA HIV level after 24 and 48 weeks therapy. Safety of HAART was evaluated on the frequency of adverse events and the change of laboratory abnormalities.

Results

After 24 weeks 61–72% of patients had undetectable RNA HIV level. CD4 cells increased in all groups. The percentage of pts with low CD4 cells (<200 cells/mm3) decreased from 40–55% to 26–30%. After 48 weeks HAART CD4 cells increased by 90–127 cells/mm3 (vs baseline) in all pts, however 17.4–26.7% pts saved low CD4 cells. Undetectable RNA HIV level registered in 75.6% pts with tuberculosis and 87.5–88.8% other pts. The proportion of pts who had adverse events was more among 1st and 2nd groups as compared as HIV‐monoinfected pts (33–35% and 19%, p < 0.05) after 24 weeks of therapy. After 48 weeks HAART the frequency of adverse events and laboratory abnormalities decreased to 20–28% in 1st and 2nd groups and to 2% in 3rd group. The most frequent we observed CNS disorders (grade 1) due to EFV and gastrointestinal symptoms due to PI or Combivir (CBV). In pts with accompanying diseases the frequent increase of ALT level was observed in 30–40%, in HIV‐monoinfected pts ‐ 4–10%. The frequency of interruption HAART was greatest among patients with tuberculosis ‐ 14.3% (vs 5% and 5.8% in patients with hepatitis and monoinfected patients). In general, the interrupt has been associated with the combination of side effects of antiretroviral and antituberculosis drugs.

Conclusions

Availability of chronic liver disease or tuberculosis almost have no influence on the HAART efficacy. However, essential increase the frequency of adverse events HAART that leads to change HAART regimen or interruption it.
Use of maraviroc in clinical practice: a multicenter observational study
Authors: Dentone C , Fraccaro P , Fenoglio D , Firpo E , Cenderello G , Piscopo R , Cassola G , Bartolacci V , Casalino Finocchio G , De Leo P , Guerra M , Orofino G , Mantia E , Zoppi M , Filaci G , Parodi A , De Maria A , Bozzano F , Marras F , Sormani M , Signori A , Bruzzone B , Nigro N , Ferrea G , Giacomini M , Viscoli C , Di Biagio A
Published: November 2012

Purpose of the study

Promising research suggest that maraviroc (MVC) has favourable clinical outcome in HIV‐infected patients (pts). Aim of the study is to assess: durability, safety profile and immunovirological recovery in a large MVC‐based cohort.

Methods

All HIV pts treated with antiretroviral therapy (ART) containing MVC for at least 6 months (all viruses CCR‐5 tropic analyzed by genotypic and phenotypic test) were recruited in an observational multicenter study. Eight Infectious Diseases Centers in Liguria and Piedmont (Italy) collected at baseline and every 3 months demographics, clinical and immunovirological data on a web‐based system (by MedinfoDist, University of Genoa). We used SPSS for Pearson Chi square test and for generalized estimating equation (GEE); in this model for longitudinal data and frequency analysis we considered altered: TCD4+≤350/mmc, HIVRNA>50 cp/ml, total cholesterol >200 mg/dl, triglycerides >160 mg/dl, transaminase>40 mg/dl, creatinine>1.3 mg/dl and we divided data in 5 time periods: baseline, 1–6, 9–12, 15–24 and 24–45 months.

Summary of results

We enrolled 55 pts: 36 (65%) males, median age 49.6 years (yrs) (range [r] 18.2–76.6, IQR 44.5–53.3), 11 (20%) HCVRNA‐positive, 4 (7%) HBsAg‐positive, 1 both infection. Twenty‐four (44%) pts were classified as CDC C stage, median nadir TCD4+ was 219/mmc (r 11‐529, IQR 125–317), median duration of ART was 15.3 yrs (r 1.3–27.3, IQR 12–16.8), median duration of treatment with MVC was 23 months (r 6–47, IQR 14–36). At baseline 42 (76%) pts had HIVRNA >50 cp/ml, 11 (20%) HIVRNA≤50 cp/ml, 2 (4%) pts no data; on treatment at the last examination 53 pts (96%) had HIVRNA≤50 cp/ml, 2 pts still had HIVRNA>50 cp/ml (CCR5 tropic) and median TCD4+ count was 469/mmc (r 73–1802, IQR 302–592). One pt died and only 2 pts shifted to X4. Chi square test at 9–12 months showed p=0.0001 and the 80% of pts had TCD4+>350/mmc; at the same observation time 83.3% of pts had HIVRNA ≤50 cp/ml (p=0.0001). About cholesterol, triglycerides, transaminase and creatinine no significative differences were found and the median value showed no changes.

