Background/Aims: Interferon alpha provides benefit in only a limited number of patients with chronic anti-HBe-positive hepatitis B. The aim of this study was to verify the long-term efficacy of ...lamivudine treatment of these patients and the incidence of lamivudine-resistant hepatitis B virus mutants.
Methods: Fifteen consecutive patients with chronic anti-HBe-positive hepatitis B were treated with lamivudine 100 mg once daily for 52 weeks. Levels of alanine aminotransferase, HBV DNA, hepatitis B surface antigen, and IgM antibodies to hepatitis B core antigen were monitored during therapy and 12-month follow up. The polymerase gene was amplified by polymerase chain reaction and the region coding for YMDD amino acid motif was directly sequenced.
Results: Only 2/15 patients (13%) had a sustained virological and biochemical response and improved histologically. Eleven out of 15 (74%) showed inhibition of viral replication and normalization of alanine aminotransferase levels during lamivudine treatment but relapsed 1–12 months after terminating therapy. In the two remaining patients (13%), HBV DNA initially became negative but reappeared in the serum after 24 weeks, and in both patients the emergence of YMDD mutants was demonstrated.
Conclusions: Our data confirm the antiviral efficacy of lamivudine in anti-HBe-positive patients, but response to a 1-year course was only transient as the majority of patients relapsed after therapy withdrawal. The lack of a sustained effect and the emergence of lamivudine-resistant mutants suggest that therapy for chronic hepatitis B should be based on a combination of several therapeutic agents.
Being able to segment unseen classes not observed during training is an important technical challenge in deep learning, because of its potential to reduce the expensive annotation required for ...semantic segmentation. Prior zero-label semantic segmentation works approach this task by learning visual-semantic embeddings or generative models. However, they are prone to overfitting on the seen classes because there is no training signal for them. In this paper, we study the challenging generalized zero-label semantic segmentation task where the model has to segment both seen and unseen classes at test time. We assume that pixels of unseen classes could be present in the training images but without being annotated. Our idea is to capture the latent information on unseen classes by supervising the model with self-produced pseudo-labels for unlabeled pixels. We propose a consistency regularizer to filter out noisy pseudo-labels by taking the intersections of the pseudo-labels generated from different augmentations of the same image. Our framework generates pseudo-labels and then retrain the model with human-annotated and pseudo-labelled data. This procedure is repeated for several iterations. As a result, our approach achieves the new state-of-the-art on PascalVOC12 and COCO-stuff datasets in the challenging generalized zero-label semantic segmentation setting, surpassing other existing methods addressing this task with more complex strategies. Code can be found at https://github.com/giuseppepastore10/STRICT.
To evaluate the presence of premature atherosclerotic lesions of epiaortic vessels in HIV-1-infected protease inhibitor-(PI) treated patients compared with PI-naive patients and healthy individuals.
...One-hundred and two HIV-1-positive patients, including 55 treated with PI for at least 12 months and 47 either naive or treated with PI-sparing regimens, were subjected to epiaortic vessel ultrasonography. These data were compared with those obtained from 104 healthy individuals.
Intima characteristics, pulsation and resistance indexes, and minimal, peak and mean speed were evaluated using a colour power doppler. Atherosclerotic plaques were described. Independent risk factors and values for glycaemia, cholesterolaemia and triglyceridaemia were considered. Statistical analysis included the chi-square test, Mantel-Haenszel test, odds ratio and logistic regression analysis.
Of the PI-treated patients, 29 out of 55 (52.7%) presented acquired lesions of the vascular wall at ultrasonography, whereas similar lesions were found in seven out of 47 (14.9%) PI-naive patients. Of the 104 healthy individuals, seven cases (6.7%) of intimal medial thickness were noted. A slightly significant correlation was found between carotid lesions and age, male sex and hypercholesterolaemia, whereas cigarette smoking, hypertriglyceridaemia and Centers for Disease Control and Prevention stage significantly increased the risk of vascular lesions (P= 0.022, P= 0.017 and P= 0.079 respectively). However, the highest significance regarded use of PI (P= 0.011). These results were confirmed by logistic regression analysis.
These data demonstrate a higher than expected prevalence of premature carotid lesions in the PI-treated compared with PI-naive patients. If confirmed, a periodic ultrasonographic study of the vascular wall should be included in the follow-up of HIV infected patients.
