Pre-exposure prophylaxis (PrEP) is a biomedical intervention that can reduce rates of HIV transmission when taken once daily by HIV-negative individuals. Little is understood about PrEP uptake and ...retention in care among the populations most heavily impacted by the HIV epidemic, particularly among young men who have sex with men (YMSM) in the Deep South. Therefore, this study explored the structural, social, behavioral, and clinical factors that affect PrEP use and retention in care among YMSM in Jackson, Mississippi. Thirty MSM who were prescribed PrEP at an outpatient primary care clinic were interviewed and included 23 men who had been retained in PrEP care and seven who had not been retained. The mean age of participants was 26.6 years. Most (23) participants were African American. Major factors affecting PrEP use and retention in PrEP care included 1) structural factors such as cost and access to financial assistance for medications and clinical services; 2) social factors such as stigma and relationship status; 3) behavioral factors including sexual risk behaviors; and 4) clinical factors such as perceived and actual side effects. Many participants also discussed the positive spillover effects of PrEP use and reported that PrEP had a positive impact on their health. Four of the seven individuals who had not been retained re-enrolled in PrEP care after completing their interviews, suggesting that case management and ongoing outreach can enhance retention in PrEP care. Interventions to enhance retention in PrEP care among MSM in the Deep South will be most effective if they address the complex structural, social, clinical, and behavioral factors that influence PrEP uptake and retention in PrEP care.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
We conducted a magnetotelluric (MT) study from Paleoproterozoic Rio de la Plata Craton, in Uruguay, toward Paleozoic‐Mesozoic Paraná Basin, in Brazil. The 850‐km‐long MT transect comprises 35 evenly ...spaced broadband electromagnetic soundings sites. In the Paraná Basin, 11 additional long‐period measurements were acquired to extend the maximum depth of investigation. All data were inverted using two‐ and three‐dimensional approaches obtaining the electrical resistivity structure from the surface down to 200 km. The Rio de la Plata Craton is >200‐km thick and resistive (~2,000 Ωm). Its northern limit is electrically defined by a lithosphere scale lateral transition and lower crust conductive anomalies (1–10 Ωm) interpreted as a Paleoproterozoic suture at the southern edge of Rivera‐Taquarembó Block. The latter is characterized by an approximately 100‐km thick and moderate resistive (>500 Ωm) upper mantle. The Ibaré shear zone is another suture where an ocean‐ocean subduction generated the 120‐km thick and resistive (>1,000 Ωm) São Gabriel juvenile arc. Proceeding northward, a 70‐ to 80‐km thick, 150‐km wide, and inclined resistive zone is imaged. This zone could be remnant of an oceanic lithosphere or island arcs accreted at the southern border of Paraná Basin. The MT transect terminates within the southern Paraná Basin where a 150‐ to 200‐km‐thick less resistive lithosphere (<1,000 Ωm) may indicate refertilization processes during plate subduction and ocean closure in Neoproterozoic‐Cambrian time. Our MT data support a tectonic model of NNE–SSW convergence for this segment of SW Gondwanaland.
Key Points
Rio de la Plata and Paraná Basin lithospheres are at ~200‐km and 150‐ to 200‐km thick, respectively, and electrically distinct
Accreted Rivera‐Taquarembó‐São Gabriel blocks compose a heterogeneous and ~100‐km‐thick resistive lithosphere
Estimated geoelectrical strikes support NNE–SSW convergence and ocean closure during the amalgamation of SW Gondwanaland
The topological properties of high-voltage electrical power transmission networks in several UE countries (the Italian 380 kV, the French 400 kV and the Spanish 400 kV networks) have been studied ...from available data. An assessment of the vulnerability of the networks has been given by measuring the level of damage introduced by a controlled removal of links. Topological studies could be useful to make vulnerability assessment and to design specific action to reduce topological weaknesses.
This study aimed to identify the clinical, radiological and prognostic features of primary adrenal lymphoma (PAL) in order to diagnose the disease more accurately.
A retrospective multi-centre study ...was conducted on the clinical, biological and radiological features as well as the treatment and overall survival outcomes in PAL.
Between 1994 and 2014, 28 patients from five regions of eastern France were diagnosed with primary adrenal lymphoma. The revealing symptoms were a worsening general state (77%), weight loss (77%) and abdominal pain (42%). Biological features of PAL were almost omnipresent: increased LDH, β2 microglobulin, CRP or ferritinaemia levels. The PAL was bilateral in 20 cases (71%), adrenal insufficiency was searched for in 11 patients and found in eight (73%). CT scans showed masses of various sizes measuring up to 180 mm. On MRI, the lesions were hypointense in T1 and hyperintense in T2. When done, positron emission tomography with fluorodeoxyglucose (FDG-PET) showed locations not seen on the CT and revealed extra-adrenal locations in 70% of examinations. Adrenalectomy brought no benefit. The overall survival rate was poor (61.9% at 2 years) despite polychemotherapy.