Conclusions

In our study a majority of pts treated with ART containing MVC achieved a count of TCD4 >350/mmc and HIVRNA undetectable within 9–12 months. This regimen is a safe, feasible option and in pts with a poor immunological stage, MVC offered a remarkable TCD4+ count gain with limited X4 strains onset.
Retrospective evaluation of late presentation and retention in care in a monocentric cohort of HIV‐patients in 2006–2011
Authors: Ursini T , Polilli E , Sozio F , Mazzotta E , Tontodonati M , Di Stefano P , Vadini F , Placido G , Agostinone A , Consorte A , Di Masi F , Cacciatore P , Pieri A , Calella G , De Cono P , Fazii P , D'Antonio D , Parruti G
Published: November 2012

Almost 1/3 of HIV‐infected individuals enter health care late in the course of infection, worsening their prognosis and costs of care. According to the recent European consensus definitions, late presenters are persons presenting with CD4 counts <350/μL, and presenters with advanced HIV disease have CD4 < 200/μL or an AIDS‐event. These latter, in particular, are at high risk of further opportunistic infections or death despite of HAART. We included all patients newly diagnosed with HIV infection at the Infectious Diseases Unit of Pescara from 2006 to present, registered for at least one day of observation. The duration of follow up was plotted for all enrolled patients up to 31/12/2011. Demographic, clinical, virological and immunological data, lines of therapy and outcome of HAART were collected for each patient. We included 140 consecutive patients, 18.6% in 2006, 17.9% in 2011; 76.4% were male, while the average age was 39.3±10.2y. AIDS diagnosis at presentation was for 39.7% (50% in 2006, 41.7% in 2011); 52.7% had advanced HIV disease (CD4 <200/μL, 53.8% in 2006, 70.8% in 2011), 67.2 % were late presenters (CD4 <350/μL, 73.1% in 2006, 79.2% in 2011). The average CD4 counts at enrollment were 313.8±294.1 in 2006, 361.3±263.1 in 2007, 281.8±295.5 in 2008, 238.4±201.6 in 2009, 394.1±183.9 in 2010, 225.7±245.2 in 2011. Eight per cent of patients were HCV coinfected. Heterosexual exposure occurred in 54% of patients, homosexual in 36%; drug addiction in 7.5%. Among enrollees, 71.4% were Italian, 18.6% from sub‐Saharan Africa, 5.7% from South America and 4.2% from Eastern Europe. With a median follow up of 2.5 years, 105 patients (75%) were still being treated as of November 30th, 2011; among these 104 (99.1%) were in virological suppression. Among the 35 patients no longer followed, 15 (11.4%) died during the first 6 months of treatment, 20 (14.3%) were lost in the first 6 months of follow‐up. All 15 deaths occurred in patients enrolled with CD4 <200/μL. After initiation of HAART only 1 patient (0.7%) switched for virological failure, 19 (13.6%) for toxicity or simplification. The proportion of late presenters at our center is high (67.2%) in the absence of appropriate local screening measures. Early mortality after diagnosis is similarly high, concentrated in patients with late presentation. Retention in care after 6 months and virological success of treated patients appear very promising, much more than recently reported in North America.
Enhancing the Performance of Solid‐State Dye‐Sensitized Solar Cells Using a Mesoporous Interfacial Titania Layer with a Bragg Stack
Authors: Park Jung Tae , Prosser Jacob H. , Ahn Sung Hoon , Kim Sang Jin , Kim Jong Hak , Lee Daeyeon
Published: November 2012

