Uncommon crown-root fracture treated with adhesive tooth fragment reattachment: 7 years of follow-up

Crown-root fractures account for 5% of all fractures in permanent teeth and can involve enamel, dentin, and cementum. Depending on whether there is pulpal involvement, these problems may be classified as complicated (which are more common) or noncomplicated. The treatment depends on the level of the fracture line, root length and/or morphology, and esthetic needs. Several treatment strategies are available for esthetic and functional rehabilitation in crown-root fractures. Adhesive tooth fragment reattachment is the most conservative restorative option when the tooth fragment is available and the biological width has no or minimal violation. This article reports a case of an uncomplicated crown-root fracture in the permanent maxillary right central incisor of a young patient who received treatment with adhesive tooth fragment reattachment, preserving the anatomic characteristics of the fractured tooth after periodontal intervention. The fracture line of the fragment had an unusual shape, starting on the palatal side and extending to the buccal side subgingivally. After 7 years, the attached coronal fragment remained in position with good esthetics, as well as clinical and radiographic signs of pulpal vitality, periodontal health, and root integrity, thus indicating success.

Long-Term Follow-Up of Patients after Acute Kidney Injury: Patterns of Renal Functional Recovery

Background and Objectives: Patients who survive acute kidney injury (AKI), especially those with partial renal recovery, present a higher long-term mortality risk. However, there is no consensus on the best time to assess renal function after an episode of acute kidney injury or agreement on the definition of renal recovery. In addition, only limited data regarding predictors of recovery are available. Design, Setting, Participants, & Measurements: From 1984 to 2009, 84 adult survivors of acute kidney injury were followed by the same nephrologist (RCRMA) for a median time of 4.1 years. Patients were seen at least once each year after discharge until end stage renal disease (ESRD) or death. In each consultation serum creatinine was measured and glomerular filtration rate estimated. Renal recovery was defined as a glomerular filtration rate value >= 60 mL/min/1.73 m2. A multiple logistic regression was performed to evaluate factors independently associated with renal recovery. Results: The median length of follow-up was 50 months (30-90 months). All patients had stabilized their glomerular filtration rates by 18 months and 83% of them stabilized earlier: up to 12 months. Renal recovery occurred in 16 patients (19%) at discharge and in 54 (64%) by 18 months. Six patients died and four patients progressed to ESRD during the follow up period. Age (OR 1.09, p < 0.0001) and serum creatinine at hospital discharge (OR 2.48, p = 0.007) were independent factors associated with non renal recovery. The acute kidney injury severity, evaluated by peak serum creatinine and need for dialysis, was not associated with non renal recovery. Conclusions: Renal recovery must be evaluated no earlier than one year after an acute kidney injury episode. Nephrology referral should be considered mainly for older patients and those with elevated serum creatinine at hospital discharge.

GPR applied to mapping utilities along the route of the Line 4 (yellow) subway tunnel construction in Sao Paulo City, Brazil

The rapid industrial development and disorganized population growth in huge cities bring about various urban problems due to intense use of physical space on and below the surface. Subsurface problems in metropolitan areas are caused by subway line construction, which often follows the routes of utility networks, such as electric and telephone cables, water and gas pipes, storm sewers, etc. Usually, the main problems are related to damage or destruction of preexisting utilities, often putting human lives at risk. With the purpose of minimizing risks. GPR-profiling with 200 MHz antennae was done at two sites, both located in downtown Sao Paulo, Brazil. The objectives of this work were to map utilities or existing infrastructure in the subsurface in order to orient the construction of the Line 4 (yellow) subway tunnel in Sao Paulo. GPR profiles can detect water pipes, utility networks in the subsurface, and concrete foundation columns or pilings in subsoil up to 2 m depth. In addition. the GPR profiles also provided details of the target shapes in the subsurface. GPR interpretations combined with lithological information from boreholes and trenches opened in the study areas were extremely important in mapping of the correct spatial distribution of buried utilities at these two sites in Sao Paulo. This information improves and updates maps of utility placement, serves as a basis for planning of the geotechnical excavation of the Line 4 (yellow) subway tunnel in Sao Paulo, helps minimize problems related to destruction of preexisting utilities in the subsoil, and avoids risk of dangerous accidents. (C) 2012 Elsevier B.V. All rights reserved.

