Meeting the WHO 90% target : antiretroviral treatment efficacy in Poland is associated with baseline clinical patient characteristics

Introduction: Modern combined antiretroviral therapies (cART) allow to effectively suppress HIV-1 viral load, with the 90% virologic success rate, meeting the WHO target in most clinical settings. The aim of this study was to analyse antiretroviral treatment efficacy in Poland and to identify variables associated with virologic suppression. Methods: Cross-sectional data on 5152 (56.92% of the countrywide treated at the time-point of analysis) patients on cART for more than six months with at least one HIV-RNA measurement in 2016 were collected from 14 Polish centres. Patients’ characteristics and treatment type-based outcomes were analysed for the virologic suppression thresholds of <50 and <200 HIV-RNA copies/ml. CART was categorized into two nucleos(t)ide (2NRTI) plus non-nucleoside reverse transcriptase (NNRTI) inhibitors, 2NRTI plus protease (PI) inhibitor, 2NRTI plus integrase (InI) inhibitor, nucleos(t)ide sparing PI/r+InI and three drug class regimens. For statistics Chi-square and U-Mann Whitney tests and adjusted multivariate logistic regression models were used. Results: Virologic suppression rates of <50 copies/mL were observed in 4672 (90.68%) and <200 copies/mL in 4934 (95.77%) individuals. In univariate analyses, for the suppression threshold <50 copies/mL higher efficacy was noted for 2NRTI+NNRTI-based combinations (94.73%) compared to 2NRTI+PI (89.93%), 2NRTI+InI (90.61%), nucleos(t)ide sparing PI/r+InI (82.02%) and three drug class regimens (74.49%) (p < 0.0001), with less pronounced but significant differences for the threshold of 200 copies/mL [2NRTI+NNRTI-97.61%, 2NRTI+PI-95.27%, 2NRTI+InI-96.61%, PI/r+InI- 95.51% and 86.22% for three drug class cART) (p < 0.0001). However, in multivariate model, virologic efficacy for viral load <50 copies/mL was similar across treatment groups with significant influence by history of AIDS [OR:1.48 (95%CI:1.01–2.17) if AIDS diagnosed, p = 0.046], viral load < 5 log copies/mL at care entry [OR:1.47 (95%CI:1.08–2.01), p = 0.016], baseline lymphocyte CD4 count ≥200 cells/µL [OR:1.72 (95%CI:1.04–2.78), p = 0.034] and negative HCV serology [OR:1.97 (95%CI:1.29–2.94), p = 0.002]. For viral load threshold <200 copies/mL higher likelihood of virologic success was only associated with baseline lymphocyte CD4 count ≥200 cells/µL [OR:2.08 (95%CI:1.01–4.35), p = 0.049] and negative HCV status [OR:2.84 (95%CI:1.52–5.26), p = 0.001]. Conclusions: Proportion of virologically suppressed patients is in line with WHO treatment target confirming successful application of antiretroviral treatment strategy in Poland. Virological suppression rates depend on baseline patient characteristics, which should guide individualized antiretroviral tre0atment decisions

Probabilistic Modelling of Fracture Toughness of Composites with Discontinuous Reinforcement

The results presented in the paper are related to the prediction of the effective fracture toughness of particulate composites (KICeff). KICeff was determined using a probabilistic model supported by a cumulative probability function qualitatively following the Weibull distribution. Using this approach, it was possible to model two-phase composites with an arbitrarily defined volume fraction of each phase. The predicted value of the effective fracture toughness of the composite was determined based on the mechanical parameter of the reinforcement (fracture toughness), matrix (fracture toughness, Young’s modulus, yield stress), and composite (Young’s modulus, yield stress). The proposed method was validated: the determined fracture toughness of the selected composites was in accordance with the experimental data (the authors’ tests and literature data). In addition, the obtained results were compared with data captured by means of the rule of mixtures (ROM). It was found that the prediction of KICeff using the ROM was subject to a significant error. Moreover, a study of the effect of averaging the elastic–plastic parameters of the composite, on KICeff, was performed. The results showed that if the yield stress of the composite increased, a decrease in its fracture toughness was noticed, which is in line with the literature reports. Furthermore, it was noted that an increase in the Young’s modulus of the composite affected KICeff in the same way as a change in its yield stress

Analytical approach for vehicle body structures behaviour under crash at aspects of overloading and crumple zone length

