Choice of Initial Combination Antiretroviral Therapy in Individuals With HIV Infection: Determinants and Outcomes.

BACKGROUND Current guidelines give recommendations for preferred combination antiretroviral therapy (cART). We investigated factors influencing the choice of initial cART in clinical practice and its outcome. METHODS We analyzed treatment-naive adults with human immunodeficiency virus (HIV) infection participating in the Swiss HIV Cohort Study and starting cART from January 1, 2005, through December 31, 2009. The primary end point was the choice of the initial antiretroviral regimen. Secondary end points were virologic suppression, the increase in CD4 cell counts from baseline, and treatment modification within 12 months after starting treatment. RESULTS A total of 1957 patients were analyzed. Tenofovir-emtricitabine (TDF-FTC)-efavirenz was the most frequently prescribed cART (29.9%), followed by TDF-FTC-lopinavir/r (16.9%), TDF-FTC-atazanavir/r (12.9%), zidovudine-lamivudine (ZDV-3TC)-lopinavir/r (12.8%), and abacavir/lamivudine (ABC-3TC)-efavirenz (5.7%). Differences in prescription were noted among different Swiss HIV Cohort Study sites (P < .001). In multivariate analysis, compared with TDF-FTC-efavirenz, starting TDF-FTC-lopinavir/r was associated with prior AIDS (relative risk ratio, 2.78; 95% CI, 1.78-4.35), HIV-RNA greater than 100 000 copies/mL (1.53; 1.07-2.18), and CD4 greater than 350 cells/μL (1.67; 1.04-2.70); TDF-FTC-atazanavir/r with a depressive disorder (1.77; 1.04-3.01), HIV-RNA greater than 100 000 copies/mL (1.54; 1.05-2.25), and an opiate substitution program (2.76; 1.09-7.00); and ZDV-3TC-lopinavir/r with female sex (3.89; 2.39-6.31) and CD4 cell counts greater than 350 cells/μL (4.50; 2.58-7.86). At 12 months, 1715 patients (87.6%) achieved viral load less than 50 copies/mL and CD4 cell counts increased by a median (interquartile range) of 173 (89-269) cells/μL. Virologic suppression was more likely with TDF-FTC-efavirenz, and CD4 increase was higher with ZDV-3TC-lopinavir/r. No differences in outcome were observed among Swiss HIV Cohort Study sites. CONCLUSIONS Large differences in prescription but not in outcome were observed among study sites. A trend toward individualized cART was noted suggesting that initial cART is significantly influenced by physician's preference and patient characteristics. Our study highlights the need for evidence-based data for determining the best initial regimen for different HIV-infected persons.

Firmground ichnofacies recording high-frequency marine flooding events (Langhian transgression, Vallè-Penedès Basin, Spain)

The decapod burrow Spongeliomorpha sudolica occurs associated with transgressive firmgrounds in the transition between Aragonian continental red beds and Langhian marine units in some of the inner sectors of the Vallès-Penedès Basin. This ichnospecies designates branching burrow systems with scratch marks in the walls produced by marine crustacean decapods. The occurrence of Spongeliomorpha represents an example of theGlossifungites ichnofacies. The several horizons where the traces are found are intercalated with continental red beds a few meters below the main transgressive surface, which is overlain by fossiliferous marine sandstones. The Spongeliomorpha-bioturbated layers record short, high frequency marine flooding surfaces that may be related either to actual sea-level changes or to variations in tectonic subsidence or sediment input. In any case, these flooding events punctuated the early phases of the Langhian transgression in the basin.

Frequency dynamics of gain-switched injection-locked semiconductor lasers

The frequency dynamics of gain-switched singlemode semiconductor lasers subject to optical injection is investigated. The requirements for low time jitter and reduced frequency chirp operation are studied as a function of the frequency mismatch between the master and slave lasers. Suppression of the power overshoot, typical during gain-switched operation, can be achieved for selected frequency detunings.

Combination therapy with venlafaxine and carbamazepine in depressive patients not responding to venlafaxine: pharmacokinetic and clinical aspects.

