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3. Cancer Survivor Preferences for Models of Breast Cancer Follow-Up Care: Selecting Attributes for Inclusion in a Discrete Choice Experiment.

Author

Kularatna, S, Allen, M, Hettiarachchi, RM, Crawford-Williams, F, Senanayake, S, Brain, D, Hart, NH, Koczwara, B, Ee, C, Chan, RJ, Kularatna, S, Allen, M, Hettiarachchi, RM, Crawford-Williams, F, Senanayake, S, Brain, D, Hart, NH, Koczwara, B, Ee, C, and Chan, RJ

Abstract

BACKGROUND AND OBJECTIVE: It is critical to evaluate cancer survivors' preferences when developing follow-up care models to better address the needs of cancer survivors. This study was conducted to understand the key attributes of breast cancer follow-up care for use in a future discrete choice experiment (DCE) survey. METHODS: Key attributes of breast cancer follow-up care models were generated using a multi-stage, mixed-methods approach. Focus group discussions were conducted with cancer survivors and clinicians to generate a range of attributes of current and ideal follow-up care. These attributes were then prioritised using an online survey with survivors and healthcare providers. The DCE attributes and levels were finalised via an expert panel discussion based on the outcomes of the previous stages. RESULTS: Four focus groups were held, two with breast cancer survivors (n = 7) and two with clinicians (n = 8). Focus groups generated sixteen attributes deemed important for breast cancer follow-up care models. The prioritisation exercise was conducted with 20 participants (14 breast cancer survivors and 6 clinicians). Finally, the expert panel selected five attributes for a future DCE survey tool to elicit cancer survivors' preferences on breast cancer follow-up care. The final attributes included: the care team, allied health and supportive care, survivorship care planning, travel for appointments, and out-of-pocket costs. CONCLUSIONS: Attributes identified can be used in future DCE studies to elicit cancer survivors' preferences for breast cancer follow-up care. This strengthens the design and implementation of follow-up care programs that best suit the needs and expectations of breast cancer survivors.

Published
2023

4. Lifestyle management in polycystic ovary syndrome – beyond diet and physical activity

Author

Cowan, S, Lim, S, Alycia, C, Pirotta, S, Thomson, R, Gibson-Helm, Melanie, Blackmore, R, Naderpoor, N, Bennett, C, Ee, C, Rao, V, Mousa, A, Alesi, S, and Moran, L

Subjects
FOS: Clinical medicine, Endocrinology, Diabetes and Metabolism, General Medicine, 110399 Clinical Sciences not elsewhere classified
Abstract

Polycystic ovary syndrome (PCOS) is a common condition affecting reproductive-aged women with reproductive, metabolic and psychological consequences. Weight and lifestyle (diet, physical activity and behavioural) management are first-line therapy in international evidence-based guidelines for PCOS. While these recommend following population-level diet and physical activity guidelines, there is ongoing interest and research in the potential benefit of including psychological and sleep interventions, as well as a range of traditional, complimentary and integrative medicine (TCIM) approaches, for optimal management of PCOS. There is limited evidence to recommend a specific diet composition for PCOS with approaches including modifying protein, carbohydrate or fat quality or quantity generally having similar effects on the presentations of PCOS. With regards to physical activity, promising evidence supports the provision of vigorous aerobic exercise, which has been shown to improve body composition, cardiorespiratory fitness and insulin resistance. Psychological and sleep interventions are also important considerations, with women displaying poor emotional wellbeing and higher rates of clinical and subclinical sleep disturbance, potentially limiting their ability to make positive lifestyle change. While optimising sleep and emotional wellbeing may aid symptom management in PCOS, research exploring the efficacy of clinical interventions is lacking. Uptake of TCIM approaches, in particular supplement and herbal medicine use, by women with PCOS is growing. However, there is currently insufficient evidence to support integration into routine clinical practice. Research investigating inositol supplementation have produced the most promising findings, showing improved metabolic profiles and reduced hyperandrogenism. Findings for other supplements, herbal medicines, acupuncture and yoga is so far inconsistent, and to reduce heterogeneity more research in specific PCOS populations, (e.g. defined age and BMI ranges) and consistent approaches to intervention delivery, duration and comparators are needed. While there are a range of lifestyle components in addition to population-recommendations for diet and physical activity of potential benefit in PCOS, robust clinical trials are warranted to expand the relatively limited evidence-base regarding holistic lifestyle management. With consumer interest in holistic healthcare rising, healthcare providers will be required to broaden their knowledge pertaining to how these therapies can be safely and appropriately utilised as adjuncts to conventional medical management.

Published
2023
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6. N-acetyl cysteine (NAC) augmentation in the treatment of obsessive-compulsive disorder: A phase III, 20-week, double-blind, randomized, placebo-controlled trial

Author

Sarris, J, Byrne, G, Castle, D, Bousman, C, Oliver, G, Cribb, L, Blair-West, S, Brakoulias, V, Camfield, D, Ee, C, Chamoli, S, Boschen, M, Dean, Olivia, Dowling, N, Menon, R, Murphy, J, Metri, NJ, Nguyen, TP, Wong, A, Jordan, R, Karamacoska, D, Rossell, SL, Berk, Michael, Ng, CH, Sarris, J, Byrne, G, Castle, D, Bousman, C, Oliver, G, Cribb, L, Blair-West, S, Brakoulias, V, Camfield, D, Ee, C, Chamoli, S, Boschen, M, Dean, Olivia, Dowling, N, Menon, R, Murphy, J, Metri, NJ, Nguyen, TP, Wong, A, Jordan, R, Karamacoska, D, Rossell, SL, Berk, Michael, and Ng, CH