ODONTOLOGIA DO ESPORTE - UMA PROPOSTA INOVADORA Pastore, Giuseppe Umberto; Moreira, Márcia; Bastos, Robson ...
Revista brasileira de medicina do esporte,
04/2017, Letnik:
23, Številka:
2
Journal Article
Recenzirano
Odprti dostop
RESUMO O objetivo deste trabalho é inserir definitivamente a odontologia no contexto do esporte de alto rendimento, com o firme propósito de estabelecer uma linguagem comum com a medicina do esporte. ...Consideramos que as práticas clínicas aplicadas a atletas de alto desempenho devem obedecer a regras e momentos adequados, levando-se em conta o contexto das demandas relativas aos atletas de ponta, ou seja, o desgaste fisiológico e o processo adaptativo ao sobre-esforço, e todas as suas consequências. A odontologia dentro dos clubes esportivos promoveria a saúde bucal e sistêmica dos atletas, controlando lesões bucais em integração com outros departamentos da área médica, equilíbrio hídrico, controle dietético, sobretreinamento e uso de energéticos e isotônicos. Quando as ações educativas forem inseridas desde a infância nas práticas esportivas, teremos, certamente, menor número de problemas bucais com mais necessidades preventivas que curativas. Sugerimos para as categorias de base, para atletas em formação, a inclusão de um odontopediatra nos clubes esportivos, como um profissional de importante atuação em saúde.
ODONTOLOGIA DO ESPORTE - UMA PROPOSTA INOVADORA Pastore, Giuseppe Umberto; Moreira, Márcia; Bastos, Robson ...
Revista brasileira de medicina do esporte,
04/2017, Letnik:
23, Številka:
2
Journal Article
Recenzirano
RESUMO O objetivo deste trabalho é inserir definitivamente a odontologia no contexto do esporte de alto rendimento, com o firme propósito de estabelecer uma linguagem comum com a medicina do esporte. ...Consideramos que as práticas clínicas aplicadas a atletas de alto desempenho devem obedecer a regras e momentos adequados, levando-se em conta o contexto das demandas relativas aos atletas de ponta, ou seja, o desgaste fisiológico e o processo adaptativo ao sobre-esforço, e todas as suas consequências. A odontologia dentro dos clubes esportivos promoveria a saúde bucal e sistêmica dos atletas, controlando lesões bucais em integração com outros departamentos da área médica, equilíbrio hídrico, controle dietético, sobretreinamento e uso de energéticos e isotônicos. Quando as ações educativas forem inseridas desde a infância nas práticas esportivas, teremos, certamente, menor número de problemas bucais com mais necessidades preventivas que curativas. Sugerimos para as categorias de base, para atletas em formação, a inclusão de um odontopediatra nos clubes esportivos, como um profissional de importante atuação em saúde.
RESUMEN El objetivo de este trabajo es, sin duda introducir la odontología en el contexto del deporte de alto rendimiento, con el firme propósito de establecer un lenguaje común con la medicina deportiva. Creemos que la práctica clínica aplicada a los atletas de alto rendimiento deben obedecer las reglas y los momentos apropiados, teniendo en cuenta el contexto de las demandas relacionadas con atletas de alto rendimiento, es decir, el desgaste fisiológico y el proceso de adaptación a un exceso de ejercicio, y todas sus consecuencias. La odontología, en los clubes deportivos promovería la salud oral y sistémica de los atletas mediante el control de las lesiones orales, interactuando con otros departamentos médicos, el balance hídrico, control de la dieta, el sobreentrenamiento y el consumo de bebidas energéticas e isotónicas. Cuando se introducen actividades educacionales desde la infancia en las prácticas deportivas, sin duda vamos a tener problemas dentales menores, con mayor necesidad de prevención en lugar de curación. Sugerimos a las categorías básicas, para los atletas en formación, incluir un dentista pediátrico en los clubes deportivos, como profesional de importante acción relacionada con la salud.
ABSTRACT The purpose of this work is to definitively insert Dentistry in the context of high performance sports, with the main goal of establishing a common language with Sports Medicine. We consider that the clinical practices applied to high performance athletes should obey appropriate rules and moments, taking into account the context of the demands on the top athletes, i.e., the physiological wastage and the adaptive process to over-effort, and all its consequences. Dentistry inside the sports clubs would promote the oral and systemic health of athletes, controlling oral lesions integrated with other medical departments, water balance, dietary control, overtraining, and the intake of energy and isotonic drinks. When educational actions are inserted since childhood in sports practices, we will certainly have fewer oral problems with more preventive than curative needs. We suggest for the basic categories, for athletes in training, the inclusion of a pediatric dentist in sports clubs, as a health professional who plays an important role.