The chiral antidepressant venlafaxine (VEN) is both a serotonin and a norepinephrine uptake inhibitor. CYP2D6 and CYP3A4 contribute to its metabolism, which has been shown to be stereoselective. Ten CYP2D6 genotyped and depressive (F32x and F33x, ICD-10) patients participated in an open study on the pharmacokinetic and pharmacodynamic consequences of a carbamazepine augmentation in VEN non-responders. After an initial 4-week treatment with VEN (195 +/- 52 mg/day), the only poor metabolizer out of 10 depressive patients had the highest plasma concentrations of S-VEN and R-VEN, respectively, whereas those of R-O-demethyl-VEN were lowest. Five non-responders completed the second 4-week study period, during which they were submitted to a combined VEN-carbamazepine treatment. In the only non-responder to this combined treatment, there was a dramatic decrease of both enantiomers of VEN, O-demethylvenlafaxine, N-desmethylvenlafaxine and N, O-didesmethylvenlafaxine in plasma, which suggests non-compliance, although metabolic induction by carbamazepine cannot entirely be excluded. The administration of carbamazepine [mean +/- SD, range: 360 +/- 89 (200-400) mg/day] over 4 weeks did not result in a significant modification of the plasma concentrations of the enantiomers of VEN and its O- and N-demethylated metabolites in the other patients. In conclusion, these preliminary observations suggest that the combination of VEN and carbamazepine represents an interesting augmentation strategy by its efficacy, tolerance and absence of pharmacokinetic modifications. However, these findings should be verified in a more comprehensive study.

Main-Channel Slopes of Selected Streams in Iowa for Estimation of Flood-Frequency Discharges, November 2004

This report describes a statewide study conducted to develop main-channel slope (MCS) curves for 138 selected streams in Iowa with drainage areas greater than 100 square miles. MCS values determined from the curves can be used in regression equations for estimating flood frequency discharges. Multi-variable regression equations previously developed for two of the three hydrologic regions defined for Iowa require the measurement of MCS. Main-channel slope is a difficult measurement to obtain for large streams using 1:24,000-scale topographic maps. The curves developed in this report provide a simplified method for determining MCS values for sites located along large streams in Iowa within hydrologic Regions 2 and 3. The curves were developed using MCS values quantified for 2,058 selected sites along 138 selected streams in Iowa. A geographic information system (GIS) technique and 1:24,000-scale topographic data were used to quantify MCS values for the stream sites. The sites were selected at about 5-mile intervals along the streams. River miles were quantified for each stream site using a GIS program. Data points for river-mile and MCS values were plotted and a best-fit curve was developed for each stream. An adjustment was applied to all 138 curves to compensate for differences in MCS values between manual measurements and GIS quantification. The multi-variable equations for Regions 2 and 3 were developed using manual measurements of MCS. A comparison of manual measurements and GIS quantification of MCS indicates that manual measurements typically produce greater values of MCS compared to GIS quantification. Median differences between manual measurements and GIS quantification of MCS are 14.8 and 17.7 percent for Regions 2 and 3, respectively. Comparisons of percentage differences between flood-frequency discharges calculated using MCS values of manual measurements and GIS quantification indicate that use of GIS values of MCS for Region 3 substantially underestimate flood discharges. Mean and median percentage differences for 2- to 500-year recurrence-interval flood discharges ranged from 5.0 to 5.3 and 4.3 to 4.5 percent, respectively, for Region 2 and ranged from 18.3 to 27.1 and 12.3 to 17.3 percent for Region 3. The MCS curves developed from GIS quantification were adjusted by 14.8 percent for streams located in Region 2 and by 17.7 percent for streams located in Region 3. Comparisons of percentage differences between flood discharges calculated using MCS values of manual measurements and adjusted-GIS quantification for Regions 2 and 3 indicate that the flood-discharge estimates are comparable. For Region 2, mean percentage differences for 2- to 500-year recurrence-interval flood discharges ranged between 0.6 and 0.8 percent and median differences were 0.0 percent. For Region 3, mean and median differences ranged between 5.4 to 8.4 and 0.0 to 0.3 percent, respectively. A list of selected stream sites presented with each curve provides information about the sites including river miles, drainage areas, the location of U.S. Geological Survey stream flowgage stations, and the location of streams Abstract crossing hydro logic region boundaries or the Des Moines Lobe landforms region boundary. Two examples are presented for determining river-mile and MCS values, and two techniques are presented for computing flood-frequency discharges.

Pharmacokinetic and pharmacodynamic effects of methylphenidate and MDMA administered alone or in combination.