Iodide treatment acutely increases pendrin (SLC26A4) mRNA expression in the rat thyroid and the PCCl3 thyroid cell line by transcriptional mechanisms

Iodine is a critical element involved in thyroid hormone synthesis. Its efflux into the follicular lumen is thought to occur, in part, through pendrin at the apical membrane of thyrocytes. This study attempted to investigate whether iodide administration affects SLC26A4 mRNA expression in rat thyroid and in PCCl3 cells. Rats and cells were treated or not with Nal from 30 min up to 48 h. One group was concomitantly treated with sodium perchlorate. SLC26A4 mRNA expression was also investigated in PCCl3 cells treated with actinomycin D prior to Nal treatment. Iodide administration significantly increased SLC26A4 mRNA content in both models. The simultaneous administration of Nal and perchlorate, as well as the treatment of PCCl3 cells with actinomycin D prevented this effect, indicating that intracellular iodide is essential for this event, which appears to be triggered by transcriptional mechanisms. These data show that intracellular iodide rapidly upregulates SLC26A4 mRNA expression. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

Flux-Line-Lattice Melting and Upper Critical Field of Bi1.65Pb0.35Sr2Ca2Cu3O10+delta Ceramic Samples

We have conducted magnetoresistance measurements rho(T,H) in applied magnetic fields up to 18 T in Bi1.65Pb0.35Sr2Ca2Cu3O10+delta ceramic samples which were subjected to different uniaxial compacting pressures. The anisotropic upper critical fields H (c2)(T) were extracted from the rho(T,H) data, yielding and the out-of-plane superconducting coherence length xi (c) (0)similar to 3 . We have also estimated and xi (ab) (0) similar to 90 . In addition to this, a flux-line-lattice (FLL) melting temperature T (m) has been identified as a second peak in the derivative of the magnetoresistance d rho/dT data close to the superconducting transition temperature. An H (m) vs. T phase diagram was constructed and the FLL boundary lines were found to obey a temperature dependence H (m) ae(T (c) /T-1) (alpha) , where alpha similar to 2 for the sample subjected to the higher compacting pressure. A reasonable value of the Lindemann parameter c (L) similar to 0.29 has been found for all samples studied.

Compact and autonomous multiwavelength microanalyzer for in-line and in situ colorimetric determinations

Nowadays, the attainment of microsystems that integrate most of the stages involved in an analytical process has raised an enormous interest in several research fields. This approach provides experimental set-ups of increased robustness and reliability, which simplify their application to in-line and continuous biomedical and environmental monitoring. In this work, a novel, compact and autonomous microanalyzer aimed at multiwavelength colorimetric determinations is presented. It integrates the microfluidics (a three-dimensional mixer and a 25 mm length "Z-shape" optical flow-cell), a highly versatile multiwavelength optical detection system and the associated electronics for signal processing and drive, all in the same device. The flexibility provided by its design allows the microanalyzer to be operated either in single fixed mode to provide a dedicated photometer or in multiple wavelength mode to obtain discrete pseudospectra. To increase its reliability, automate its operation and allow it to work under unattended conditions, a multicommutation sub-system was developed and integrated with the experimental set-up. The device was initially evaluated in the absence of chemical reactions using four acidochromic dyes and later applied to determine some key environmental parameters such as phenol index, chromium(VI) and nitrite ions. Results were comparable with those obtained with commercial instrumentation and allowed to demonstrate the versatility of the proposed microanalyzer as an autonomous and portable device able to be applied to other analytical methodologies based on colorimetric determinations.

Variable rotational line broadening in the Be star Achernar

Aims. The main theoretical problem for the formation of a Keplerian disk around Be stars is how angular momentum is supplied from the star to the disk, even more so since Be stars probably rotate somewhat subcritically. For instance, nonradial pulsation may transport angular momentum to the stellar surface until (part of) this excess supports the disk-formation/replenishment. The nearby Be star Achernar is presently building a new disk and o ers an excellent opportunity to observe this process from relatively close-up. Methods. Spectra from various sources and epochs are scrutinized to identify the salient stellar parameters characterizing the disk life cycle as defined by H emission. The variable strength of the non-radial pulsation is confirmed, but does not a ect the other results. Results. For the first time it is demonstrated that the photospheric line width does vary in a Be star, by as much as v sin i . 35 km However, unlike assumptions in which a photospheric spin-up accumulates during the diskless phase and then is released into the disk as it is fed, the apparent photospheric spin-up is positively correlated with the appearance of H line emission. The photospheric line widths and circumstellar emission increase together, and the apparent stellar rotation declines to the value at quiescence after the H line emission becomes undetectable

