Routine CD4 cell count monitoring seldom contributes to clinical decision-making on antiretroviral therapy in virologically suppressed HIV-infected patients

OBJECTIVES

In Australia, CD4 cell count is monitored approximately every 6 months in HIV-infected patients during antiretroviral therapy (ART). The aim of this study was to determine if routine CD4 monitoring contributed to decisions on changes to ART, and to estimate how reduced CD4 monitoring could contribute to cost savings in Australia.

METHODS

We conducted a retrospective cohort analysis investigating all HIV-infected patients who attended the Melbourne Sexual Health Centre (MSHC) in Australia from 1 April 2011 to 1 October 2013. We reviewed the electronic medical records of all patients who changed or stopped antiretroviral regimens during this time period to determine whether CD4 cell count could have contributed to this clinical decision.

RESULTS

Among 1004 patients with HIV infection on ART, none [95% confidence interval (CI) 0-2.3%] of the 162 clinical decisions to change or stop treatment were influenced by CD4 cell counts. Reducing the current biannual CD4 monitoring strategy to annually could potentially save ∼AU$ 1.5 million (US$ 1.4 million) each year in Australia [i.e. ∼AU$ 74 700 (US$ 67 700) could be saved per 1000 HIV-infected patients during ART].

CONCLUSIONS

Routine CD4 monitoring in HIV-infected patients during ART could be reduced from biannually to annually, as it rarely influences clinical decisions in patients' management. Not only could this avoid patients being unnecessarily anxious about normal fluctuations in their CD4 counts but it would also result in cost savings.

Design of add-drop multiplexer based on multi-core optical fibers for mode-division multiplexing

A multi-core fiber coupler is proposed to extract one of the modes in a few-mode optical fiber from a light beam, leaving the other modes undisturbed, and allowing a new signal to be retransmitted on that mode. Selective coupling of higher-order modes from a few-mode optical fiber can be realized by increasing the coupling length difference of the modes in the fiber using the multi-core configuration. Low cross-talk and wide bandwidth operation are realized owing to the fact that only one mode can be effectively coupled.

Cloning and expression analysis of Wnt6 and Hox6 during intestinal regeneration in the sea cucumber Apostichopus japonicus

Many developmental genes play important roles in regeneration. Here, we cloned the two developmental genes, Wnt6 and Hox6, from Apostichopus japonicus by rapid amplification of cDNA ends (RACE) polymerase chain reaction (PCR). The Wnt6 full-length cDNA is 1140 bp long with a 1029-bp open reading frame encoding 342 amino acids. The deduced Wnt6 protein contained a 22-amino acid signal peptide and a 274-amino acid mature peptide. The Hox6 (AjHBOX6) full-length cDNA contained 1312 bp with a 966-bp open reading frame encoding 321 amino acids. Its deduced amino acid sequence included one homeodomain (60 amino acids) and three domains with low compositional complexity. Comparison and phylogenetic analysis revealed that Wnt6 and Hox6 in A. japonicus had the nearest relationship to those in sea urchins. Further expression analysis by real-time PCR showed that Wnt6 and Hox6 were apparently upregulated during intestine regeneration, which suggested that they were involved in the intestinal regeneration of sea cucumbers.

[Effect of electroacupuncture stimulation of "Guanyuan" (CV 4), bilateral "Housanli" (ST 36), etc. on anti-fatigue ability and liver mitochondrial respiratory function in ageing rats with Yang-deficiency]

OBJECTIVE

To observe the effect of electroacupuncture (EA) of "Guanyuan" (CV 4) and bilateral "Housanli" (ST 36) plus acupuncture stimulation of "Baihui" (GV 20) [an acupoint recipe for "Shuanggu Yitong" (strengthening both congenital foundation and the acquired constitution and regulating the yang-qi of the body] on the anti-fatigue ability and liver mitochondrial respiratory function in yang-deficiency ageing rats.

METHODS

A total of 48 male SD rats were equally and randomly divided into normal control, model, EA and EA control groups. The aged yang-deficiency model was established by subcutaneous injection of D-galactose (125 mg/kg, once daily for 40 days) and sequential muscular injection of hydrocortisone (1.5 mg/100 g, once daily for 7 days). For rats of the normal control group, subcutaneous injection of same dose of normal saline was gi-ven. EA stimulation (2 Hz, 1 mA) of "Guanyuan" (CV 4) and bilateral "Housanli"(ST 36) and manual acupuncture stimulation of "Baihui" (GV 20) were given to rats of the EA group. For rats of the EA control group, EA of "Zhongji"(CV 3) and bilateral "Yinlinquan"(SP 9), and manual acupuncture stimulation of "Yintang" (EX-HN 3) were given. The treatment was conducted once daily, 6 time a week and continuously for 4 weeks. Rats of the normal control and model groups were grabbed and fixed in the same way. The anti-fatigue ability was evaluated by using the time of exhausted swimming task and liver mitochondrial respiratory function was detected by Clark oxygen electrode.