Road safety problem is still topical, especially since the number of vehicles and the volume of traffic are increasing. It is possible to increase the safety of road users through systemic changes in many areas related to transport. The deformation of the vehicle body during an accident has an impact on the loads acting on the passengers. Vehicle body deformation depends on complex parameters, and knowledge of these parameters is essential for designing crumple zones and the accident reconstruction process. Knowledge of the mechanical parameters of the vehicle structure during deformation is also a reference to passenger injury indicators assessment. This paper reports results from the analytical approach for determining the protection level of personal vehicles. The proposed conception is based on the results from the static stiffness characteristic of the Ford Taurus, which gives the possibility of phenomenological and simple body crumple analytical description at a speed equal to 10 km/h, 40 km/h, 56 km/h and 60 km/h, which is an original part of the work. The approach enables us to describe the vehicle crash by focusing on variations of deformation in time, stiffness, vehicle collision time (duration), deceleration and dynamic crash force. Basing on the body stiffness data of the personal vehicle, the length of the deformation zone in the front of the car and the maximum values of force at the crash for a speed of 60 km/h are presented. Results obtained by the authors show that is possible to estimate the overloading level during the crash time of a vehicle based on the stiffness characteristic of the car body. The proposed methodology can be developed and the advantage of the presented procedure is an uncomplicated useful tool for solving complex problems of a vehicle crash

Laparoscopic Pectopexy—CUSUM Learning Curve and Perioperative Complications Analysis

The study aimed to examine the learning curve and perioperative complications for laparoscopic pectopexy (LP). A total of 60 women with stage II–IV apical prolapse who underwent LP were dichotomized into groups: LSH(+) with concomitant laparoscopic supracervical hysterectomy (LSH), LSH(−) after previous supracervical/total hysterectomy. Operative time, estimated blood loss and hospitalization length were evaluated with cumulative sum (CUSUM) analysis and the Kwiatkowski–Phillips–Schmidt–Shin (KPSS) test, separately for two surgeons (A and B). Intraoperative and perioperative complications according to the Clavien–Dindo (C–D) classification were analyzed. Mean operative time, change in hemoglobin level, and postoperative hospital stay were 143.5 ± 23.1 min—1.5 ± 0.5g/dL and 2.5 ± 0.9 days, respectively. LSH during pectopexy was associated with longer operative time (p = 0.01) but not with higher intraoperative bleeding or prolonged hospital stay. Severe complications rate was low (1.7%) with one bowel injury in LSH(−) (C–D grade IIIb). No C–D grade II, IV and V complications were found. Conversion to open pectopexy, return to the operating room or blood transfusion were not required. The KPSS test showed that a steady operative time for Surgeon A was achieved after 28 procedures. A proficiency for laparoscopic pectopexy based on CUSUM analysis was observed after 38–40 procedures

Perioperative and Long-Term Anatomical and Subjective Outcomes of Laparoscopic Pectopexy and Sacrospinous Ligament Suspension for POP-Q Stages II&ndash;IV Apical Prolapse

The aim of this paper was to analyze perioperative and long-term outcomes in 114 women undergoing surgery for POP-Q &ge; 2 apical prolapse: sacrospinous ligament colpo/hysteropexy (SSLF/SSHP)&mdash;61; laparoscopic pectopexy (LP)&mdash;53. Validated questionnaires (PGI-I, ISI, #35 EPIQ, PFIQ-7, PFDI-20) were completed at baseline and follow-up. POP-Q stages II, III and IV were diagnosed in 1 (0.9%), 84 (73.7%) and 29 (25.4%) patients, respectively. Mean operative time and hospital stay were 151.8 &plusmn; 36.2 min/2.6 &plusmn; 1.1 days for LP and 69 &plusmn; 20.4 min (p &lt; 0.001)/2.7 &plusmn; 1.0 days for SSLF. Severe intraoperative complications occurred in two (1.8%) patients. Mean follow-up was 26.9 &plusmn; 12 and 37.3 &plusmn; 17.5 months for LP and SSLF, respectively. At follow-up, significant improvement for all POP-Q points was observed in both groups (p &lt; 0.001). Shortening of total vaginal length was found in both groups, but predominantly in SSLF patients (p = 0.01). The sensation of vaginal bulge (EPIQ) was reduced, and total PFDI-20 and PFIQ-7 scores improved (p &lt; 0.04) in both groups. Subjective success was reported by 40 (75.5%) LP and 44 (72.1%) SSLF patients. ISI detected no deterioration in urinary incontinence. PGI-I, PFDI-20, #35 EPIQ, PFIQ-7 and ISI did not differ between the groups. In conclusion both, SSLF and LP for apical prolapse generate good anatomical and subjective outcomes, with protective effect on the anterior compartment observed for LP