Published
2022

7. Treatment of refractory obsessive-compulsive disorder with nutraceuticals (TRON): a 20-week, open label pilot study

Author

Sarris, J, Byrne, GJ, Oliver, G, Cribb, L, Blair-West, S, Castle, D, Dean, OM, Camfield, DA, Brakoulias, V, Bousman, C, Dowling, N, Ee, C, Murphy, J, Menon, R, Berk, M, Chamoli, S, Boschen, M, Ng, CH, Sarris, J, Byrne, GJ, Oliver, G, Cribb, L, Blair-West, S, Castle, D, Dean, OM, Camfield, DA, Brakoulias, V, Bousman, C, Dowling, N, Ee, C, Murphy, J, Menon, R, Berk, M, Chamoli, S, Boschen, M, and Ng, CH

Abstract

BACKGROUND: Obsessive-compulsive disorder (OCD) is often challenging to treat and resistant to psychological interventions and prescribed medications. The adjunctive use of nutraceuticals with potential neuromodulatory effects on underpinning pathways such as the glutamatergic and serotonergic systems is one novel approach. OBJECTIVE: To assess the effectiveness and safety of a purpose-formulated combination of nutraceuticals in treating OCD: N-acetyl cysteine, L-theanine, zinc, magnesium, pyridoxal-5' phosphate, and selenium. METHODS: A 20-week open label proof-of-concept study was undertaken involving 28 participants with treatment-resistant DSM-5-diagnosed OCD, during 2017 to 2020. The primary outcome measure was the Yale-Brown Obsessive-Compulsive Scale (YBOCS), administered every 4 weeks. RESULTS: An intention-to-treat analysis revealed an estimated mean reduction across time (baseline to week-20) on the YBOCS total score of -7.13 (95% confidence interval = -9.24, -5.01), with a mean reduction of -1.21 points per post-baseline visit (P ≤ .001). At 20-weeks, 23% of the participants were considered "responders" (YBOCS ≥35% reduction and "very much" or "much improved" on the Clinical Global Impression-Improvement scale). Statistically significant improvements were also revealed on all secondary outcomes (eg, mood, anxiety, and quality of life). Notably, treatment response on OCD outcome scales (eg, YBOCS) was greatest in those with lower baseline symptom levels, while response was limited in those with relatively more severe OCD. CONCLUSIONS: While this pilot study lacks placebo-control, the significant time effect in this treatment-resistant OCD population is encouraging and suggests potential utility especially for those with lower symptom levels. Our findings need to be confirmed or refuted via a follow-up placebo-controlled study.

Published
2022

10. Dementia risk reduction in practice: The knowledge, opinions and perspectives of Australian healthcare providers

Author

Zheng, L, Godbee, K, Steiner, GZ, Daylight, G, Ee, C, Hill, TY, Hohenberg, MI, Lautenschlager, NT, McDonald, K, Pond, D, Radford, K, Anstey, KJ, Peters, R, Zheng, L, Godbee, K, Steiner, GZ, Daylight, G, Ee, C, Hill, TY, Hohenberg, MI, Lautenschlager, NT, McDonald, K, Pond, D, Radford, K, Anstey, KJ, and Peters, R

Abstract

This study examined Australian primary healthcare providers' knowledge about dementia risk factors and risk reduction and their perspectives on barriers and enablers to risk reduction in practice. Primary healthcare providers were recruited through Primary Health Networks across Australia (n = 51). Participants completed an online survey that consisted of fixed-responses and free-text components to assess their knowledge, attitudes and current practices relating to dementia risk factors and risk reduction techniques. The results showed that Australian primary healthcare providers have good knowledge about the modifiable risk factors for dementia however, face several barriers to working with patients to reduce dementia risk. Commonly reported barriers included low patient motivation and healthcare system level limitations. The most commonly reported recommendations to helping primary healthcare providers to work with patients to reduce dementia risk included increasing resources and improving dementia awareness and messaging. While the results need to be interpreted in the context of the limitations of this study, we conclude that collaborative efforts between researchers, clinicians, policy makers and the media are needed to support the uptake of risk reduction activities in primary care settings.

Published
2021

11. Health literacy needs in weight management of women with Polycystic Ovary Syndrome.

Author

Lim S., Smith C.A., Costello M.F., MacMillan F., Moran L., Teede H., Ee C., Lim S., Smith C.A., Costello M.F., MacMillan F., Moran L., Teede H., and Ee C.

Abstract

ISSUE ADDRESSED: Lifestyle modification plays a key role in weight management and chronic disease prevention in polycystic ovary syndrome (PCOS). Women with PCOS experience challenges in adopting and maintaining healthy lifestyle behaviours, which may be related to health literacy. The aims of this study were to explore the health literacy needs of women with PCOS in lifestyle and weight management to inform research and practice. METHOD(S): Ten women with PCOS participated in focus groups and semi-structured telephone interviews on lifestyle and weight management in PCOS. RESULT(S): For functional health literacy, women with PCOS are highly motivated for lifestyle and weight management due to the long-term consequences of PCOS. For interactive health literacy, barriers included delayed diagnosis and poor communication. Women with PCOS were resourceful in accessing a wide range of weight management services but some experience barriers such as costs or the feelings of embarrassment associated with accessing relevant services. For critical health literacy, no facilitators and barriers could be identified for the domain of participation in making decisions for health. CONCLUSION(S): Women with PCOS experience facilitators and barriers in functional and interactive health literacy in lifestyle and weight management. SO WHAT?: Future interventions should seek to further understand and address these gaps in health literacy by increasing weight management skills through behaviour change techniques, improving health professional-patient communication through tools such as question prompt lists, enhancing peer support by increasing distributed health literacy in PCOS support groups and by providing opportunities for co-design of interventions.Copyright © 2021 Australian Health Promotion Association.

