The risk of late or advanced presentation of HIV infected patients is still high, associated factors evolve but impact on overall mortality is vanishing over calendar years: Results from the Italian MASTER Cohort

BACKGROUND: We aimed at evaluating frequency and factors associated with late presentation and advanced HIV disease and excess risk of death due to these conditions from 1985 to 2013 among naïve HIV infected patients enrolled in the Italian MASTER Cohort. METHODS: All antiretroviral naive adults with available CD4+ T cell count after diagnosis of HIV infection were included. Multivariable logistic regression analysis investigated factors associated either with late presentation or advanced HIV disease. Probabilities of survival were estimated both at year-1 and at year-5 according to the Kaplan-Meier method. Flexible parametric models were used to evaluate changes in risk of death overtime according to late presentation and advanced HIV disease. The analyses were stratified for calendar periods. RESULTS: 19,391 patients were included (54 % were late presenters and 37.6 % were advanced presenters). At multivariable analysis, the following factors were positively associated with late presentation: male gender (OR = 1.29), older age (≥55 years vs. <25 years; OR = 7.45), migration (OR = 1.54), and heterosexual risk factor for HIV acquisition (OR = 1.52) or IDU (OR = 1.27) compared to homosexual risk. Survival rates at year-5 increased steadily and reached 92.1 % for late presenters vs. 97.4 % for non-late presenters enrolled in the period 2004-2009. Using flexible parametric models we found a sustained reduction of hazard ratios over time for any cause deaths between late and non-late presenters over time. Similar results were found for advanced HIV disease. CONCLUSION: Screening polices need to be urgently implemented, particularly in most-at-risk categories for late presentation, such as migrants, older patients and those with heterosexual intercourse or IDU as risk factors for HIV acquisition. Although in recent years the impact of late presentation on survival decreased, about 10 % of patients diagnosed in more recent years remains at increased risk of death over a long-term follow-up

Discriminating radiation injury from recurrent tumor with [18F]PARPi and amino acid PET in mouse models

Background Radiation injury can be indistinguishable from recurrent tumor on standard imaging. Current protocols for this differential diagnosis require one or more follow-up imaging studies, long dynamic acquisitions, or complex image post-processing; despite much research, the inability to confidently distinguish between these two entities continues to pose a significant dilemma for the treating clinician. Using mouse models of both glioblastoma and radiation necrosis, we tested the potential of poly(ADP-ribose) polymerase (PARP)-targeted PET imaging with [18F]PARPi to better discriminate radiation injury from tumor. Results In mice with experimental radiation necrosis, lesion uptake on [18F]PARPi-PET was similar to contralateral uptake (1.02 ± 0.26 lesion/contralateral %IA/ccmax ratio), while [18F]FET-PET clearly delineated the contrast-enhancing region on MR (2.12 ± 0.16 lesion/contralateral %IA/ccmax ratio). In mice with focal intracranial U251 xenografts, tumor visualization on PARPi-PET was superior to FET-PET, and lesion-to-contralateral activity ratios (max/max, p = 0.034) were higher on PARPi-PET than on FET-PET. Conclusions A murine model of radiation necrosis does not demonstrate [18F]PARPi avidity, and [18F]PARPi-PET is better than [18F]FET-PET in distinguishing radiation injury from brain tumor. [18F]PARPi-PET can be used for discrimination between recurrent tumor and radiation injury within a single, static imaging session, which may be of value to resolve a common dilemma in neuro-oncology

Switch to maraviroc with darunavir/r, both QD, in patients with suppressed HIV-1 was well tolerated but virologically inferior to standard antiretroviral therapy: 48-Week results of a randomized trial