High efficiency dye‐sensitized solar cells (DSSCs) are fabricated with a heterostructured photoanode that consists of a 500‐nm‐thick organized mesoporous TiO2 (om‐TiO2) interfacial layer (IF layer), a 7 or 10‐μm thick nanocrystalline TiO2 layer (NC layer), and a 2‐μm‐thick mesoporous Bragg stack (meso‐BS layer) as the bottom, middle and top layers, respectively. An om‐TiO2 layer with a high porosity, transmittance, and interconnectivity is prepared via a sol‐gel process, in which a poly(vinyl chloride)‐g‐poly(oxyethylene methacrylate) (PVC‐g‐POEM) graft copolymer is used as a structure‐directing agent. The meso‐BS layer with large pores is prepared via alternating deposition of om‐TiO2 and colloidal SiO2 (col‐SiO2) layers. Structure and optical properties (refractive index) of the om‐TiO2 and meso‐BS layers are studied and the morphology of the heterostructured photoanode is characterized. DSSCs fabricated with the heterostructured IF/NC/BS photoanode and combined with a polymerized ionic liquid (PIL) exhibit an energy conversion efficiencies of 6.6% at 100 mW/cm2, one of the highest reported for solid‐state DSSCs and much larger than cells prepared with only a IF/NC layer (6.0%) or a NC layer (4.5%). Improvements in energy conversion efficiency are attributed to the combination of improved light harvesting, decreased resistance at the electrode/electrolyte interface, and excellent electrolyte infiltration.
Heat transfer analysis in thermal entrance region under turbulent flow conditions
Authors: Hasan Basim O.
Published: November 2012

Turbulent heat transfer in the thermal entrance region of the pipe was studied by numerical solution of the energy equation using finite difference technique under different operating conditions. The turbulence effect was accounted for by introducing thermal eddy diffusivity term in the energy equation in both axial and radial directions. The axial and radial temperature profiles, the local heat transfer coefficient in the entrance and fully developed regions, and the entrance lengths were obtained and discussed. In addition, the role of thermal eddy diffusivity in the thermal entrance region and fully developed region was investigated. The finite difference numerical solution was also commented on. The theoretical results were compared with previous experimental works, and a reasonably good agreement was found. It was found that the temperature gradient in axial direction is very steep, close to the leading edge near the pipe's surface and becomes almost negligible after a distance equals few pipe diameters, depending on Reynolds number (Re), Prandtl number (Pr), and heat flux (q). The radial temperature profile was very steep, close to the pipe's surface near the leading edge and becomes almost constant at a very short distance from the pipe surface, depending on Re, Pr, and q. The entrance length (Lt) was found to be reached after 0.5–3.5 pipe diameters distance for the investigated ranges of Re, Pr, and q. Thermal eddy diffusivity plays an important role in axial and radial transport. Ignoring it, causes underestimation in the heat transfer coefficient and overestimation in the entrance length. © 2012 Curtin University of Technology and John Wiley & Sons, Ltd.
Multiphysics simulations of cure residual stresses and springback in a thermoset resin using a viscoelastic model with cure‐temperature‐time superposition
Authors: Patham Bhaskar
Published: November 2012

Simulations of evolution of cure‐induced stresses in a viscoelastic thermoset resin are presented. The phenomenology involves evolution of resin modulus with degree of cure and temperature, the development of stresses due to crosslink induced shrinkage, and the viscoelastic relaxation of these stresses. For the simulations, the detailed kinetic and chemo‐thermo‐rheological models for an epoxy‐amine thermoset resin system, described in Eom et al. (Polym. Eng. Sci. 2000, 40, 1281) are employed. The implementation of this model into the simulation is facilitated by multiphysics simulation strategies. The trends in simulated cure‐induced stresses obtained using the full‐fledged viscoelastic model are compared with those obtained from two other equivalent material models, one involving a constant elastic modulus, and the other involving a cure‐dependent (but time‐invariant) elastic modulus. It is observed that the viscoelastic model not only results in lower estimates of cure‐induced stresses, but also provides subtle details of the springback behavior. © 2012 Wiley Periodicals, Inc. J. Appl. Polym. Sci., 2013
Covalently crosslinked hyaluronic acid‐chitosan hydrogel containing dexamethasone as an injectable scaffold for soft tissue engineering
Authors: Sun Jinchen , Xiao Chao , Tan Huaping , Hu Xiaohong
Published: November 2012

