Choice of the initial antiretroviral treatment for HIV-positive individuals in the era of integrase inhibitors

BACKGROUND: We aimed to describe the most frequently prescribed initial antiretroviral therapy (ART) regimens in recent years in HIV-positive persons in the Cohort of the Spanish HIV/AIDS Research Network (CoRIS) and to investigate factors associated with the choice of each regimen. METHODS: We analyzed initial ART regimens prescribed in adults participating in CoRIS from 2014 to 2017. Only regimens prescribed in >5% of patients were considered. We used multivariable multinomial regression to estimate Relative Risk Ratios (RRRs) for the association between sociodemographic and clinical characteristics and the choice of the initial regimen. RESULTS: Among 2874 participants, abacavir(ABC)/lamivudine(3TC)/dolutegavir(DTG) was the most frequently prescribed regimen (32.1%), followed by tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC)/elvitegravir(EVG)/cobicistat(COBI) (14.9%), TDF/FTC/rilpivirine (RPV) (14.0%), tenofovir alafenamide (TAF)/FTC/EVG/COBI (13.7%), TDF/FTC+DTG (10.0%), TDF/FTC+darunavir/ritonavir or darunavir/cobicistat (bDRV) (9.8%) and TDF/FTC+raltegravir (RAL) (5.6%). Compared with ABC/3TC/DTG, starting TDF/FTC/RPV was less likely in patients with CD4100.000 copies/mL. TDF/FTC+DTG was more frequent in those with CD4100.000 copies/mL. TDF/FTC+RAL and TDF/FTC+bDRV were also more frequent among patients with CD4<200 cells//muL and with transmission categories other than men who have sex with men. Compared with ABC/3TC/DTG, the prescription of other initial ART regimens decreased from 2014-2015 to 2016-2017 with the exception of TDF/FTC+DTG. Differences in the choice of the initial ART regimen were observed by hospitals' location. CONCLUSIONS: The choice of initial ART regimens is consistent with Spanish guidelines' recommendations, but is also clearly influenced by physician's perception based on patient's clinical and sociodemographic variables and by the prescribing hospital location

Soil development at the roadside: a case study of a novel ecosystem

Over the last few decades, road construction has increased dramatically, and new surfaces have appeared in most landscapes. Standard roadside reclamation practices often fail, because vegetation establishment appears to be limited by microsite availability. We considered soil properties as a key factor driving vegetation establishment on roadslopes over time. We address the following questions: (i) Are soil features conditioned by type of roadslope, position thereupon or applied hydroseeding? (ii) Is there any evidence of soil development at the roadside four years after road construction? (iii) Do mutual interactions exist between soil features and vegetation cover? We designed an experimental set-up on a highway in Central Spain (Madrid). We selected 15 roadslopes (nine roadcuts and six embankments) with three hydroseeding treatments (commercial, alternative and untreated). Four years after the road construction, we considered three roadslope positions (top, middle and bottom) to take into account the geomorphological gradient.We monitored soil features and vegetation cover over 4 years after the road construction. Soil chemical differences were found between roadslope types, mainly resulted from topsoil spreading on embankments and the weathering of the newly exposed materials on roadcuts. Applied amendments do not affect soil fertility or vegetation cover. In the course of time, vegetation establishment and geomorphological gradients operate differentially on roadcuts and embankments. Accordingly, cycling back of organic compounds or geomorphological processes differs between roadslopes types. Restoration efforts should be directed to guarantee key ecological processes and support soil formation

Disentangle the Causes of the Road Barrier Effect in Small Mammals through Genetic Patterns.

Road barrier effect is among the foremost negative impacts of roads on wildlife. Knowledge of the factors responsible for the road barrier effect is crucial to understand and predict species' responses to roads, and to improve mitigation measures in the context of management and conservation. We built a set of hypothesis aiming to infer the most probable cause of road barrier effect (traffic effect or road surface avoidance), while controlling for the potentially confounding effects road width, traffic volume and road age. The wood mouse Apodemus sylvaticus was used as a model species of small and forest-dwelling mammals, which are more likely to be affected by gaps in cover such as those resulting from road construction. We confront genetic patterns from opposite and same roadsides from samples of three highways and used computer simulations to infer migration rates between opposite roadsides. Genetic patterns from 302 samples (ca. 100 per highway) suggest that the highway barrier effect for wood mouse is due to road surface avoidance. However, from the simulations we estimated a migration rate of about 5% between opposite roadsides, indicating that some limited gene flow across highways does occur. To reduce highway impact on population genetic diversity and structure, possible mitigation measures could include retrofitting of culverts and underpasses to increase their attractiveness and facilitate their use by wood mice and other species, and setting aside roadside strips without vegetation removal to facilitate establishment and dispersal of small mammals

Efectividad del tratamiento de las úlceras venosas con vendaje compresivo multicapa asociado a protección de la piel perilesional con Cavilon® (película barrera no irritante) Effectiveness of the association of multilayer compression therapy and periwound protection with Cavilon® (no sting barrier film) in the treatment of venous leg ulcers