Published
2021

12. Dietary quality and nutrient intake in adults with obsessive-compulsive disorder

Author

Nguyen, TP, Cribb, L, Ng, CH, Byrne, GJ, Castle, D, Brakoulias, V, Blair-West, S, Oliver, G, Ee, C, Dean, Olivia, Camfield, DA, Bousman, C, Dowling, N, Roy, R, Berk, Michael, Sarris, J, Nguyen, TP, Cribb, L, Ng, CH, Byrne, GJ, Castle, D, Brakoulias, V, Blair-West, S, Oliver, G, Ee, C, Dean, Olivia, Camfield, DA, Bousman, C, Dowling, N, Roy, R, Berk, Michael, and Sarris, J

Abstract

Published
2021

13. Integrative Medicine in General Practice in Australia: A Mixed-Methods Study Exploring Education Pathways and Training Needs.

Author

Ee, C, Templeman, K, Forth, A, Kotsirilos, V, Singleton, G, Deed, G, Dubois, S, Pirotta, M, Harnett, J, Myers, S, Hunter, J, Ee, C, Templeman, K, Forth, A, Kotsirilos, V, Singleton, G, Deed, G, Dubois, S, Pirotta, M, Harnett, J, Myers, S, and Hunter, J

Abstract

BACKGROUND: Globally, a substantial proportion of general practitioners (GPs) incorporate integrative medicine (IM) into their clinical practice. OBJECTIVE: This study aimed to map the IM education and training pathways and needs of a cohort of Australian GPs who are members of the Royal Australian College of General Practitioners' IM Specific Interest Network, which is a group of GPs with interest in IM. METHODS: We conducted a mixed-methods study comprising of an online, cross-sectional survey supplemented with in-depth semi-structured interviews. Data from the survey and interviews were initially analysed separately and then combined. RESULTS: Eighty-three (83) of 505 eligible GPs/GPs in training (16.4%) participated in the survey, and 15 GPs were interviewed. Results from the two datasets either converged or were complementary. Almost half (47%) of survey respondents had undertaken formal undergraduate or postgraduate IM education, a short course (63%), informal education (71%) or self-education (54%), in at least one of 20 IM modalities listed. Interviewees affirmed there was no single education pathway in IM. Survey respondents who identified as practicing IM were significantly more likely to have IM education, positive attitudes towards IM, particularly natural products, and higher self-rated IM knowledge and competencies. However, knowledge gaps were identified in professional skills domains of population health and context, and organisational and legal dimensions of applied IM practice. Interviewees also highlighted a range of professional and systemic barriers to the practice of IM, education, and training. There was broad support for recognition of IM as a sub-specialty through formalised post-graduate training and accreditation. Most survey respondents (62%) expressed interest in post-fellowship recognition of GPs with advanced skills in IM. CONCLUSION: Our findings demonstrate that it is important to define best practice in IM for GPs in Australia and p

Published
2021

14. An integrative collaborative care model for people with mental illness and physical comorbidities

Author

Ee, C, Lake, J, Firth, J, Hargraves, F, de Manincor, M, Meade, T, Marx, Wolfgang, Sarris, J, Ee, C, Lake, J, Firth, J, Hargraves, F, de Manincor, M, Meade, T, Marx, Wolfgang, and Sarris, J

Abstract

Background Many individuals with mental health problems have comorbid physical conditions, or may present with substance/alcohol misuse or abuse issues. This results in complex treatment challenges that may not be adequately addressed by a model of care that is solely delivered by an individual clinician using a sole intervention. Mainstream pharmacotherapeutic treatment of mental health problems often have limited effectiveness in completely resolving symptoms, and may cause adverse side effects. Adjunctive treatment approaches, including nutraceuticals, lifestyle and behaviour change interventions, are widely used to assist with treatment of mental health problems. However, whilst these can be generally safer with fewer side effects, they have varying levels of evidentiary support. These circumstances warrant reframing the current treatment approach towards a more evidence-based integrative model which may better address the real-world challenges of psychiatric disorders and comorbid physical conditions. In essence, this means developing an integrative model of care which embodies an evidence-informed, personalized stepwise approach using both conventional pharmacological treatments alongside novel adjunctive treatments (where applicable) via the application of a collaborative care approach. Discussion In order to inform this position, a brief review of findings on common patterns of comorbidity in mental illness is presented, followed by identification of limitations of conventional treatments, and potential applications of integrative medicine interventions. Advantages and challenges of integrative mental health care, collaborative models of care, review of research highlights of select integrative approaches, and comment on potential cost advantages are then discussed. Summary We propose that a collaborative care model incorporating evidence-based integrative medicine interventions may more adequately address mental health problems with comorbid medical conditi

Published
2020

16. What Is the Role of Dietary Inflammation in Severe Mental Illness? A Review of Observational and Experimental Findings

Author

Firth, J, Veronese, N, Cotter, J, Shivappa, N, Hebert, JR, Ee, C, Smith, L, Stubbs, B, Jackson, SE, Sarris, J, Firth, J, Veronese, N, Cotter, J, Shivappa, N, Hebert, JR, Ee, C, Smith, L, Stubbs, B, Jackson, SE, and Sarris, J

Abstract

Severe mental illnesses (SMI), including major depressive disorder, bipolar disorder, and schizophrenia, are associated with increased inflammation. Given diet's role in modulating inflammatory processes, excessive calorie-dense, nutrient-deficient processed food intake may contribute toward the heightened inflammation observed in SMI. This review assesses the evidence from observational and experimental studies to investigate how diet may affect physical and mental health outcomes in SMI through inflammation-related pathways. Cross-sectional studies indicate that individuals with SMI, particularly schizophrenia, consume more pro-inflammatory foods and fewer anti-inflammatory nutrients than the general population. Cohort studies indicate that high levels of dietary inflammation are associated with increased risk of developing depression, but there is currently a lack of evidence for schizophrenia or bipolar disorder. Randomized controlled trials show that dietary interventions improve symptoms of depression, but none have tested the extent to which these benefits are due to changes in inflammation. This review summarizes evidence on dietary inflammation in SMI, explores the directionality of these links, and discusses the potential use of targeted nutritional interventions for improving psychological well-being and physical health outcomes in SMI. Establishing the extent to which diet explains elevated levels of inflammatory markers observed in SMI is a priority for future research.