Methylphenidate and 3,4-methylenedioxymethamphetamine (MDMA, 'ecstasy') are widely misused psychoactive drugs. Methylphenidate increases brain dopamine and norepinephrine levels by blocking the presynaptic reuptake transporters. MDMA releases serotonin, dopamine and norepinephrine through the same transporters. Pharmacodynamic interactions of methylphenidate and MDMA are likely. This study compared the pharmacodynamic and pharmacokinetic effects of methylphenidate and MDMA administered alone or in combination in healthy subjects using a double-blind, placebo-controlled, crossover design. Methylphenidate did not enhance the psychotropic effects of MDMA, although it produced psychostimulant effects on its own. The haemodynamic and adverse effects of co-administration of methylphenidate and MDMA were significantly higher compared with MDMA or methylphenidate alone. Methylphenidate did not change the pharmacokinetics of MDMA and vice versa. Methylphenidate and MDMA shared some subjective amphetamine-type effects; however, 125 mg of MDMA increased positive mood more than 60 mg of methylphenidate, and methylphenidate enhanced activity and concentration more than MDMA. Methylphenidate and MDMA differentially altered facial emotion recognition. Methylphenidate enhanced the recognition of sad and fearful faces, whereas MDMA reduced the recognition of negative emotions. Additionally, the present study found acute pharmacodynamic tolerance to MDMA but not methylphenidate. In conclusion, the combined use of methylphenidate and MDMA does not produce more psychoactive effects compared with either drug alone, but potentially enhances cardiovascular and adverse effects. The findings may be of clinical importance for assessing the risks of combined psychostimulant misuse. Trial registration identification number: NCT01465685 (http://clinicaltrials.gov/ct2/show/NCT01465685).

Off-axis vortices in trapped Bose-condensed gases: Angular momentum and frequency splitting

We consider noncentered vortices and their arrays in a cylindrically trapped Bose-Einstein condensate at zero temperature. We study the kinetic energy and the angular momentum per particle in the Thomas-Fermi regime and their dependence on the distance of the vortices from the center of the trap. Using a perturbative approach with respect to the velocity field of the vortices, we calculate, to first order, the frequency shift of the collective low-lying excitations due to the presence of an off-center vortex or a vortex array, and compare these results with predictions that would be obtained by the application of a simple sum-rule approach, previously found to be very successful for centered vortices. It turns out that the simple sum-rule approach fails for off-centered vortices.

Duration-frequency relationships of heavy rainfall in Santa Catarina, Brazil

The purpose of this study was to adjust equations that establish relationships between rainfall events with different duration and data from weather stations in the state of Santa Catarina, Brazil. In this study, the relationships between different duration heavy rainfalls from 13 weather stations of Santa Catarina were analyzed. From series of maximum annual rainfalls, and using the Gumbel-Chow distribution, the maximum rainfall for durations between 5 min and 24 h were estimated considering return periods from 2 to 100 years. The data fit to the Gumbel-Chow model was verified by the Kolmogorov-Smirnov test at 5 % significance. The coefficients of Bell's equation were adjusted to estimate the relationship between rainfall duration t (min) and the return period T (y) in relation to the maximum rainfall with a duration of 1 hour and a 10 year return period. Likewise, the coefficients of Bell's equation were adjusted based on the maximum rainfall with a duration of 1 day and a 10 year return period. The results showed that these relationships are viable to estimate short-duration rainfall events at locations where there are no rainfall records.

Malaria haplotype frequency estimation.

We present a Bayesian approach for estimating the relative frequencies of multi-single nucleotide polymorphism (SNP) haplotypes in populations of the malaria parasite Plasmodium falciparum by using microarray SNP data from human blood samples. Each sample comes from a malaria patient and contains one or several parasite clones that may genetically differ. Samples containing multiple parasite clones with different genetic markers pose a special challenge. The situation is comparable with a polyploid organism. The data from each blood sample indicates whether the parasites in the blood carry a mutant or a wildtype allele at various selected genomic positions. If both mutant and wildtype alleles are detected at a given position in a multiply infected sample, the data indicates the presence of both alleles, but the ratio is unknown. Thus, the data only partially reveals which specific combinations of genetic markers (i.e. haplotypes across the examined SNPs) occur in distinct parasite clones. In addition, SNP data may contain errors at non-negligible rates. We use a multinomial mixture model with partially missing observations to represent this data and a Markov chain Monte Carlo method to estimate the haplotype frequencies in a population. Our approach addresses both challenges, multiple infections and data errors.