Objectives: Primary study outcome was absence of treatment failure (virological failure, VF, or treatment interruption) per protocol at week 48. Methods: Patients on 3-drug ART with stable HIV-1 RNA &lt;50 copies/mL and CCR5-tropic virus were randomized 1:1 to maraviroc with darunavir/ritonavir qd (study arm) or continue current ART (continuation arm). Results: In June 2015, 115 patients were evaluable for the primary outcome (56 study, 59 continuation arm). The study was discontinued due to excess of VF in the study arm (7 cases, 12.5%, vs 0 in the continuation arm, p = 0.005). The proportion free of treatment failure was 73.2% in the study and 59.3% in the continuation arm. Two participants in the study and 10 in the continuation arm discontinued therapy due to adverse events (p = 0.030). At VF, no emergent drug resistance was detected. Co-receptor tropism switched to non-R5 in one patient. Patients with VF reported lower adherence and had lower plasma drug levels. Femoral bone mineral density was significantly improved in the study arm. Conclusion: Switching to maraviroc with darunavir/ritonavir qd in virologically suppressed patients was associated with improved tolerability but was virologically inferior to 3-drug therapy

On farm agronomic and first environmental evaluation of oil crops for sustainable bioenergy chains

Energy crops, and in particular oil crops, could be an important occasion for developing new non food production rows for a new multi-functional agriculture in Italy. In this view, the use of local biomass is a fundamental starting point for the development of a virtuous energy chain that should pursue not only agricultural profitability, but also chain sustainability and that is less dependent on the global market, characterized by instability in terms of biomass availability and price. From this perspective, particular attention must be paid to crop choice on the basis of its rusticity and of its adaptability to local growing conditions and to low input cropping systems. In this context, alike woody and herbaceous biomasses, oil crops such as sunflower and rapeseed should be able to support local agricultural bioenergy chain in Italy. In addition, in a local bioenergy chain, the role of the farmers should not be limited just to grain production; but also grain processing should be performed at farm or consortium level in oilseed extraction plants well proportioned to the cropped surface. In this way, by means of a simple power generator, farmer could thus produce its own thermal and electric energy from the oil, maximizing his profit. This objective could also be achieved through the exploitation of the total biomass, including crop residues and defatted seed meals, that may be considered as fundamental additional economic and/or environmental benefits of the chain. This paper reports some results of three-years on-farm experiments on oil crop chain carried out in the framework of "Bioenergie" project, that was focused to enhance farmers awareness of these criteria and to the feasibility at open field scale of low-input cultivation of rapeseed, sunflower and Brassica carinata in seven Italian regions. In several on-farm experiences, these crops produced more than 800 kg ha-1 of oil with good energy properties. Defatted seed meals could be interesting as organic fertilizers and, in the case of B. carinata, as a biofumigant amendment that could offer a total or partial alternative to some chemicals in agriculture. Furthermore, biomass soil incorporation could contribute to C sequestration, catching CO2 from atmosphere and sinking a part in soil as stable humus. Finally, four different open field experiences carried out again in the second year of the project, have been analysed in order to evaluate their energy and greenhouse gasses balance after cultivation phase

Evaluation of the prognostic value of impaired renal function on clinical progression in a large cohort of HIV-infected people seen for care in Italy

Whilst renal dysfunction, especially mild impairment (60 die;ve (Icona) Foundation Study collected between January 2000 and February 2014 with at least two creatinine values available. eGFR (CKD-epi) and renal dysfunction defined using a priori cut-offs of 60 (severely impaired) and 90 ml/min/1.73m2 (mildly impaired). Characteristics of patients were described after stratification in these groups and compared using chi-square test (categorical variables) or Kruskal Wallis test comparing median values. Follow-up accrued from baseline up to the date of the CCVD or AIDS related events or death or last available visit. Kaplan Meier curves were used to estimate the cumulative probability of occurrence of the events over time. Adjusted analysis was performed using a proportional hazards Cox regression model. We included 7,385 patients, observed for a median follow-up of 43 months (interquartile range [IQR]: 21-93 months). Over this time, 130 cerebro-cardiovascular events (including 11 deaths due to CCVD) and 311 AIDS-related events (including 45 deaths) were observed. The rate of CCVD events among patients with eGFR &gt;90, 60-89, &lt;60 ml/min, was 2.91 (95% CI 2.30-3.67), 4.63 (95% CI 3.51-6.11) and 11.9 (95% CI 6.19-22.85) per 1,000 PYFU respectively, with an unadjusted hazard ratio (HR) of 4.14 (95%CI 2.07-8.29) for patients with eGFR &lt;60 ml/min and 1.58 (95%CI 1.10-2.27) for eGFR 60-89 compared to those with eGFR ≥90. Of note, these estimates are adjusted for traditional cardiovascular risk factors (e.g. smoking, diabetes, hypertension, dyslipidemia). Incidence of AIDS-related events was 9.51 (95%CI 8.35-10.83), 6.04 (95%CI 4.74-7.71) and 25.0 (95% CI 15.96-39.22) per 1,000 PYFU, among patients with eGFR &gt;90, 60-89, &lt;60 ml/min, respectively, with an unadjusted HR of 2.49 (95%CI 1.56-3.97) for patients with eGFR &lt;60 ml/min and 0.68 (95%CI 0.52-0.90) for eGFR 60-89. The risk of AIDS events was significantly lower in mild renal dysfunction group even after adjustment for HIV-related characteristics. Our data confirm that impaired renal function is an important risk marker for CCVD events in the HIV-population; importantly, even those with mild renal impairment (90&lt;60)&gt