Il craniofaringioma nel bambino e nell'adolescente. Luci ed ombre durante il follow-up

Introduction. Craniopharyngioma (CF) is a malformation of the hypothalamicpituitary region and it is the most common nonglial cerebral tumor in children with an high overall survival rate. In some case severe endocrinologic and metabolic sequelae may occur during follow up. 50% of patients (pts), in particular those with radical removal of suprasellar lesions, develop intractable hyperphagia and morbid obesity, with dyslypidemia and high cardiovascular risk. We studied the auxological and metabolic features of a series of 29 patients (18 males) treated at a mean age of 7,6 years, followed up in our Centre from 1973 to 2008 with a mean follow up of 8,3 years. Patients features at the onset. 62% of pts showed as first symptoms of disease visual impairment and neurological disturbancies (headache); 34% growth arrest; 24% signs of raised intracranial pressure and 7% diabetes insipidus. Diagnosis. Diagnosis of CF was reached finally by TC or MRI scans which showed endo-suprasellar lesion in 23 cases and endosellar tumour in 6 cases. Treatment and outcome. 25/29 pts underwent surgical removal of CF (19 by transcranial approach and 6 by endoscopic surgery); 4 pts underwent stereotactic surgery as first line therapy. 3 pts underwent local irradiation with yttrium-90, 5 pts post surgery radiotherapy. 45% of pts needed more than one treatment procedure. Results. After CF treatment all patients suffered from 3 or more pituitary hormone deficiencies and diabetes insipidus. They underwent promptly substitutive therapy with corticosteroids, l-thyroxine and desmopressin. In 28/29 pts we found growth hormone (GH) deficiency. 20/28 pts started GH substitutive therapy and 15 pts reached final height(FH) near target height(TH). 8 pts were not GH treated for good growth velocity, even without GH, or for tumour residual. They reached in 2 cases FH over TH showing the already known phenomenon of growth without GH. 38% of patients showed BMI SDS >2 SDS at last assessment, in particular pts not GH treated (BMI 2,5 SDS) are more obese than GH treated (BMI 1,2 SDS). Lipid panel of 16 examined pts showed significative differencies among GH treated (9 pts) and not treated (7 pts) with better profile in GH treated ones for Total Cholesterol/C-HDL and C-LDL/C-HDL. We examined intima media thickness of common carotid arteries in 11 pts. 3/4 not GH treated pts showed ultrasonographic abnormalities: calcifications in 2 and plaque in 1 case. Of them 1 pt was only 12,6 years old and already showed hypothalamic obesity with hyperphagia, high HOMA index and dyslipidemia. In the GH treated group (7) we found calcifications in 1 case and a plaque in another one. GH therapy was started in the young pt with carotid calcifications, with good improvement within 6 months of treatment. 5/29 pts showed hypothalamic obesity, related to hypothalamic damage (type of surgical treatment, endo-suprasellar primitive lesion, recurrences). 48% of patients recurred during follow up ( mean time from treatment: 3 years) and underwent, in some cases up to 4 transcranial surgical treatments. GH seems not to increase recurrence rate since 40% of GH treated recurred vs 66,6% of not GH treated pts. Discussion. Our data show the extereme difficulties that occur during follow up of craniopharyngioma treated patients. GH therapy should be offered to all patients even with good growth velocity after CF treatment, to avoid dislypidemia and reduce cardiovascular risk. The optimal therapy is not completely understood and whether gross tumor removal or partial surgery is the best option remains to be decided only on one patient tumour features and hypothalamic involvement. In conclusion the gold standard treatment of CF remains complete tumour removal, when feasible, or partial resection to preserve hypothalamic function in endosuprasellar large neoplasms.