Critical frequency for vortex nucleation in Bose-Fermi mixtures in optical lattices

We investigate within mean-field theory the influence of a one-dimensional optical lattice and of trapped degenerate fermions on the critical rotational frequency for vortex line creation in a Bose-Einstein condensate. We consider laser intensities of the lattice such that quantum coherence across the condensate is ensured. We find a sizable decrease of the thermodynamic critical frequency for vortex nucleation with increasing applied laser strength and suggest suitable parameters for experimental observation. Since 87Rb-40K mixtures may undergo collapse, we analyze the related question of how the optical lattice affects the mechanical stability of the system.

Combination therapy with venlafaxine and carbamazepine in depressive patients non-responding to venlafaxine : pharmacokinetic and clinical aspects

Résumé L'antidépresseur chiral venlafaxine (VEN) est à la fois un inhibiteur de la récapture de la sérotonine et de la noradrénaline. Le CYP2D6 et le CYP3A4 contribuent à son métabolisme stéreosélectif. Dix patients génotypés au CYP2D6 et dépressifs (F32x et F33x, ICD-10) ont participé à cette étude ouverte sur les conséquences pharmacocinétiques et pharmacodynamiques d'une « augmentation » avec la carbamazepine chez des non-répondeurs à la venlafaxine. Après une première période de traitement de quatre semaines avec VEN (195 - 52 mg/ jour), le seul patient qui présentait un déficience génétique de CYP2D6 (poor metaboliser), avait les taux plasmatiques de S-VEN et R-VEN les plus élevés, tandis que ceux de R-0-déméthyl-VEN étaient les plus bas dans ce groupe. Comme seulement 4 patients ont été des répondeurs après 4 semaines de traitement, 6 patients ont été inclus dans la deuxième période de traitement combiné VEN et carbamazépine. Cinq patients non-répondeurs ont complété cette deuxième période d'étude de quatre semaines. Chez l'unique non-répondeur au traitement combiné, on pouvait observer à la fin de la période d'étude une diminution importante des deux énantiomères de VEN, 0-desmethy'lvenlafaxine (ODV), N-desmethylvenlafaxine (NDV) et N, 0-didesmethylvenlafaxine (NODV) dans le plasma. Cela suggère un manque de compliance chez ce patient, mais une induction métabolique par la carbamazepine ne peut pas être exclue entièrement. L'administration de la carbamazepine (moyen ± s.d. (range) ; 360 ± 89 (200-400) mg/jour)) pendant quatre semaines n'a pas eu comme résultat une modification significative des concentrations plasmatiques des énantiomères de VEN et de ses métabolites 0- et N-démethylés chez les autres patients. En conclusion, ces observations préliminaires suggèrent qu'une combinaison de VEN et de carbamazepine représente une stratégie intéressante par son efficacité, sa tolérance et l'absence de modifications pharmcocinétiques, mais ces résultats devraient être vérifiés dans une plus grande étude.

Combination of MRI and dynamic FET PET for initial glioma grading.

AIM: MRI and PET with 18F-fluoro-ethyl-tyrosine (FET) have been increasingly used to evaluate patients with gliomas. Our purpose was to assess the additive value of MR spectroscopy (MRS), diffusion imaging and dynamic FET-PET for glioma grading. PATIENTS, METHODS: 38 patients (42 ± 15 aged, F/M: 0.46) with untreated histologically proven brain gliomas were included. All underwent conventional MRI, MRS, diffusion sequences, and FET-PET within 3±4 weeks. Performances of tumour FET time-activity-curve, early-to-middle SUVmax ratio, choline / creatine ratio and ADC histogram distribution pattern for gliomas grading were assessed, as compared to histology. Combination of these parameters and respective odds were also evaluated. RESULTS: Tumour time-activity-curve reached the best accuracy (67%) when taken alone to distinguish between low and high-grade gliomas, followed by ADC histogram analysis (65%). Combination of time-activity-curve and ADC histogram analysis improved the sensitivity from 67% to 86% and the specificity from 63-67% to 100% (p < 0.008). On multivariate logistic regression analysis, negative slope of the tumour FET time-activity-curve however remains the best predictor of high-grade glioma (odds 7.6, SE 6.8, p = 0.022). CONCLUSION: Combination of dynamic FET-PET and diffusion MRI reached good performance for gliomas grading. The use of FET-PET/MR may be highly relevant in the initial assessment of primary brain tumours.