Injectable hybrid hydrogels were produced by mixing crosslinked aldehyde hyaluronic acid with dexamethasone grafted water soluble chitosan, without the addition of a chemical crosslinking agent. The gelation is attributed to the Schiff‐base reaction between amino and aldehyde groups of hydrogel precursors. In this article, the water soluble chitosan, N‐succinyl‐chitosan, grafted with dexamethasone via water soluble carbodiimide chemistry has been characterized. In vitro gelation time, morphologies, swelling, weight loss, and compressive modulus of hybrid hydrogels in phosphate buffered saline were studied. The dexamethasone grafted hydrogel showed a slightly lower gelation time, higher water uptake and faster weight loss compared to the hydrogel without dexamethasone. Human adipose‐derived stem cells were encapsulated into the dexamethasone grafted hydrogel in vitro to assess the biological performance and applicability of the hydrogel as cell carrier. Results demonstrated that the dexamethasone grafted hydrogel resulted in enhanced cell adhesion and proliferation as compared to the hydrogel without dexamethasone. These characteristics provide a potential opportunity for the dexamethasone grafted hybrid hydrogel as an injectable scaffold in adipose tissue engineering applications. © 2012 Wiley Periodicals, Inc. J. Appl. Polym. Sci., 2013
Utilization of fly ash acid residue as a reinforcing filler in ethylene propylene diene monomer rubber
Authors: Luo Feng , Wang Shujuan , Xue Bing , Jiang Yinshan , Wei Cundi
Published: November 2012

Fly ash acid residue (FAAR), a by‐product of circulating fluidized bed fly ash extracted Al2O3 by acid leaching method, has been posing problems because of its disposal. The major chemical components of FAAR are amorphous SiO2 (66.38 wt %) and unburned carbon (20 wt %). Attempts were made for its application as a reinforcing filler for ethylene propylene diene monomer (EPDM) rubber in this article. Surface modification for FAAR by silane coupling agent (Si69) was carried out. The effect of surface modification and unburned carbon existing in FAAR on the performance of FAAR was characterized by Fourier transform infrared and dispersibility test. The results indicated that surface modification could reduce the hydrophilicity of FAAR and unburned carbon also had positive effect on the dispersion of FAAR particles in kerosene. The effect of partial replacement of carbon black by FAAR on the curing behavior, mechanical properties, and morphological characteristics of EPDM rubber was also studied. It was proved that with partial replacement of carbon black by FAAR, the cure time (t90) and maximum torque (MH) of EPDM composites increased with the content of FAAR. The mechanical properties were significantly improved when 15 wt % of carbon black was replaced by FAAR. SEM micrographs confirmed that surface modification can improve the compatibility between FAAR and rubber matrix. Unburned carbon existing in FAAR was also beneficial to the interface bonding. © 2012 Wiley Periodicals, Inc. J. Appl. Polym. Sci., 2013
Synthesis and Pharmacological Screening of Novel meso‐Substituted Porphyrin Analogs
Authors: Fadda Ahmed A. , El‐Mekawy Rasha E. , El‐Shafei Ahmed I. , Freeman Harold
Published: November 2012