Algorithms for on-line image registration from multiple views

Images of a scene, static or dynamic, are generally acquired at different epochs from different viewpoints. They potentially gather information about the whole scene and its relative motion with respect to the acquisition device. Data from different (in the spatial or temporal domain) visual sources can be fused together to provide a unique consistent representation of the whole scene, even recovering the third dimension, permitting a more complete understanding of the scene content. Moreover, the pose of the acquisition device can be achieved by estimating the relative motion parameters linking different views, thus providing localization information for automatic guidance purposes. Image registration is based on the use of pattern recognition techniques to match among corresponding parts of different views of the acquired scene. Depending on hypotheses or prior information about the sensor model, the motion model and/or the scene model, this information can be used to estimate global or local geometrical mapping functions between different images or different parts of them. These mapping functions contain relative motion parameters between the scene and the sensor(s) and can be used to integrate accordingly informations coming from the different sources to build a wider or even augmented representation of the scene. Accordingly, for their scene reconstruction and pose estimation capabilities, nowadays image registration techniques from multiple views are increasingly stirring up the interest of the scientific and industrial community. Depending on the applicative domain, accuracy, robustness, and computational payload of the algorithms represent important issues to be addressed and generally a trade-off among them has to be reached. Moreover, on-line performance is desirable in order to guarantee the direct interaction of the vision device with human actors or control systems. This thesis follows a general research approach to cope with these issues, almost independently from the scene content, under the constraint of rigid motions. This approach has been motivated by the portability to very different domains as a very desirable property to achieve. A general image registration approach suitable for on-line applications has been devised and assessed through two challenging case studies in different applicative domains. The first case study regards scene reconstruction through on-line mosaicing of optical microscopy cell images acquired with non automated equipment, while moving manually the microscope holder. By registering the images the field of view of the microscope can be widened, preserving the resolution while reconstructing the whole cell culture and permitting the microscopist to interactively explore the cell culture. In the second case study, the registration of terrestrial satellite images acquired by a camera integral with the satellite is utilized to estimate its three-dimensional orientation from visual data, for automatic guidance purposes. Critical aspects of these applications are emphasized and the choices adopted are motivated accordingly. Results are discussed in view of promising future developments.

Origin and Nature of Radio-Loud Broad Absorption Line Quasars

The origin of Broad Absorption Line Quasars (BAL QSOs) is still an open issue. Accounting for ~20% of the QSO population, these objects present broad absorption lines in their optical spectra generated from outflows with velocities up to 0.2 c. Nowadays, the hypotheses about their nature are principally related to orientation or evolutionary scenarios. In the first one, absorption lines are produced by outflows originated by the accretion disk, basically present in all QSOs, but seen only when they intercept the line of sight. In the second hypothesis, BAL QSOs would be young or recently re-fueled QSOs, still ejecting their dust cocoon. In this case orientation would not play a role, since the absorption features would be produced by spherically ejected matter. In this work we present the results of a multi-frequency study of a Radio-Loud BAL QSO sample, and a comparison sample of Radio-Loud non-BAL QSOs. We performed observations from radio to Near-Infrared, aiming at collecting useful informations about the orientation, the age, and the morphologies of these objects. Various techniques have been applied, including local and continental radio interferometry, single dish observations and spectroscopy. The comparison with the non-BAL QSO sample allows us to conclude that no particular orientation is present in BAL QSOs. Moreover, various morphologies and ages can be found, analogously to "normal" QSOs. Thus, the solution to this astrophysical problem seems not to reside in a peculiarity of the BAL QSO subclass with respect to non-BAL QSOs, since both the studied models do not completely explain the observed characteristics. Further experiments with future instrumentation will allow us to underline useful differences and test the physical conditions in BAL QSOs.

Tra società informazionale e prosumerismo: il citizen journalism e la partecipazione on line

