Healthcare delivery for HIV-positive people with tuberculosis in Europe

Background In a 2013 survey, we reported distinct discrepancies in delivery of tuberculosis (TB) and HIV services in eastern Europe (EE) vs. western Europe (WE). Objectives To verify the differences in TB and HIV services in EE vs. WE. Methods Twenty-three sites completed a survey in 2018 (EE, 14; WE, nine; 88% response rate). Results were compared across as well as within the two regions. When possible, results were compared with the 2013 survey. Results Delivery of healthcare was significantly less integrated in EE: provision of TB and HIV services at one site (36% in EE vs. 89% in WE; P = 0.034), and continued TB follow-up in one location (42% vs. 100%; P = 0.007). Although access to TB diagnostics, standard TB and HIV drugs was generally good, fewer sites in EE reported unlimited access to rifabutin/multi-drug-resistant TB (MDR-TB) drugs, HIV integrase inhibitors and opioid substitution therapy (OST). Compared with 2013, routine usage of GeneXpert was more common in EE in 2018 (54% vs. 92%; P = 0.073), as was access to moxifloxacin (46% vs. 91%; P = 0.033), linezolid (31% vs. 64%; P = 0.217), and bedaquiline (0% vs. 25%; P = 0.217). Integration of TB and HIV services (46% vs. 39%; P = 1.000) and provision of OST to patients with opioid dependency (54% vs. 46%; P = 0.695) remained unchanged. Conclusion Delivery of TB and HIV healthcare, including integration of TB and HIV care and access to MDR-TB drugs, still differs between WE and EE, as well as between individual EE sites

Inducing persistent flow disturbances accelerates atherogenesis and promotes thin cap fibroatheroma development in D374Y-PCSK9 hypercholesterolemic minipigs

BACKGROUND: -Although disturbed flow is thought to play a central role in the development of advanced coronary atherosclerotic plaques, no causal relationship has been established. We evaluated whether inducing disturbed flow would cause the development of advanced coronary plaques, including thin cap fibroatheroma (TCFA). METHODS AND RESULTS: -D374Y-PCSK9 hypercholesterolemic minipigs (N=5) were instrumented with an intracoronary shear-modifying stent (SMS). Frequency-domain optical coherence tomography was obtained at baseline, immediately post-stent, 19, and 34 weeks and used to compute shear stress metrics of disturbed flow. At 34 weeks, plaque type was assessed within serially-collected histological sections and co-registered to the distribution of each shear metric. The SMS caused a flow-limiting stenosis and blood flow exiting the SMS caused regions of increased shear stress on the outer curvature and large regions of low and multidirectional shear stress on the inner curvature of the vessel. As a result, plaque burden was ~3-fold higher downstream of the SMS compared to both upstream of the SMS and in the control artery (p<0.001). Advanced plaques were also primarily observed downstream of the SMS, in locations initially exposed to both low (p<0.002) and multidirectional (p<0.002) shear stress. TCFA regions demonstrated significantly lower shear stress that persisted over the duration of the study compared to other plaque types (p<0.005). CONCLUSIONS: -These data support a causal role for lowered and multidirectional shear stress in the initiation of advanced coronary atherosclerotic plaques. Persistently lowered shear stress appears to be the principal flow disturbance needed for the formation of TCFA

Magnetic Self-Assembling of spherical Co nanoparticles used as building blocks: Syntheses, properties and theory

International audienceIn this chapter, we show that thanks to the use of micellar and organometallic approaches, one can favor the growth of uniform spherical Co NPs with controlled surface passivation (dodecanoic acid or oleylamine), tunable size (from around 4 to 9 nm) and tunable nanocrystallinity (from fcc to hcp structure). As a result of the balance between van der Waals attractions between the metallic NPs, magnetic interactions between the magnetic NPs and solvent-mediated interactions between ligands, these uniform colloidal NPs can be used as building units to form a full set of assemblies which morphology depends on the deposition strategy, involving solvent evaporation. In the case of spontaneous self-assembling of magnetic NPs, compact hexagonal 2D arrays and 3D superlattices called supercrystals can form. In the latter case, either face-centered cubic supercrystalline films or single colloidal crystals can be obtained. Mesostructures of hexagonally ordered columns, labyrinths and void structures can result from assisted self-assembling, induced by the application of an external magnetic field. In highly ordered superlattices, individual NPs act as “artificial atoms” and occupy the lattice sites to form repetitive, periodic “artificial planes". From a fundamental point of view, these artificial solids constitute good models for investigating crystallization behavior. Resulting from collective interactions between neighboring NPs, they exhibit novel magnetic properties. The magnitude of these interactions, and then, the magnetic properties, can be tuned by various parameters including (1) the (crystallographic) nature of the magnetic NP, (2) the NP size, (3) the nature of the coating agent, (4) the nature of the solvent, (5) the evaporation rate and (6) if appropriate, the application of an external field during the solvent evaporation. On the one hand, simulations based on a flory-type solvation theory using Hansen solubility colloidal parameters allow to predict the cobalt NP size. On the other hand, Monte Carlo simulations and free energy theories are able to predict the size and type of patterns appearing during the evaporation of a solution of magnetic NPs under a magnetic fiel