Introducción: el adecuado tratamiento de las úlceras de extremidad inferior de etiología venosa es fundamental para mejorar la calidad de vida de los pacientes. El uso de terapia compresiva con vendaje multicapa es el tratamiento que mejores resultados presenta. En la práctica, se utiliza en combinación con unos adecuados cuidados locales de la herida y de la piel perilesional. El objetivo del estudio fue evaluar la efectividad clínica de un vendaje multicapa de compresión y el impacto de la utilización de la película barrera Cavilon® en úlceras vasculares de origen venoso. Metodología: ensayo clínico controlado, aleatorizado, abierto, multicéntrico y pragmático en España. Todos los pacientes incluidos fueron tratados con terapia de compresión con el mismo vendaje multicapa y asignados aleatoriamente al grupo de intervención, tratados con la PBNI Cavilon®, o al grupo control. Se realizaron un máximo de 13 visitas de estudio separadas entre ellas por una semana. El estudio fue evaluado y aprobado por los comités éticos de investigación clínica (CEIC) de los siete centros participantes. Resultados: participaron 98 pacientes en el estudio (49 en el grupo intervención y 49 como control). Tras cuatro semanas, el grupo intervención presentó una reducción media (DE) del tamaño de úlcera superior al grupo control (56,7% (30,3) vs. 45,5% (47,4); p = 0,087). A las 12 semanas de tratamiento, las diferencias observadas fueron estadísticamente significativas (83,4% (31,1) vs. 71,6% (44,1); p = 0,046). El 69,4% de los pacientes del grupo intervención redujo el área de úlcera en > 50% en las cuatro primeras semanas de tratamiento, respecto al 46,9% de los pacientes del grupo control (p <0,01). Conclusión: la efectividad clínica de un vendaje multicapa de compresión (Coban® 2) en pacientes con úlceras venosas, valorada en términos de porcentaje de reducción del área, se incrementa al asociar un tratamiento protector de la piel perilesional con la PBNI (Cavilon®).<br>Aim: appropriate treatment of venous leg ulcers is essential to improve the quality of life of patients. Compression therapy using multilayer bandages show to the best clinical results. In practice, it is used in combination with a suitable local care of the wound and periwound skin. The aim of this study was to evaluate the clinical effectiveness of a multi-layer compression bandage and the impact on it of the use of barrier film Cavilon® in venous leg ulcers. Methods: controlled clinical trial, randomized, open, multicentre and pragmatic in Spain. All included patients were treated with compression therapy with the same multilayer bandages and randomized to the intervention group, treated with NSBF Cavilon®, or to the control group. Up to 13 weekly visits were performed. The study was reviewed and approved by the institutional research board (IRB) of the 7 participating centres. Results: ninety eight patients were included in the study (49 in the intervention group and 49 in control group). At 4 weeks of treatment, the intervention group showed a mean ulcer size reduction (SD) greater than the control group (56.7% (30.3) vs. 45.5% (47.4), (p=0.087). At 12 weeks of treatment, differences were statistically significant (83.4% (31.1) vs. 71.6% (44.1), p=0.046). In the intervention group, 69.4% of patients reduced the ulcer area > 50% in the first 4 weeks of treatment, instead of 46.9% of patients in the control group (p <0.01). Conclusions: the clinical effectiveness of a multi-layer compression bandage (Coban® 2) in patients with venous leg ulcers, assessed in terms of percentage reduction of area, is increased by concomitant use of a protective treatment of periwound skin with NSBF (Cavilon®)

Effectiveness of the association of multilayer compression therapy and periwound protection with Cavilon® (no sting barrier film) in the treatment of venous leg ulcers.