I temi della ricerca riguardano il rapporto fra avvento del web e la modificazione dei processi di formazione di identità personale e sociale, della percezione dello spazio e del tempo, del prosumerismo digitale e delle varie forme di partecipazione ed associazione. Centrale è stata l’analisi del rapporto fra il Web 2.0 e la trasformazione delle forme di comunicazione a vari livelli, sia personali che sociali. Partendo da una analisi dei contesti socio-economici globali che hanno trasformato la società moderna nella società informazionale, è stato impostato un percorso di ricerca che approfondisse gli attuali criteri di strutturazione della propria identità, alla luce dell’avvento dei social network e delle reti virtuali di comunicazione come strumento preferenziale di socializzazione. La realtà delle reti sociali è stata analizzata in un’ottica di aggregazione spontanea mirata tanto alla comunicazione quanto alla tutela dei consumatori, e le trasformazioni portate dal Web 2.0 sono state la chiave di lettura per ridefinire i parametri della partecipazione dal basso generata dalla rete. Per comprendere la portata di tali trasformazioni nel contesto italiano è stato impostato un paragone tra l’uso del web negli Stati Uniti e in Italia, avendo le recente campagne elettorali dimostrato l’importanza del web nella partecipazione politica bottom-up; il percorso di ricerca ha dunque affrontato una comparazione di due casi, quello italiano e quello statunitense, finalizzato a comprendere l’attuale ruolo dell’utente nelle dinamiche di comunicazione mediatica. Per focalizzare al meglio le trasformazioni sociali generate dalla partecipazione on line è stato infine analizzato il caso del citizen journalism, per misurare, attraverso la metodologia dell’etnografia digitale, l’entità delle trasformazioni in corso. Il portale di giornalismo partecipativo YouReporter è stato il contesto privilegiato dove poter verificare le ipotesi iniziali circa le dinamiche di partecipazione, e il supporto di programmi di elaborazione statistica netnografica ha permesso di destrutturare al meglio tali dinamiche.

Mitochondrial inheritance and germ line determination in a bivalve species with Doubly Uniparental Inheritance (DUI)

Mitochondria are inherited maternally in most metazoans. However, in some bivalves, two mitochondrial lineages are present: one transmitted through eggs (F), the other through sperm (M). This is called Doubly Uniparental Inheritance (DUI). During male embryo development, spermatozoon mitochondria aggregate and end up in the primordial germ cells, while they are dispersed in female embryos. The molecular mechanisms of segregation patterns are still unknown. In the DUI species Ruditapes philippinarum, I examined sperm mitochondria distribution by MitoTracker, microtubule staining and TEM, and I localized germ line determinants with immunocytochemical analysis. I also analyzed the gonad transcriptome, searching for genes involved in reproduction and sex determination. Moreover, I analyzed an M-type specific open reading frame that could be responsible for maintenance/degradation of M mitochondria during embryo development. These transcripts were also localized in tissues using in situ hybridization. As in Mytilus, two distribution patterns of M mitochondria were detected in R. philippinarum, supporting that they are related to DUI. Moreover, the first division midbody concurs in positioning aggregated M mitochondria on the animal-vegetal axis of the male embryo: in organisms with spiral segmentation this zone is not involved in further cleavages, so aggregation is maintained. Moreover, sperm mitochondria reach the same embryonic area where germ plasm is transferred, suggesting their contribution in male germ line formation. The finding of reproduction and ubiquitination transcripts led to formulate a model in which ubiquitination genes stored in female oocytes during gametogenesis would activate sex-gene expression in the early embryonic developmental stages (preformation). Only gametogenetic cells were labeled by in situ hybridization, proving their specific transcription in developing gametes. Other than having a role in sex determination, some ubiquination factors could also be involved in mitochondrial inheritance, and their differential expression could be responsible for the different fate of sperm mitochondria in the two sexes.

Media activism on and off line by Italian adolescents and young adults

From several researchers it appears that Italian adolescents and young people are grown up with commercial television which is accused to contain too much violence, sex, reality shows, advertising, cartoons which are watched from 1 to 4 hours daily. Adolescents are also great users of mobile phones and spend a lot of time to use it. Their academic results are below the average of Ocse States. However the widespread use of communication technology and social networks display also another side of adolescents who engage in media activism and political movement such as Ammazzateci tutti!, Indymedia, Movimento 5 Stelle, Movimento No Tav. In which way does the world economic crisis -with the specific problems of Italy as the cutting founds for school, academic research and welfare, the corruption of political class, mafia and camorra organisation induce a reaction in our adolescents and young people? Several researches inform us about their use of internet in terms of spending time but, more important, how internet, and the web 2.0, could be an instrument for their reaction? What do they do online? How they do it? Which is the meaning of their presence online? And, has their online activity a continuity offline? The research aims are: 1. Trough a participant observation of Social Network profiles opened by 10 young active citizens, I would seek to understand which kind of social or political activities they engage in online as individuals and which is the meaning of their presence online. 2. To observe and understand if adolescents and young people have a continuity of their socio-political engagement online in offline activities and which kind of experiences it is. 3. Try to comprehend which was (or which were) the significant, learning experiences that convinced them about the potential of the web as tool for their activism.