The clinical presentation of PAL comprised major general symptoms. Adrenal insufficiency was very common in patients with bilateral involvement but was not systematically tested. PET was an efficient examination to visualize extra-adrenal locations. The preliminary results of MRI to distinguish between PAL and adrenocortical carcinoma should be confirmed. Further studies are needed to establish an optimal strategy for the management of these primary adrenal lymphomas.
Treatment with escalated BEACOPP achieved a superior time to treatment failure over ABVD in patients with disseminated Hodgkin lymphoma. However, recent clinical trials have failed to confirm BEACOPP ...overall survival (OS) superiority over ABVD. In addition, the gain in low-risk patients is still a matter of debate.
We randomly compared ABVD (8 cycles) with BEACOPP (escalated 4 cycles ≥baseline 4 cycles) in low-risk patients with an International Prognostic Score (IPS) of 0–2. The primary end point was event-free survival (EFS). This parallel group, open-label phase 3 trial was registered under #RECF0219 at French National Cancer Institute.
One hundred and fifty patients were randomized in this trial (ABVD 80, BEACOPP 70): 28 years was the median age, 50% were male and IPS was 0–1 for 64%. Complete remission rate was 85% for ABVD and 90% for BEACOPP. Progression or relapses were more frequent in the ABVD patients than in the BEACOPP patients (17 versus 5 patients). With a median follow-up period of 5.5 years, seven patients died: six in the ABVD arm and one in the BEACOPP arm (HL 3 and 0, 2nd cancer 2 and 1, accident 1 and 0). The EFS at 5 years was estimated at 62% for ABVD versus 77%, for BEACOPP hazards ratio (HR) = 0.6, P = 0.07. The progression-free survival (PFS) at 5 years was 75% versus 93% (HR = 0.3, P = 0.007). The OS at 5 years was 92% versus 99% (HR = 0.18, P = 0.06).
Fewer progressions/relapses were observed with BEACOPP, demonstrating the high efficacy of the more intensive regimen, even in low-risk patients. However, additional considerations, balancing treatment-related toxicity and late morbidity due to salvage may help with decision-making with regard to treatment with ABVD or BEACOPP.
Salivary glands (SGs) can be affected by lupus erythematosus (LE). Many authors debate whether this condition is a secondary manifestation of Sjögren syndrome (SS) or a glandular aspect of LE. The ...present study investigated the histopathological aspects of biopsied minor salivary glands from LE patients to analyze their peculiar features that lead to xerostomia. Twenty-three minor labial salivary gland (MLSG) cases were included in the study; the diagnosis of LE was rendered according to the American College of Rheumatology criteria. Twenty-three healthy MLSGs were used as a control, for comparison. Regarding lupus MLSG, the presence of hyalinization and thickening of ductal basement membrane, perivascular inflammatory infiltrate, epithelial spongiosis with no ductal lymphocytic aggression, vacuolar degeneration of the ductal cells and acinar serous metaplasia were statistically significant compared to the control group. In the LE group, there was a statistically significant correlation between acinar atrophy and acinar fibrosis; acinar atrophy and ductal ectasia; acinar fibrosis and ductal ectasia; ductal atrophy and ductal spongiosis with no lymphocytic focus, interstitial inflammatory infiltrate intensity and vasculitis as well as vascular thrombi and vasculitis. There were no morphological differences between the three subtypes of lupus analyzed. Minor salivary glands from patients diagnosed with LE present peculiar histopathological changes and may be a multisystemic presentation.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Inflammatory bowel disease (IBD) comprises two chronic, tissue‐destructive, clinical entities: Crohn's disease (CD) and ulcerative colitis (UC), both immunologically based. Bowel symptoms are ...predominant, but extra‐intestinal complications may occur, including involvement of the oral cavity. Oral involvement during IBD includes several types of lesions: the most common are aphthae; uncommon lesions include, among others, pyostomatitis vegetans and granulomatous lesions of CD. Starting with a presentation of six patients with oral manifestations, which were crucial for the final diagnosis of IBD, a review on the subject is presented. Oral involvement in IBD may be previous or simultaneous to the gastrointestinal symptoms. However, in the majority of cases, bowel disease precedes the onset of oral lesions by months or years. In many patients, the intestinal symptoms may be minimal and can go undetected; thus, most authors believe that the bowel must be thoroughly examined in all patients with suspected IBD even in the absence of specific symptoms. Usually, the clinical course of oral lesions is parallel to the activity of IBD; therefore, oral manifestations are a good cutaneous marker of IBD.
To evaluate the activity and safety of nonpegylated liposomal doxorubicin (Myocet™) when substituted for doxorubicin in the R-CHOP regimen (R-COMP).