Published
2019

21. Feasibility and acceptability of a proposed trial of acupuncture as an adjunct to lifestyle interventions for weight loss in Polycystic Ovary Syndrome: A qualitative study 11 Medical and Health Sciences 1117 Public Health and Health Services.

Author

MacMillan F., Teede H., Ee C., Baylock B., Moran L., Smith C., Costello M., MacMillan F., Teede H., Ee C., Baylock B., Moran L., Smith C., and Costello M.

Abstract

Background: Polycystic Ovary Syndrome (PCOS) is a common female reproductive disorder with multiple manifestations. Weight management is a key therapeutic goal. Acupuncture is a potential adjunctive weight loss treatment in non-PCOS populations. We aimed to engage patients in co-design and assess the feasibility and acceptability of methods for a randomised controlled trial (RCT) on acupuncture and telephone-based health coaching for weight management in overweight or obese women with PCOS using qualitative methods. Method(s): We recruited women who had PCOS and were aged 18-45 years and with a body mass index of 25 kg/m2 and over, using social media. Two face-to-face focus group meetings and three semi-structured telephone interviews were conducted (n = 10). We analysed data using thematic analysis and aimed to compare and contrast motivations for joining the trial between women who were actively trying to conceive (n = 7) and not trying to conceive (n = 3). Attitudes to, knowledge and experiences of acupuncture; perceptions and attitudes towards the interventions in the RCT (real acupuncture, sham acupuncture and telephone-based health coaching); the outcomes of importance; and barriers and facilitators to successful trial recruitment and retention were collected. Result(s): Women were both acupuncture-naive and acupuncture-experienced. Overall, attitudes towards acupuncture were positive, and the trial design was acceptable with appointment flexibility requested. Ideal enrolment time, if women were trying to conceive, was six months prior to conception. Women supported three-month intervention and the use of sham acupuncture as a control. Financial incentives were not believed to be necessary, and women spoke of altruistic intentions in enrolling for such a trial. Women who were trying to conceive voiced a need for support from their family, health coaches, and peers. The telephone-based health coaching offered welcome support and accountability, noted as possibl

Published
2018

22. Accreditation Standard Guideline Initiative for Tai Chi and Qigong Instructors and Training Institutions.

Author

Oh, B, Yeung, A, Klein, P, Larkey, L, Ee, C, Zaslawski, C, Knobf, T, Payne, P, Stener-Victorin, E, Lee, R, Choi, W, Chun, M, Bonucci, M, Lang, H-D, Pavlakis, N, Boyle, F, Clarke, S, Back, M, Yang, P, Wei, Y, Guo, X, Weng, C-HD, Irwin, MR, Elfiky, AA, Rosenthal, D, Oh, B, Yeung, A, Klein, P, Larkey, L, Ee, C, Zaslawski, C, Knobf, T, Payne, P, Stener-Victorin, E, Lee, R, Choi, W, Chun, M, Bonucci, M, Lang, H-D, Pavlakis, N, Boyle, F, Clarke, S, Back, M, Yang, P, Wei, Y, Guo, X, Weng, C-HD, Irwin, MR, Elfiky, AA, and Rosenthal, D

Abstract

Evidence of the health and wellbeing benefits of Tai Chi and Qigong (TQ) have emerged in the past two decades, but TQ is underutilized in modern health care in Western countries due to lack of promotion and the availability of professionally qualified TQ instructors. To date, there are no government regulations for TQ instructors or for training institutions in China and Western countries, even though TQ is considered to be a part of Traditional Chinese medicine that has the potential to manage many chronic diseases. Based on an integrative health care approach, the accreditation standard guideline initiative for TQ instructors and training institutions was developed in collaboration with health professionals, integrative medicine academics, Tai Chi and Qigong master instructors and consumers including public safety officers from several countries, such as Australia, Canada, China, Germany, Italy, Korea, Sweden and USA. In this paper, the rationale for organizing the Medical Tai Chi and Qigong Association (MTQA) is discussed and the accreditation standard guideline for TQ instructors and training institutions developed by the committee members of MTQA is presented. The MTQA acknowledges that the proposed guidelines are broad, so that the diversity of TQ instructors and training institutions can be integrated with recognition that these guidelines can be developed with further refinement. Additionally, these guidelines face challenges in understanding the complexity of TQ associated with different principles, philosophies and schools of thought. Nonetheless, these guidelines represent a necessary first step as primary resource to serve and guide health care professionals and consumers, as well as the TQ community.

Published
2018

23. Drying Kinetics and Modelling of Convective Drying of Kedondong Fruit.

Author

Ee, C. T., Khaw, Y. J., Hii, C. L., Chiang, C. L., and Djaeni, M.