A novel series of mesotetrakis[aryl]‐21H,23H‐porphyrin derivatives 2a–j was synthesized from the condensation of aldehyde derivatives 1a–j with pyrrole in the presence of p‐toluenesulfonic acid. The synthesized porphyrins were considered as a model to study the free radical‐induced damage of biological membranes and the protective effects of these porphyrins. It was found that these compounds effectively inhibit the free radical‐induced oxidative hemolysis of red blood cells. Compounds 2c and 2d which bear a sulfur atom, a nitro group, and a chlorine atom exhibited markedly higher antihemolysis activity than the other analogous. Compounds 2a, 2c, 2d, and 2j showed the highest protection activity against DNA damage induced by the bleomycin–iron complex. Compounds 2d, 2f, 2i, and 2j were proved to exhibit antioxidative activity.
Impact of obesity on the cost of major colorectal surgery
Authors: Tapper R , Dixon L , Frampton C , Frizelle F
Published: November 2012

Background

The incidence of obesity is increasing in New Zealand. The aim of the study was to determine whether obesity impacts on the cost of treating patients undergoing major colorectal surgery.

Methods

Between 1 February 2008 and 31 July 2009, consecutive patients undergoing major colorectal surgery at Christchurch Hospital, New Zealand, were enrolled in the study. Body mass index (BMI) and waist-to-hip ratios were assessed using standardized techniques. Patients with a high surgical risk were identified using established criteria and all patients were assessed using the Portsmouth modification of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM). Cost analysis was performed using a structured query language database. Patients were analysed using accepted groupings for BMI, waist circumference and waist-to-hip ratio.

Results

A total of 372 patients were enrolled in the study, of whom 345 were included in the analysis. The incidence of diabetes was significantly higher with increased BMI (P = 0·002), whereas all other co-morbidities, and P-POSSUM values, did not differ between BMI groups. The groups were similar in terms of case mix. Treatment of obese patients (BMI at least 30 kg/m2) was significantly more expensive than that of normal weight patients (BMI 20–24·9 kg/m2): €10 036 versus €7390 (P = 0·005). Treatment costs for patients with a BMI of 25–29·9 kg/m2 were next highest (€9048) followed by those for patients whose BMI was less than 20 kg/m2 (€8884). Patients with a waist circumference above recognized standards for men and women also cost significantly more to treat (€10 063 versus €7836; P = 0·014).

Conclusion

Excess body fat was associated with higher costs of major colorectal surgery.
Measuring colorectal cancer care quality for the publicly insured in New York State
Authors: Sinclair Amber H. , Schymura Maria J. , Boscoe Francis P. , Yung Rachel L. , Chen Kun , Roohan Patrick , Tai Eric , Schrag Deborah
Published: November 2012

The extent to which concordance with colorectal cancer treatment quality metrics varies by patient characteristics in the publicly insured is not well understood. Our objective was to evaluate the quality of colorectal cancer care for publicly insured residents of New York State (NYS). NYS cancer registry data were linked to Medicaid and Medicare claims and hospital discharge data. We identified colorectal cancer cases diagnosed from 2004 through 2006 and evaluated three treatment quality measures: adjuvant chemotherapy within 4 months of diagnosis for American Joint Cancer Committee (AJCC) stage III colon cancer, adjuvant radiation within 6 months of diagnosis for AJCC stage IIB or III rectal cancer, and adjuvant chemotherapy within 9 months of diagnosis for AJCC stage II–III rectal cancer. Concordance with guidelines was evaluated separately for Medicaid‐enrollees under age 65 years and Medicare‐enrollees aged 65–79 years. For adjuvant chemotherapy for colon cancer, 79.4% (274/345) of the Medicaid cohort and 71.8% (585/815) of the Medicare cohort were guideline concordant. For adjuvant radiation for rectal cancer, 72.3% (125/173) of the Medicaid cohort and 66.9% (206/308) of the Medicare cohort were concordant. For adjuvant chemotherapy for rectal cancer, 89.5% (238/266) of the Medicaid cohort and 76.0% (392/516) of the Medicare cohort were concordant. Younger age was associated with higher adjusted odds of concordance for all three measures in the Medicare cohort. Racial differences were not evident in either cohort. There is room for improvement in concordance with accepted metrics of cancer care quality. Feedback about performance may assist in targeting efforts to improve care.
3D‐QSAR‐Assisted Drug Design: Identification of a Potent Quinazoline‐Based Aurora Kinase Inhibitor
Authors: Ke Yi‐Yu , Shiao Hui‐Yi , Hsu Yung Chang , Chu Chang‐Ying , Wang Wen‐Chieh , Lee Yen‐Chun , Lin Wen‐Hsing , Chen Chun‐Hwa , Hsu John T. A. , Chang Chun‐Wei , Lin Cheng‐Wei , Yeh Teng‐Kuang , Chao Yu‐Sheng , Coumar Mohane Selvaraj , Hsieh Hsing‐Pang
Published: November 2012