RESULTS

In comparison with the normal control group, the exhausted swimming time was significantly shortened in the model group (P < 0.01). Compared with the model group, the exhausted swimming time was evidently prolonged in the EA group (P < 0.01) not in the EA control group (P > 0.05). As for the liver mitochondrial respi-ratory function, the oxygen consumption rate IV was obviously higher in the model group than in the normal control group (P < 0.01), and significantly lower in the EA group than in the model group (P < 0.01). Both liver mitochondrial respiratory control rate (RCR) and ratio of phosphorus/oxgen (P/O) were significantly lower in the model group than in the normal control group (P < 0.01), and considerably higher in the EA group than in the model group (P < 0.01, P < 0.05). Comparison between the EA and EA control groups showed that the effects of the former group were evidently superior to those of the latter group in prolonging the exhausted swimming time, lowering oxygen consumption rate IV and upregulating RCR and P/O (P < 0.05).

CONCLUSION

Electroacupuncture of CV 4 and ST 36 plus manual acupuncture stimulation of GV 20 can improve the anti-fatigue capability in aging rats with yang-deficiency, which may be related to its effects in reducing liver mitochondrial oxygen consumption and increasing liver mitochondrial RCR and ratio of P/O.

Size of anal squamous cell carcinomas at diagnosis: a retrospective case series

Anal squamous cell carcinoma is more common in HIV-positive homosexual men than in the general population and prognosis worsens with increasing tumour size. To identify opportunities for earlier diagnosis, we aimed to determine size and visibility of anal squamous cell carcinoma at diagnosis. We conducted a retrospective review of medical records between 1992 and 2010 from one hospital radiotherapy centre, a major centre for HIV care, in Melbourne, Australia. Of 128 cases of anal squamous cell carcinoma, 24 (19%) were in HIV-positive men. At diagnosis, half (52%) of the tumours were externally visible and mean estimated tumour size was 36 mm (29 mm in HIV-positive and 38 mm in HIV-negative patients; p = 0.04) and 114/121 (94%) tumours were 1 cm or larger. The most frequent symptoms were bleeding (43%) and pain (36%) and mean duration of symptoms was 22 weeks. This suggests most anal squamous cell carcinoma were visible or palpable for some time before diagnosis, meaning that screening high-risk groups by anal inspection and palpation is plausible.

Acceptability of digital anal cancer screening examinations in HIV-positive homosexual men

OBJECTIVES

Anal cancer is more common in HIV-positive homosexual men than in HIV-negative homosexual men and the general population. Earlier diagnosis leads to improved prognosis. We aimed to determine if regular anal inspection and digital examination of asymptomatic homosexual men attending for routine HIV care were acceptable and to record the rate of referral for diagnosis of potentially malignant anal lesions.

METHODS

We offered anal examinations to consecutive homosexual men with HIV infection aged ≥ 35 years during their routine HIV clinic visits, aiming to complete three examinations over a 12-month period. Acceptability questionnaires were completed at baseline and after each examination and doctors recorded examination findings and all resulting interventions. Hospital referral outcomes were collected and interventions were costed using the Australian Medical Benefits Schedule.

RESULTS

Of 142 men who were offered enrolment in the study, 102 [72%; 95% confidence interval (CI) 64-79%] participated. Following the initial anal examinations, four men were referred to surgeons. Cancer was excluded in three men (3%; 95% CI 1-8%) and one was diagnosed with anal squamous cell carcinoma (SCC). Three men had anoscopy performed at the time and two were referred for colonoscopy. Ninety-eight per cent (95% CI 93-100%) of respondents said that they would probably have the examination next time. The intervention was estimated to cost approximately Australian $16 per examination.

CONCLUSIONS

Regular anal digital examinations are an acceptable and inexpensive addition to the routine care of homosexual men with HIV infection.

Design of refractive index sensors based on the wavelength-selective resonant coupling phenomenon in dual-core photonic crystal fibers

Design strategies for high-sensitivity refractive index sensors based on the principle of wavelength-selective resonant coupling in dual-core photonic crystal fibers are presented. Phase matching at a single wavelength can be achieved between an analyte-filled microstructured core and a small core with a down-doped rod or one small air hole in the center, thus enabling selectively directional resonant-coupling between the two cores. The transmission spectra of the output light presents a notch at the index-matched wavelength, yielding a resonant wavelength depending on the refractive index of the analyte. Numerical simulations demonstrate that both of the two proposed sensors can be used for highly sensitive detection of low-index analyte. In particular, the configuration realized by introducing the fiber with a small air hole in one core can be used to the detection of the analyte index around 1.33 and the sensitivity reach to 1.2×10(4) nm per refractive index unit (RIU). In addition, the detection limit is as low as 2.5×10(-7) RIU at n(a)=1.33.