Subjects
*DRIED fruit, *FRUIT drying, *NONLINEAR regression, *ACTIVATION energy, *FRUIT, *SNACK foods
Abstract

Kedondong is an underutilized fruit cultivated in a small scale in Malaysia and it contains nutrients that can be preserved through drying. The dried product can be sold as a premium fruit snack that could generate revenue for the producer. We studied the drying of peeled and unpeeled kedondong fruits using hot air (60-80°C). This study aims to investigate the drying kinetics (drying rates and effective diffusivities) of kedondong fruits and model the drying curves using thin layer models. Ten thin layer models were employed and solved using non-linear regression. Drying kinetics showed that only falling rate periods were observed, which implied that internal diffusion was the dominant mechanism for moisture release. Mathematical models showed that Modified Hii et al. (I) and (II) models were able to predict the drying curve well with the highest R² (0.9992-0.9999), the lowest RMSE (8.0 x 10-4 - 2.5 x 10-3) and the lowest X² (4.0 ×10-5 - 2.0 x 10-4). Peeled samples showed higher effective diffusivities (average 3.2 x 10-11 m²/s) than unpeeled samples (average 2.7 x 10-11 m²/s). The activation energy was lower in peeled samples (25.8 kJ/mol) as moisture diffusion could occur more easily than unpeeled samples (32.1 kJ/mol). Results from this study provide kinetic information that can be used in scaling up of dryer and optimizing dryer performances. [ABSTRACT FROM AUTHOR]

Published
2021
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24. World Congress Integrative Medicine & Health 2017: part two Berlin, Germany. 3-5 May 2017 Abstracts