Seventy-five elderly patients with diffuse large ...B-cell lymphoma (DLBCL) were studied. Only patients with left ventricular ejection fraction (LVEF) ≥50% were allowed. R-COMP regimen was administered every 3 weeks for three cycles, followed by additional five cycles in case of complete response (CR) or partial response.
From November 2002 to April 2005, 75 patients were registered, of which 72 were evaluated. Median age was 72 years (range 61–83); 56% of patients had high or high–intermediate International Prognostic Index score. Median LVEF at baseline was 61%. Thirty-eight patients had history of abnormal cardiovascular conditions. The overall response rate was 71%, with a CR rate of 57%. After a median follow-up of 33 months, the 3-year overall survival, failure-free survival, and progression-free survival rates were 72%, 39%, and 69%, respectively. Neutropenia (54%) was the most frequent grade 3–4 adverse event (AE); 21% of patients experienced cardiac AEs, graded as 3–4 in 4% of the cases.
R-COMP is an effective regimen for the treatment of DLBCL in elderly patients, with an acceptable tolerability profile.
Broadband and long-period magnetotelluric soundings were collected along a 560km E–W profile in a region of central Brazil subjected to Neoproterozoic collision tectonics and Archean to Cretaceous ...magmatic events. The profile crosses the northeastern portion of Phanerozoic sediments and volcanics of the Paraná basin, the southern extension of the Neoproterozoic metasedimentary rocks of the Brasília belt, locally pervaded by Cretaceous alkaline magmas of the Alto Paranaíba igneous province (APIP), and Neoproterozoic sedimentary cover and exposed Archean basement of the southern São Francisco craton. 2D conductivity structures derived by joint inversions of the TE and TM polarization modes and a separate inversion of the tipper components show signatures of the past tectonomagmatic events that affected the area. A gravity-defined suture zone beneath the Paraná basin is detected in the models as a subvertical conductor extending from crustal to upper mantle depths, which strengthen the interpretation of a Neoproterozoic collision of the São Francisco craton and a continental block beneath the sedimentary basin. Deep underthrusting of organic graphite-bearing metasedimentary rocks composing a fossil suture zone is proposed to explain such increase in electrical conductivity. A similar conductivity signature beneath the sedimentary covered region of the São Francisco craton can be tentatively interpreted as another similar cryptic suture zone. Other isolated high-conductivity anomalies at midcrustal depths below the Paraná and APIP provinces are interpreted as fossil residues representing precipitated graphite and sulfide derived from percolating volatiles during the emplacement of Cretaceous mafic-ultramafic volcanics. A very high conductivity wedge into the lower lithosphere is highlighted in the deep mantle beneath the APIP volcanic complex, coincident with a zone of low velocity defined by seismic tomography. Geochemical evidence indicates that the alkaline magmatism stemmed from a metasomatized upper mantle at only slightly raised temperatures. Thus, interconnected carbonatite melts of low melting point and graphite in the lithospheric mantle are the most likely candidates to explain this high conductivity. The seismic and conductivity anomalies are probably triggered by the same source mechanisms (incipient melting) because they are plausibly related to the same magmatic process. Conductivity anomalies at crustal and mantle depths in the southern segment of the São Francisco craton suggest that its lithosphere was significantly affected by the several tectonomagmatic episodes it has experienced throughout its geological history. Consequently, the enhanced conductivity in the lower crust can be genetically related to upwelling volatile-rich intrusions whereas upper mantle high conductivity can be related to refertilization by infiltrations of low-degree carbonatitic melts from deeper-sourced metasomatic processes.
The superiority of a chemotherapy with doxorubicin, cyclophosphamide, vindesine, bleomycin and prednisone (ACVBP) in comparison with cyclophosphamide, doxorubicin, vincristin and prednisone plus ...radiotherapy for young patients with localized diffuse large B-cell lymphoma (DLBCL) was previously demonstrated. We report the results of a trial which evaluates the role of rituximab combined with ACVBP (R-ACVBP) in these patients.
Untreated patients younger than 66 years with stage I or II DLBCL and no adverse prognostic factors of the age-adjusted International Prognostic Index were randomly assigned to receive three cycles of ACVBP plus sequential consolidation with or without the addition of four infusions of rituximab.
A total of 223 patients were randomly allocated to the study, 110 in the R-ACVBP group and 113 in the ACVBP group. After a median follow-up of 43 months, our 3-year estimate of event-free survival was 93% in the R-ACVBP group and 82% in the ACVBP group (P = 0.0487). Three-year estimate of progression-free survival was increased in the R-ACVBP group (95% versus 83%, P = 0.0205). Overall survival did not differ between the two groups with a 3-year estimates of 98% and 97%, respectively (P = 0.686).
In young patients with low-risk localized DLBCL, rituximab combined with three cycles of ACVBP plus consolidation is significantly superior to ACVBP plus consolidation alone.
PDF