Introducción: el adecuado tratamiento de las úlceras de extremidad inferior de etiología venosa es fundamental para mejorar la calidad de vida de los pacientes. El uso de terapia compresiva con vendaje multicapa es el tratamiento que mejores resultados presenta. En la práctica, se utiliza en combinación con unos adecuados cuidados locales de la herida y de la piel perilesional. El objetivo del estudio fue evaluar la efectividad clínica de un vendaje multicapa de compresión y el impacto de la utilización de la película barrera Cavilon® en úlceras vasculares de origen venoso. Metodología: ensayo clínico controlado, aleatorizado, abierto, multicéntrico y pragmático en España. Todos los pacientes incluidos fueron tratados con terapia de compresión con el mismo vendaje multicapa y asignados aleatoriamente al grupo de intervención, tratados con la PBNI Cavilon®, o al grupo control. Se realizaron un máximo de 13 visitas de estudio separadas entre ellas por una semana. El estudio fue evaluado y aprobado por los comités éticos de investigación clínica (CEIC) de los siete centros participantes. Resultados: participaron 98 pacientes en el estudio (49 en el grupo intervención y 49 como control). Tras cuatro semanas, el grupo intervención presentó una reducción media (DE) del tamaño de úlcera superior al grupo control (56,7% (30,3) vs. 45,5% (47,4); p = 0,087). A las 12 semanas de tratamiento, las diferencias observadas fueron estadísticamente significativas (83,4% (31,1) vs. 71,6% (44,1); p = 0,046). El 69,4% de los pacientes del grupo intervención redujo el área de úlcera en * 50% en las cuatro primeras semanas de tratamiento, respecto al 46,9% de los pacientes del grupo control (p <0,01). Conclusión: la efectividad clínica de un vendaje multicapa de compresión (Coban® 2) en pacientes con úlceras venosas, valorada en términos de porcentaje de reducción del área, se incrementa al asociar un tratamiento protector de la piel perilesional con la PBNI (Cavilon®).Aim: appropriate treatment of venous leg ulcers is essential to improve the quality of life of patients. Compression therapy using multilayer bandages show to the best clinical results. In practice, it is used in combination with a suitable local care of the wound and periwound skin. The aim of this study was to evaluate the clinical effectiveness of a multi-layer compression bandage and the impact on it of the use of barrier film Cavilon® in venous leg ulcers. Methods: controlled clinical trial, randomized, open, multicentre and pragmatic in Spain. All included patients were treated with compression therapy with the same multilayer bandages and randomized to the intervention group, treated with NSBF Cavilon®, or to the control group. Up to 13 weekly visits were performed. The study was reviewed and approved by the institutional research board (IRB) of the 7 participating centres. Results: ninety eight patients were included in the study (49 in the intervention group and 49 in control group). At 4 weeks of treatment, the intervention group showed a mean ulcer size reduction (SD) greater than the control group (56.7% (30.3) vs. 45.5% (47.4), (p=0.087). At 12 weeks of treatment, differences were statistically significant (83.4% (31.1) vs. 71.6% (44.1), p=0.046). In the intervention group, 69.4% of patients reduced the ulcer area * 50% in the first 4 weeks of treatment, instead of 46.9% of patients in the control group (p <0.01). Conclusions: the clinical effectiveness of a multi-layer compression bandage (Coban® 2) in patients with venous leg ulcers, assessed in terms of percentage reduction of area, is increased by concomitant use of a protective treatment of periwound skin with NSBF (Cavilon®).El estudio ha sido promovido y financiado por 3M.Medicin

Using inulin‐based emulsion gels as fat substitute in salt reduced Bologna sausage

[Background]: A high‐fiber emulsion gel (EG) containing inulin, soy protein isolate, and soybean oil was applied as animal fat replacer in reduced salt and fat Bologna sausage containing mechanically deboned chicken meat, pork meat, and pork back fat. Technological and microbiological properties were evaluated for 60 days at 4 °C.[Results]: A reduction of 11 to 34% and 35 to 45% of fat and sodium were obtained in reformulated products, respectively. An increase in fiber content and polyunsaturated fatty acid was noticed in the formulations with EG. The addition of EG in Bologna increased L* (lightness) values and reduced a* (redness/greenness) values comparing to control treatment. Microstructural properties of sausages exhibited a denser network with the presence of EG. Softer, more elastic, cohesive and resilient samples with a higher intensity of lipid oxidation (P < 0.05) were observed in EG added sausages. The nuclear magnetic resonance (NMR) data shows that the presence of EG recovers the matrix that has been weakened due to reduction of fat and salt. Sensory evaluation showed that the incorporation of the EGs resulted in acceptable scores.[Conclusion]: These results suggest that inulin‐based EG is a potential fat substitute for developing healthier meat products, with better fatty acids composition and stable to chilled storage.The authors are thankful to CNPq (140 531/2015‐7), CAPES (140 531/2015‐7), and FAPESP (2016/19 967‐7) for providing financial support and scholarships that sustained this study.Peer reviewe

Using inulin‐based emulsion gels as fat substitute in salt reduced Bologna sausage

[Background]: A high‐fiber emulsion gel (EG) containing inulin, soy protein isolate, and soybean oil was applied as animal fat replacer in reduced salt and fat Bologna sausage containing mechanically deboned chicken meat, pork meat, and pork back fat. Technological and microbiological properties were evaluated for 60 days at 4 °C.[Results]: A reduction of 11 to 34% and 35 to 45% of fat and sodium were obtained in reformulated products, respectively. An increase in fiber content and polyunsaturated fatty acid was noticed in the formulations with EG. The addition of EG in Bologna increased L* (lightness) values and reduced a* (redness/greenness) values comparing to control treatment. Microstructural properties of sausages exhibited a denser network with the presence of EG. Softer, more elastic, cohesive and resilient samples with a higher intensity of lipid oxidation (P < 0.05) were observed in EG added sausages. The nuclear magnetic resonance (NMR) data shows that the presence of EG recovers the matrix that has been weakened due to reduction of fat and salt. Sensory evaluation showed that the incorporation of the EGs resulted in acceptable scores.[Conclusion]: These results suggest that inulin‐based EG is a potential fat substitute for developing healthier meat products, with better fatty acids composition and stable to chilled storage.The authors are thankful to CNPq (140 531/2015‐7), CAPES (140 531/2015‐7), and FAPESP (2016/19 967‐7) for providing financial support and scholarships that sustained this study.Peer reviewe