Author

Ee, C, Thuraisingam, S, Pirotta, M, French, S, Xue, C, Teede, H, Kristoffersen, AE, Sirois, F, Stub, T, Engler, J, Joos, S, Güthlin, C, Felenda, J, Beckmann, C, Stintzing, F, Evans, R, Bronfort, G, Keefe, D, Taberko, A, Hanson, L, Haley, A, Ma, H, Jolton, J, Yarosh, L, Keefe, F, Nam, J, Ojala, L, Kreitzer, MJ, Fink, C, Kraft, K, Flower, A, Lewith, G, Harman, K, Stuart, B, Bishop, FL, Frawley, J, Füleki, L, Kiss, E, Vancsik, T, Krenacs, T, Funabashi, M, Pohlman, KA, Mior, S, Thiel, H, Hill, MD, Cassidy, DJ, Westaway, M, Yager, J, Hurwitz, E, Kawchuk, GN, O’Beirne, M, Vohra, S, Gaboury, I, Morin, C, Gaertner, K, Torchetti, L, Frei-Erb, M, Kundi, M, Frass, M, Gallo, E, Maggini, V, Comite, M, Sofi, F, Baccetti, S, Vannacci, A, Di Stefano, M, Monechi, MV, Gori, L, Rossi, E, Firenzuoli, F, Mediati, RD, Ballerini, G, Gardiner, P, Lestoquoy, AS, Negash, L, Stillman, S, Shah, P, Liebschutz, J, Adelstein, P, Farrell-Riley, C, Brackup, I, Penti, B, Saper, R, Sampedro, IG, Carvajal, G, Gleiss, A, Gross, MM, Brendlin, D, Röttger, J, Stritter, W, Seifert, G, Grzanna, N, Stange, R, Guendling, PW, Gu, W, Lu, Y, Wang, J, Zhang, C, Bai, H, He, Y, Zhang, X, Zhang, Z, Wang, D, Meng, F, Hagel, A, Albrecht, H, Vollbracht, C, Dauth, W, Hagel, W, Vitali, F, Ganzleben, I, Schultis, H, Konturek, P, Stein, J, Neurath, M, Raithel, M, Krick, B, Haller, H, Klose, P, Dobos, G, Kümmel, S, Cramer, H, Saha, FJ, Kowoll, A, Ebner, B, Berger, B, Choi, K-E, He, L, Wang, H, He, X, Gu, C, Zhang, Y, Zhao, L, Tong, X, Ho, RST, Chung, VCH, Wu, X, Wong, CHL, Wu, JCY, Wong, SYS, Lau, AYL, Sit, RWS, Wong, W, Holmes, M, Bishop, F, Calman, L, Newell, D, Field, J, Htut, WL, Han, D, Choi, DI, Choi, SJ, Kim, HY, Hwang, JH, Huang, CW, Jang, BH, Chen, FP, Ko, SG, Huang, W, Jin, D, Lian, F, Jang, S, Kim, KH, Lee, EK, Sun, SH, Go, HY, Ko, Y, Park, S, Shin, YC, Janik, H, Greiffenhagen, N, Bolte, J, Jaworski, M, Adamus, M, Dobrzynska, A, Jeitler, M, Jaspers, J, von Scheidt, C, Koch, B, Michalsen, A, Steckhan, N, Kessler, C, Huang, W-J, Pang, B, Lian, F-M, Jong, M, Baars, E, Glockmann, A, Hamre, H, Kainuma, M, Murakami, A, Kubota, T, Kobayashi, D, Sumoto, Y, Furusyo, N, Ando, S-I, Shimazoe, T, Kelber, O, Verjee, S, Gorgus, E, Schrenk, D, Kemper, K, Hill, E, Rao, N, Gascon, G, Mahan, J, Kienle, G, Dietrich, J, Schmoor, C, Huber, R, Kim, WH, Ahmed, M, Meggyeshazi, N, Kovago, C, Klaus, AK, Zerm, R, Pranga, D, Ostermann, T, Reif, M, von Laue, HB, Brinkhaus, B, Kröz, M, Recchia, DR, Klein-Laansma, CT, von Hagens, C, Jansen, JP, van Wietmarschen, H, Jong, MC, Sun, S-H, Go, H-Y, Jeon, C-Y, Song, Y-K, Ko, S-G, Koch, AK, Rabsilber, S, Lauche, R, Langhorst, J, Trifunovic-Koenig, M, Koster, E, Delnoij, D, Kroll, L, Weiss, K, Kubo, A, Hendlish, S, Altschuler, A, Connolly, N, Avins, A, Wardle, J, Lee, D, Sibbritt, D, Adams, J, Park, C, Mishra, G, Lechner, J, Lee, I, Chae, Y, Lee, J, Cho, SH, Choi, Y, Lee, JY, Ryu, HS, Yoon, SS, Oh, HK, Hyun, LK, Kim, JO, Yoon, SW, Lee, J-Y, Shin, S-H, Jang, M, Müller, I, Park, S-HJ, Laird, L, Mitchell, S, Li, X, Wang, Y, Zhen, J, Yu, H, Liu, T, Gu, X, Liu, H, Ma, W, Shang, X, Bai, Y, Liu, W, Rooney, C, Smith, A, Lopes, S, Demarzo, M, do Patrocínio Nunes, M, Lorenz, P, Gründemann, C, Heinrich, M, Garcia-Käufer, M, Grunewald, F, Messerschmidt, S, Herrick, A, Gruber, K, Knödler, M, Steinborn, C, Lu, T, Wang, L, Wu, D, Luberto, CM, Hall, DL, Chad-Friedman, E, Lechner, S, Park, ER, Park, E, Goodman, J, Luer, S, Heri, M, von Ammon, K, Landini, I, Lapucci, A, Nobili, S, Mini, E, McDermott, C, Richards, S, Cox, D, Frossell, S, Leydon, G, Eyles, C, Raphael, H, Rogers, R, Selby, M, Adler, C, Allam, J, Bu, X, Zhang, H, Zhang, J, Mikolasek, M, Berg, J, Witt, C, Barth, J, Miskulin, I, Lalic, Z, Miskulin, M, Dumic, A, Sebo, D, Vcev, A, Mohammed, NAA, Im, HB, Mukherjee, A, Kandhare, A, Bodhankar, S, Thakurdesai, P, Munk, N, Evans, E, Froman, A, Kline, M, Bair, MJ, Musial, F, Alræk, T, Hamre, HJ, Björkman, L, Fønnebø, VM, Ni, Q, Tong, X-L, Li, X-L, Liu, W-K, Feng, S, Zhao, X-Y, 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Kim, KH, Lee, EK, Sun, SH, Go, HY, Ko, Y, Park, S, Shin, YC, Janik, H, Greiffenhagen, N, Bolte, J, Jaworski, M, Adamus, M, Dobrzynska, A, Jeitler, M, Jaspers, J, von Scheidt, C, Koch, B, Michalsen, A, Steckhan, N, Kessler, C, Huang, W-J, Pang, B, Lian, F-M, Jong, M, Baars, E, Glockmann, A, Hamre, H, Kainuma, M, Murakami, A, Kubota, T, Kobayashi, D, Sumoto, Y, Furusyo, N, Ando, S-I, Shimazoe, T, Kelber, O, Verjee, S, Gorgus, E, Schrenk, D, Kemper, K, Hill, E, Rao, N, Gascon, G, Mahan, J, Kienle, G, Dietrich, J, Schmoor, C, Huber, R, Kim, WH, Ahmed, M, Meggyeshazi, N, Kovago, C, Klaus, AK, Zerm, R, Pranga, D, Ostermann, T, Reif, M, von Laue, HB, Brinkhaus, B, Kröz, M, Recchia, DR, Klein-Laansma, CT, von Hagens, C, Jansen, JP, van Wietmarschen, H, Jong, MC, Sun, S-H, Go, H-Y, Jeon, C-Y, Song, Y-K, Ko, S-G, Koch, AK, Rabsilber, S, Lauche, R, Langhorst, J, Trifunovic-Koenig, M, Koster, E, Delnoij, D, Kroll, L, Weiss, K, Kubo, A, Hendlish, S, Altschuler, A, Connolly, N, Avins, A, Wardle, J, Lee, D, Sibbritt, D, Adams, J, Park, C, Mishra, G, Lechner, J, Lee, I, Chae, Y, Lee, J, Cho, SH, Choi, Y, Lee, JY, Ryu, HS, Yoon, SS, Oh, HK, Hyun, LK, Kim, JO, Yoon, SW, Lee, J-Y, Shin, S-H, Jang, M, Müller, I, Park, S-HJ, Laird, L, Mitchell, S, Li, X, Wang, Y, Zhen, J, Yu, H, Liu, T, Gu, X, Liu, H, Ma, W, Shang, X, Bai, Y, Liu, W, Rooney, C, Smith, A, Lopes, S, Demarzo, M, do