HIV-testing of men who have sex with men: variable testing rates among clinicians

High HIV testing coverage of high-risk populations is required to reduce the number of HIV-infected individuals unaware of their status. The aim of this study was to determine HIV testing rates among men who have sex with men (MSM) attending a sexual health service, including the impact of the treating clinician on HIV testing rates. Factors associated with HIV testing of MSM attending the Melbourne Sexual Health Centre for the first time between 2003 and 2009 were determined, including testing rates for individual treating clinicians. Overall, 78% of 4425 men were tested for HIV. Clinician HIV testing rates were higher among nurses (median 89%; range 77–95%) than doctors (median 73%; range 45–88%) with significant differences between individual physicians ( P < 0.001). Lower testing among doctors was independent of reported sexual risk and time since the last HIV test. Substantial differences in HIV testing rates between clinicians were evident with low testing by some. Increasing HIV testing rates among high-risk groups require engagement not only of individuals at risk but also awareness among health-care providers who perform HIV testing.

Does MR perfusion imaging impact management decisions for patients with brain tumors? A prospective study

BACKGROUND AND PURPOSE

MR perfusion imaging can be used to help predict glial tumor grade and disease progression. Our purpose was to evaluate whether perfusion imaging has a diagnostic or therapeutic impact on clinical management planning in patients with glioma.

MATERIALS AND METHODS

Standard MR imaging protocols were interpreted by a group of 3 NRs in consensus, with each case being interpreted twice: first, including routine sequences; and second, with the addition of perfusion imaging. A multidisciplinary team of treating physicians assessed tumor status and created hypothetical management plans, on the basis of clinical presentation and routine MR imaging and then routine MR imaging plus perfusion MR imaging. Physicians' confidence in the tumor status assessment and management plan was measured by using Likert-type items.

RESULTS

Fifty-nine consecutive subjects with glial tumors were evaluated; 50 had known pathologic diagnoses. NRs and the treatment team agreed on tumor status in 45/50 cases (κ = 0.81). With the addition of perfusion, confidence in status assessment increased in 20 (40%) for NRs and in 28 (56%) for the treatment team. Of the 59 patient-care episodes, the addition of perfusion was associated with a change in management plan in 5 (8.5%) and an increase in the treatment team's confidence in their management plan in 34 (57.6%). NRs and the treatment team found perfusion useful in most episodes of care and wanted perfusion included in future MR images for >80% of these subjects.

CONCLUSIONS

Perfusion imaging appears to have a significant impact on clinical decision-making and subspecialist physicians' confidence in management plans for patients with brain tumor.

Age-related changes in kallikreins-kinins system in rat corpus cavernosum

Many factors, such as nitric oxide synthase, androgen and growth factors, can regulate the tone of corpus cavernosum (CC) smooth muscle with an age-related tendency. It has been shown that the active metabolites of kallikreins-kinins system (KKS), including bradykinin, Lys-BK and Met-Lys-BK, can also relax the CC smooth muscle significantly in vitro. Our aim was to evaluate the specific association between KKS and age in rat CC. CC and thoracic aorta were isolated from rats at postnatal weeks (PW) of 2, 8, 12, 20, 30, 40 and 60, respectively. Tissue kallikrein-I (KLKI) and kinin B2 receptor (B2R) mRNA in CC and thoracic aorta were detected by real-time polymerase chain reaction (PCR). Protein expression of KLKI and B2R were determined with immunofluorescence in situ and Western blot. Real-time PCR, immunofluorescence in situ and Western blot all demonstrated that the age-related changes in expression of KLKI were similar between the CC and thoracic aorta. It significantly increased with age from PW2 to PW30, reached the peak at PW30 and then declined gradually. However, there was no statistically significant difference among PW30, PW40 and PW60. Similarly, the expression of B2R increased gradually with age reached and remained at the peak during adult stages and no significant differences were found among PW20, PW30 and PW40; then, it decreased significantly at PW60. The changes in the expression of B2R in CC and age-matched aorta were similar except that it was significantly less than that in the aorta at PW60. The expression of KLKI and B2R changed in an age-dependent pattern in rat CC and have a tendency to decline during ageing, which is of the same tendency as reported for erection capacity in ageing males and suggests why ageing is an independent predictor of ED, to some extent.

Microstructured-core photonic-crystal fiber for ultra-sensitive refractive index sensing

We propose a novel photonic crystal fiber refractive index sensor which is based on the selectively resonant coupling between a conventional solid core and a microstructured core. The introduced microstructured core is realized by filling the air-holes in the core with low index analyte. We show that a detection limit (DL) of 2.02×10⁻⁶ refractive index unit (RIU) and a sensitivity of 8500 nm/RIU can be achieved for analyte with refractive index of 1.33.