We describe the 3D‐QSAR‐assisted design of an Aurora kinase A inhibitor with improved physicochemical properties, in vitro activity, and in vivo pharmacokinetic profiles over those of the initial lead. Three different 3D‐QSAR models were built and validated by using a set of 66 pyrazole (Model I) and furanopyrimidine (Model II) compounds with IC50 values toward Aurora kinase A ranging from 33 nM to 10.5 μM. The best 3D‐QSAR model, Model III, constructed with 24 training set compounds from both series, showed robustness (r2CV=0.54 and 0.52 for CoMFA and CoMSIA, respectively) and superior predictive capacity for 42 test set compounds (R2pred=0.52 and 0.67, CoMFA and CoMSIA). Superimposition of CoMFA and CoMSIA Model III over the crystal structure of Aurora kinase A suggests the potential to improve the activity of the ligands by decreasing the steric clash with Val147 and Leu139 and by increasing hydrophobic contact with Leu139 and Gly216 residues in the solvent‐exposed region of the enzyme. Based on these suggestions, the rational redesign of furanopyrimidine 24 (clog P=7.41; Aurora A IC50=43 nM; HCT‐116 IC50=400 nM) led to the identification of quinazoline 67 (clog P=5.28; Aurora A IC50=25 nM; HCT‐116 IC50=23 nM). Rat in vivo pharmacokinetic studies showed that 67 has better systemic exposure after i.v. administration than 24, and holds potential for further development.
A fine‐grained access control and revocation scheme on clouds
Authors: Tu Shan‐shan , Niu Shao‐zhang , Li Hui
Published: November 2012

In recent years, more and more companies outsource their data to the cloud service provider to greatly reduce the cost. However, it also raises underlying security and privacy issues for the significant corporate data. Therefore, a natural way to keep sensitive data confidential against an untrusted cloud service provider is only to store the encrypted data in the cloud. Flexible encryption schemes can provide a fine grain access control for the encrypted data and ensure legitimate user to decrypt the corresponding data. The key problems of this approach include establishing access control for the encrypted data and revoking the access rights from users when they are no longer authorized to access the encrypted data on cloud servers. This paper aims to solve these problems. First, with the attribute encryption and the dual encryption system, we propose a concrete access control scheme constructed over the composite‐order bilinear groups, and we prove its security under the standard model. Then, we propose a fully fine‐grained revocation scheme under the direct revocation model so as to efficiently revoke access rights from users on cloud servers. Copyright © 2012 John Wiley & Sons, Ltd.
Enhancing the performances of recycling folded cascode OpAmp in nanoscale CMOS through voltage supply doubling and design for reliability
Authors: Mak Pui‐In , Liu Miao , Zhao Yaohua , Martins Rui P.
Published: November 2012