Patrocínio Nunes, M, Lorenz, P, Gründemann, C, Heinrich, M, Garcia-Käufer, M, Grunewald, F, Messerschmidt, S, Herrick, A, Gruber, K, Knödler, M, Steinborn, C, Lu, T, Wang, L, Wu, D, Luberto, CM, Hall, DL, Chad-Friedman, E, Lechner, S, Park, ER, Park, E, Goodman, J, Luer, S, Heri, M, von Ammon, K, Landini, I, Lapucci, A, Nobili, S, Mini, E, McDermott, C, Richards, S, Cox, D, Frossell, S, Leydon, G, Eyles, C, Raphael, H, Rogers, R, Selby, M, Adler, C, Allam, J, Bu, X, Zhang, H, Zhang, J, Mikolasek, M, Berg, J, Witt, C, Barth, J, Miskulin, I, Lalic, Z, Miskulin, M, Dumic, A, Sebo, D, Vcev, A, Mohammed, NAA, Im, HB, Mukherjee, A, Kandhare, A, Bodhankar, S, Thakurdesai, P, Munk, N, Evans, E, Froman, A, Kline, M, Bair, MJ, Musial, F, Alræk, T, Hamre, HJ, Björkman, L, Fønnebø, VM, Ni, Q, Tong, X-L, Li, X-L, Liu, W-K, Feng, S, Zhao, X-Y, Zheng, Y-J, Zhao, X-M, Lin, Y-Q, Zhao, T-Y, Phd, HC, Liu, F, Zhao, L-H, Ye, R, Gu, C-J, Peng, W, De Carvalho, D, El-Bayoumi, M, Haig, B, Kelly, K, Wade, DJ, Portalupi, E, Gobo, G, Bellavita, L, Guglielmetti, C, Raak, C, Teuber, M, Molsberger, F, von Rath, U, Reichelt, U, Schwanebeck, U, Zeil, S, Vogelberg, C, Veintimilla, DR, Mery, GT, Villavicencio, MM, Moran, SH, Sachse, C, Gündlin, PW, Sahebkarkhorasani, M, Azizi, H, Schumann, D, Sundberg, T, Leach, MJ, Seca, S, Greten, H, Selliah, S, Shakya, A, Sherbakova, A, Ulrich-Merzenich, G, Abdel-Aziz, H, Sibinga, E, Webb, L, Ellen, J, Skrautvol, K, Nåden, D, Song, R, Grabowska, W, Osypiuk, K, Diaz, GV, Bonato, P, Park, M, Hausdorff, J, Fox, M, Sudarsky, LR, Tarsy, D, Novakowski, J, Macklin, EA, Wayne, PM, Hwang, I, Ahn, S, Lee, M-A, Sohn, MK, Sorokin, O, Heydeck, D, Borchert, A, Hohmann, C-D, Kühn, H, Kirschbaum, C, Stalder, T, Stöckigt, B, Teut, M, Suhr, R, Sulmann, D, Streeter, C, Gerbarg, P, Silveri, M, Brown, R, Jensen, J, Rutert, B, Eggert, A, Längler, A, Holmberg, C, Sun, J, Deng, X, Li, W-Y, Wen, B, Robinson, N, Liu, J-P, Sung, HK, Yang, N, Shin, SM, Jung, H, Kim, YJ, Jung, WS, Park, TY, Suzuki, K, Ito, T, Uchida, S, Kamohara, S, Ono, N, Takamura, M, Yokochi, A, Maruyama, K, Tapia, P, Thabaut, K, Thronicke, A, Steele, M, Matthes, H, Herbstreit, C, Schad, F, Tian, J, Yang, L, Tian, T, Tian, X, Wang, C, Chai, QY, Zhang, L, Xia, R, Huang, N, Fei, Y, Liu, J, Trent, N, Miraglia, M, Dusek, J, Pasalis, E, Khalsa, SB, Trifunovic-König, M, Koch, A, Uebelacker, L, Tremont, G, Gillette, L, Epstein-Lubow, G, Strong, D, Abrantes, A, Tyrka, A, Tran, T, Gaudiano, B, Miller, I, Ullmann, G, Li, Y, Vaidya, S, Marathe, V, Vale, AC, Motta, J, Donadão, F, Valente, AC, Valente, LCC, Ghelman, R, Vesovic, D, Jevdic, D, Jevdic, A, Jevdic, K, Djacic, M, Letic, D, Bozic, D, Markovic, M, Dunjic, S, Ruscuklic, G, Baksa, D, Vrca, K, Vincent, A, Wahner-Roedler, D, Whipple, M, Vogelius, MM, Friesecke, I, Gündling, PW, Mahapatra, S, Hynes, R, Van Rooy, K, Looker, S, Ghosh, A, Bauer, B, Cutshall, S, Walach, H, Flores, AB, Ofner, M, Kastner, A, Schwarzl, G, Schwameder, H, Alexander, N, Strutzenberger, G, Wang, S, Shi, J, Hao, Y, Wu, J, Qiu, Z, Wang, Y-H, Lou, C-J, Watts, S, Wayne, P, Vergara-Diaz, G, Gow, B, Miranda, J, Sudarsky, L, Macklin, E, Wode, K, Bergqvist, J, Bernhardsson, B-M, Nordberg, JH, Sharp, L, Henriksson, R, Woo, Y, Hyun, MK, Wu, H, Wang, T-F, Zhao, Y, Wei, Y, Tian, L, Wang, X, Wu, R, Han, M, Caldwell, PHY, Liu, S, Chai, Q, Guo, Z, Liu, Z, Yang, IJ, Lincha, VR, Ahn, SH, Lee, DU, Shin, HM, Sung, H, Kim, Y, Yap, A, Kwan, YH, Tan, CS, Ibrahim, S, Ang, SB, Yayi, A, Yoo, JE, Yoo, HR, Jang, SB, Lee, HL, Youssef, A, Ezzat, S, Motaal, AA, El-Askary, H, Yu, X, Cui, Y, Yun, Y, Ahn, J-H, Jang, B-H, Kim, K-S, Choi, I, Glinz, A, ten Brink, F, Büssing, A, Gutenbrunner, C, Helbrecht, B, Fang, T, Shen, Z, Zhang, R, Wu, F, Li, M, Xuan, X, Shen, X, Ren, K, Berman, B, Zheng, Z, Wan, Y, Ma, X, Dong, F, Zick, S, Harris, R, Bae, GE, Kwon, JN, Lee, HY, Nam, JK, Lee, SD, Lee, DH, Han, JY, Yun, YJ, Lee, JH, Park, HL, Park, SH, Bocci, C, Ivaldi, GB, Vietti, I, Meaglia, I, Guffi, M, Ruggiero, R, Gualea, M, Longa, E, Bonucci, M, Croke, S, Rodriguez, LD, Caracuel-Martínez, JC, Fajardo-Rodríguez, MF, Ariza-García, A, la Fuente, FG-D, Arroyo-Morales, M, Estrems, MS, Gómez, VG, Sabater, MV, Ferreri, R, Bernardini, S, Pulcri, R, Cracolici, F, Rinaldi, M, Porciani, C, Fisher, P, Hughes, J, Mendoza, A, MacPherson, H, Filshie, J, Di Francesco, A, Bernardini, A, Messe, M, Primitivo, V, Iasella, PA, Taminato, M, Alcantara, JDC, De Oliveira, KR, Rodrigues, DCDA, Mumme, JRC, Sunakozawa, OKM, Filho, VO, Goldenberg, J, Day, A, Sasagawa, M, Ward, L, Cooley, K, Gunnarsdottir, T, Hjaltadottir, I, Hajimonfarednejad, M, Hannan, N, Hellsing, R, Andermo, S, Arman, M, von Hörsten, I, Torrielo, PV, Vilaró, CLA, Cabrera, FC, Hui, H, Ziea, E, Tsui, D, Hsieh, J, Lam, C, Chan, E, Jensen, MP, Battalio, SL, Chan, J, Edwards, KA, Gertz, KJ, Day, MA, Sherlin, LH, Ehde, DM, Börner, A, Lee, B, Chang, GT, Menassa, A, Motoo, Y, Müller, J, Rabini, S, Vinson, B, Storr, M, Niemeijer, M, Hoekman, J, Ruijssenaaars, W, Njoku, FC, Norheim, AJ, Okumus, F, and Oncu-Celik, H