Clinical outcome and biological characteristics of Chronic Myeloid Leukemia patients treated with nilotinib front-line

The present work reports the outcome of the GIMEMA CML WP study CML0811, an independent trial investigating nilotinib as front-line treatment in chronic phase chronic myeloid leukemia (CML). Moreover, the results of the proteomic analysis of the CD34+ cells collected at CML diagnosis, compared to the counterpart from healthy donors, are reported. Our study confirmed that nilotinib is highly effective in the prevention of the progression to accelerated/blast phase, a condition that today is still associated with high mortality rates. Despite the relatively short follow-up, cardiovascular issues, particularly atherosclerotic adverse events (AE), have emerged, and the frequency of these AEs may counterbalance the anti-leukemic efficacy. The deep molecular response rates in our study compare favorably to those obtained with imatinib, in historic cohorts, and confirm the findings of the Company-sponsored ENESTnd study. Considering the increasing rates of deep MR over time we observed, a significant proportion of patients will be candidate to treatment discontinuation in the next years, with higher probability of remaining disease-free in the long term. The presence of the additional and complex changes we found at the proteomic level in CML CD34+ cells should be taken into account for the investigation on novel targeted therapies, aimed at the eradication of the disease.

Treatment failure and mortality factors in patients receiving second-line HIV therapy in resource-limited countries

Context Long-term antiretroviral therapy (ART) use in resource-limited countries leads to increasing numbers of patients with HIV taking second-line therapy. Limited access to further therapeutic options makes essential the evaluation of second-line regimen efficacy in these settings. Objectives To investigate failure rates in patients receiving second-line therapy and factors associated with failure and death. Design, Setting, and Participants Multicohort study of 632 patients >14 years old receiving second-line therapy for more than 6 months in 27 ART programs in Africa and Asia between January 2001 and October 2008. Main Outcome Measures Clinical, immunological, virological, and immunovirological failure (first diagnosed episode of immunological or virological failure) rates, and mortality after 6 months of second-line therapy use. Sensitivity analyses were performed using alternative CD4 cell count thresholds for immunological and immunovirological definitions of failure and for cohort attrition instead of death. Results The 632 patients provided 740.7 person-years of follow-up; 119 (18.8%) met World Health Organization failure criteria after a median 11.9 months following the start of second-line therapy (interquartile range [IQR], 8.7-17.0 months), and 34 (5.4%) died after a median 15.1 months (IQR, 11.9-25.7 months). Failure rates were lower in those who changed 2 nucleoside reverse transcriptase inhibitors (NRTIs) instead of 1 (179.2 vs 251.6 per 1000 person-years; incidence rate ratio [IRR], 0.64; 95% confidence interval [CI], 0.42-0.96), and higher in those with lowest adherence index (383.5 vs 176.0 per 1000 person-years; IRR, 3.14; 95% CI, 1.67-5.90 for <80% vs ≥95% [percentage adherent, as represented by percentage of appointments attended with no delay]). Failure rates increased with lower CD4 cell counts when second-line therapy was started, from 156.3 vs 96.2 per 1000 person-years; IRR, 1.59 (95% CI, 0.78-3.25) for 100 to 199/μL to 336.8 per 1000 person-years; IRR, 3.32 (95% CI, 1.81-6.08) for less than 50/μL vs 200/μL or higher; and decreased with time using second-line therapy, from 250.0 vs 123.2 per 1000 person-years; IRR, 1.90 (95% CI, 1.19-3.02) for 6 to 11 months to 212.0 per 1000 person-years; 1.71 (95% CI, 1.01-2.88) for 12 to 17 months vs 18 or more months. Mortality for those taking second-line therapy was lower in women (32.4 vs 68.3 per 1000 person-years; hazard ratio [HR], 0.45; 95% CI, 0.23-0.91); and higher in patients with treatment failure of any type (91.9 vs 28.1 per 1000 person-years; HR, 2.83; 95% CI, 1.38-5.80). Sensitivity analyses showed similar results. Conclusions Among patients in Africa and Asia receiving second-line therapy for HIV, treatment failure was associated with low CD4 cell counts at second-line therapy start, use of suboptimal second-line regimens, and poor adherence. Mortality was associated with diagnosed treatment failure.