Bubble impingement in the presence of a solid particle: a computational study

In this work, we numerically investigate the dynamics of the growth and impingement of two gas bubbles in a Newtonian liquid in the presence of a rigid spherical particle. The computational analysis is carried out through 3D Arbitrary Lagrangian Eulerian (ALE) Finite Element Method (FEM) simulations. During their growth, as the bubbles start to ‘feel’ each other, they lose their spherical shape, with the side facing the other bubble becoming almost flat. In the liquid layer between the gas inclusions, an essentially biaxial extensional flow takes place. Depending on its initial position with respect to the bubbles, the solid particle can be ‘captured’ by the coalescing bubbles or ‘escape’ them. The effects of the physical and geometrical parameters of the system on such phenomenon are studied

Bubble impingement in the presence of a solid particle:a computational study

\u3cp\u3eIn this work, we numerically investigate the dynamics of the growth and impingement of two gas bubbles in a Newtonian liquid in the presence of a rigid spherical particle. The computational analysis is carried out through 3D Arbitrary Lagrangian Eulerian (ALE) Finite Element Method (FEM) simulations. During their growth, as the bubbles start to ‘feel’ each other, they lose their spherical shape, with the side facing the other bubble becoming almost flat. In the liquid layer between the gas inclusions, an essentially biaxial extensional flow takes place. Depending on its initial position with respect to the bubbles, the solid particle can be ‘captured’ by the coalescing bubbles or ‘escape’ them. The effects of the physical and geometrical parameters of the system on such phenomenon are studied.\u3c/p\u3

<em>Saccharomyces pastorianus</em> as cell factory to improve production of fructose 1,6-diphosphate using novel fermentation strategies

Enzymatic phosphorylation of glucose with inorganic phosphate, mediated by permeabilized yeast cells, is one of the methods commonly used to manufacture fructose 1,6-diphosphate, a compound of pharmaceutical interest. This process requires high concentrations of yeast active biomass, that is the catalyst of bioconversion of glucose and inorganic phosphate into fructose 1,6-diphosphate. In this study we firstly describe the high cell density production of a brewer's Saccharomyces strain (Saccharomyces pastorianus DSM 6581), focusing on the optimization of medium composition and exploiting fed-batch strategies and novel technologies based on membrane bioreactors. In fed-batch fermentation an appropriate exponential feed profile was set up to maintain the glucose concentration in the bioreactor below 0.9 g·L-1, thus yielding reproducibly 58 g dry weight biomass per liter in 80 h fermentation, improving eight-fold batch processes output. In addition a higher final biomass density was reached when implementing a microfiltration strategy (70 g dry weight biomass), that led to a productivity of 2.1 gcdw·L-1·h-1, 2.4-fold the fed-batch one. Successively, this biomass was opportunely permeabilized and proved capable of catalyzing the bioconversion of glucose into fructose 1,6-diphosphate. Acting on critical parameters of the bioconversion (substrates molar ratio, catalyst concentration and permeabilization agent), fructose 1,6-diphosphate was produced, after 3 h of process, at 56.3 ± 1 g·L-1 with a yield of 80% of the theoretical value