Abstract The Italian recommendations for the therapy of hepatitis B virus (HBV)-related disease were issued in 2008. Subsequently in 2008 the nucleotide analogue (NA) Tenofovir was approved for ...antiviral treatment. The introduction of this important new drug has called for the current guidelines update, which includes some additional revisions: (a) the indication for therapy is extended to mild liver fibrosis and the indication for treatment is graded as “possible”, “optional” or “mandatory” according to the fibrosis stage; (b) two different treatment strategies are described: first line definite duration treatment with interferon, long-term treatment of indefinite duration with NA; (c) the indication to follow either strategy is also based on the stage of liver fibrosis; (d) virological monitoring is modified to include the definitions of failure and of sustained virological response to interferon therapy; (e) the recommendation to use HBV DNA assays with high sensitivity and wide linear ranges is underlined (f) guidelines on post-treatment follow-up after finite treatment with NA, potential side effects of therapy and non-virological monitoring are defined; (g) definitions and treatment of patients without optimal response to NA are reported; (f) treatment and monitoring of compensated or decompensated cirrhosis and hepatocellular carcinoma are updated.
Abstract It is increasingly clear that a tailored therapeutic approach to patients with hepatitis C virus infection is needed. Success rates in difficult to treat and low-responsive hepatitis C virus ...patients are not completely satisfactory, and there is the need to optimise treatment duration and intensity in patients with the highest likelihood of response. In addition, the management of special patient categories originally excluded from phase III registration trials needs to be critically re-evaluated. This article reports the recommendations for the treatment of hepatitis C virus infection on an individual basis, drafted by experts of three scientific societies.
The aim of the study was to evaluate the characteristics of chronic hepatitis B with special reference to the geographical origin of the patients and to the prevalence of HBeAg and viral and ...non-viral co-factors of liver disease. A cross-sectional multicenter survey was undertaken, which enrolled 1,386 HBsAg chronic carriers observed consecutively in 21 referral centers over a 6-month period. The prevalence of HBeAg in patients was 11%; the presence of HBeAg was associated independently with a younger age and co-infection with HIV. Anti-HDV, anti-HCV, or anti-HIV antibodies were detected in 8.1%, 6.5%, and 2%, respectively. However, among the patients first diagnosed during the study period (incident cases), 14.3% were anti-HDV positive. Seven percent of the patients were immigrants; they were younger than Italian patients and 18% were HBeAg positive; no difference was observed in the prevalence of anti-HDV, anti-HCV, or anti-HIV antibodies. The presence of cirrhosis was associated independently with an age >52 years, the presence of anti-HDV or anti-HCV, alcohol use >4 drinks/day, and a high BMI. The clinical epidemiology of chronic hepatitis B virus (HBV) infection shows a dynamic profile, with the potential for re-emergence of cases with HBeAg or anti-HDV and an emerging impact of metabolic factors on the evolution of liver disease. J. Med. Virol. 81:1999-2006, 2009.
To evaluate the determinants of HIV-1 RNA shedding in cervicovaginal secretions and the effects of antiretroviral therapy in a group of infected women.
A total of 122 women from whom paired ...peripheral blood and cervicovaginal lavage samples were available were enrolled in the study. HIV-1 RNA was quantified in the plasma and cell-free fraction of cervicovaginal lavages by the nucleic acid sequence-based amplification assay (lower limit of detection 80 copies/ml).
Seventy-one per cent of the women had detectable viral load in the cervicovaginal lavage and this appeared to be correlated to plasma viral load and to the degree of immunodeficiency as expressed by the absolute number of CD4 cells. Antiretroviral-treated patients had a lower risk of shedding the virus in the genital tract, but this association was limited to patients treated with highly active antiretroviral therapy (HAART). However, in 25% of women with undetectable plasma viral load, a genital shedding of the virus was demonstrated.
Plasma viral load may fail as a marker of infectivity of genital secretions. HAART treatment seems to be more efficacious in suppressing viral shedding at the genital level. The female genital tract represents a distinct compartment for HIV-1 replication/evolution.
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