Current‐oriented operational amplifier (OpAmp) design has been common for its orderly current‐to‐speed tradeoff. However, for high‐precision or high‐linearity applications, increasing the current does not help much, as the supply voltage (VDD) and intrinsic gain of the MOSFETs in ultra‐scaled CMOS technologies are very limited. This paper introduces voltage‐oriented circuit techniques to address such limitations. Specifically, a 2xVDD‐enabled recycling folded cascade (RFC) OpAmp is proposed. It features: (1) current recycling to enhance the effective trans conductance by 4x with no extra power; (2) transistor stacking to boost the output resistance by one to two orders of magnitude; and (3) VDD elevating to enlarge the linear output swing by 4x. Comparing with its 1xVDD RFC and FC counterparts, the proposed solution achieves 20‐dB higher DC gain (i.e. 72.8 dB) in open loop and 20‐dB lower IM3 (i.e., –76.5 dB) in closed loop, under the same power budget of 0.6 mW in a 1‐V General Purpose 65‐nm CMOS process. In many applications, these joint improvements in a single stage are already adequate, being more power efficient (i.e. less current paths), stable (i.e. more phase margin), and compact (i.e. no frequency compensation) than multi‐stage OpAmps. Voltage‐conscious biasing and node‐voltage trajectory check ensure the device reliability in both transient and steady states. No specialized high‐voltage device is necessary. Copyright © 2012 John Wiley & Sons, Ltd.
Fundamental study on the quantification of tactile sensation
Authors: Akiyama Yoko , Mishima Fumihito , Nishijima Shigerhiro
Published: November 2012

The objective of this study is to quantify tactile sensation by physical indexes for the material design of cosmetics or fabrics. We attempted to express the sensory scores of tactile sensation as a combination of physical indexes. In order to extract the principal factors of tactile sensation, factor analysis was applied to the sensory evaluation data of skin lotions, whose tactile sensation was designed experimentally. The extracted factors were related to physical indexes by multiple regression analysis, and the sensory score was estimated by using physical indexes such as viscosity, contact angle, friction coefficient, and weight loss on temperature rise. © 2012 Wiley Periodicals, Inc. Electron Comm Jpn, 95(12): 29–36, 2012; Published online in Wiley Online Library (wileyonlinelibrary.com). DOI 10.1002/ecj.11435 8
A missing value imputation method using a Bayesian network with weighted learning
Authors: Miyakoshi Yoshihiro , Kato Shohei
Published: November 2012

With the development of computer networks, it has become easy to have huge databases. Accordingly, it is becoming difficult for users to extract knowledge from such databases. In this paper we focus on data mining, especially classification. In real‐world data mining, the missing value problem occurs in cases such as speech containing noise, facial occlusion, and the like. When a test sample has missing values, a classification system cannot handle them. In previous studies, various imputation methods have been developed, with the objective of solving the missing value problem with numerous explanatory variables, even if some explanatory variables were ineffective for imputation. It has been said that the use of many variables degrades learning efficiency, and thus we believe that imputation methods should be developed considering the relations among explanatory variables. It is also effective to consider the relations between the test sample and each of the training samples. Therefore, we have proposed an imputation method using a Bayesian network with weighted learning. Experiments have confirmed that the proposed method imputes missed values with approximate values, and the classification system successfully classified test samples in which missed values were imputed by the proposed method, with better success than some conventional imputation methods. © 2012 Wiley Periodicals, Inc. Electron Comm Jpn, 95(12): 1–9, 2012; Published online in Wiley Online Library (wileyonlinelibrary.com). DOI 10.1002/ecj.11449
Governance and Sense of Place: Half a Century of a German Nature Park
Authors: Mehnen Nora , Mose Ingo , Strijker Dirk
Published: November 2012

The purpose of this article is to analyse the relationship between sense of place and the governance of nature parks. Sense of place has been well researched, including in protected areas, but its relationship to and influence on the governance structure of a protected area has received little attention thus far. Over the last few years, the concept of (regional) governance has been increasingly used with respect to protected areas. It is often stated that governance actually reflects a desire for increased participation of the local population. We argue that regional governance structures will come about more easily in IUCN Category V protected landscapes, where bottom‐up approaches are required and multiple interests have to be taken into account. The findings from a case study on the German Lauenburg Lakes Nature Park, one of the oldest nature parks in Germany, are explored against this background. Today, this nature park faces new challenges (e.g. structural and demographical changes, financial insecurity, weaker legislation, and pressure on nature conservation) and it is important to consider in which direction it wants to develop. More attention to regional governance and sense of place is important to improving the standing and acceptance of the park and to strengthening both regional development and biodiversity protection. Copyright © 2012 John Wiley & Sons, Ltd and ERP Environment.