Published
2017

25. Structural insights into the binding of hepatitis B virus core peptide to HLA-A2 alleles: Towards designing better vaccines

Author

Ee C. Ren, Kenneth Y. Chen, and Jingxian Liu

Subjects
chemistry.chemical_classification, Hepatitis B virus, Immunogenicity, Immunology, Peptide, Human leukocyte antigen, Biology, medicine.disease_cause, Virology, Epitope, Immune system, chemistry, Antigen, medicine, Immunology and Allergy, Allele
Abstract

Binding of specific antigenic peptides with human leukocyte antigen (HLA) molecules is a prerequisite for the initiation of T-cell responses and structural information about the peptide‐HLA complex is essential for the detailed understanding of such interactions. HLA-A2 is the most prevalent HLA allele globally but aside from A*02:01 there is a significant lack of crystal structures, particularly for alleles that occur in high frequencies among Asian populations. Here, we report three HLA-A2 structures with the immunodominant hepatitis B core antigen 18‐27 (HBcAg18‐27) epitope, namely A*02:03, A*02:06, and A*02:07 at reso

Published
2011
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26. Quantifying Skeletal Muscle Properties in Cadaveric Test Specimens: Effects of Mechanical Loading, Postmortem Time, and Freezer Storage

Author

Van Ee, C. A., Chasse, A. L., and Myers, B. S.

Subjects
Striated muscle -- Analysis, Cadaver -- Analysis, Plasticity -- Analysis, Cryobiology -- Analysis, Postmortem changes -- Analysis, Biomechanics -- Research, Engineering and manufacturing industries, Science and technology
Abstract

Investigators currently lack the data necessary to define the state of skeletal muscle properties within cadaveric specimens. The purpose of this study is to define the temporal changes in the postmortem properties of skeletal muscle as a function of mechanical loading and freezer storage. The tibialis anterior of the New Zealand white rabbit was chosen for study. Modulus and no-load strain were found to vary significantly from live after eight hours postmortem. Following the changes that occur during rigor mortis, a stable region of postmortem, post-rigor properties occurred between 36 to 72 hours postmortem. A freeze-thaw process was not found to have a significant effect on the post-rigor response. The first loading cycle response of post-rigor muscle was unrepeatable but stiffer than live passive muscle. After preconditioning, the post-rigor muscle response was repeatable. The preconditioned post-rigor response was less stiff than the live passive response due to a significant increase in no-load strain. Failure properties of postmortem muscle were found to be significantly different from live passive muscle with a significant decrease in. failure stress (61 percent) and energy (81 percent), while failure strain was unchanged. These results suggest that the post-rigor response of cadaveric muscle is unaffected by freezing but sensitive to even a few cycles of mechanical loading. [S0148-0731(00)00301-0]

Published
2000

33. Structural insights into the binding of hepatitis B virus core peptide to HLA-A2 alleles: towards designing better vaccines

Author

Jingxian, Liu, Kenneth Y, Chen, and Ee C, Ren

Subjects
Hepatitis B virus, Immunodominant Epitopes, Protein Conformation, Circular Dichroism, HLA-A2 Antigen, Humans, Hepatitis B Vaccines, Crystallography, X-Ray, Hepatitis B Core Antigens, Alleles, Cell Line, Protein Binding
Abstract

Binding of specific antigenic peptides with human leukocyte antigen (HLA) molecules is a prerequisite for the initiation of T-cell responses and structural information about the peptide-HLA complex is essential for the detailed understanding of such interactions. HLA-A2 is the most prevalent HLA allele globally but aside from A*02:01 there is a significant lack of crystal structures, particularly for alleles that occur in high frequencies among Asian populations. Here, we report three HLA-A2 structures with the immunodominant hepatitis B core antigen 18-27 (HBcAg18-27) epitope, namely A*02:03, A*02:06, and A*02:07 at resolutions of 2.16, 1.70, and 1.75 Å respectively. This comparative analysis reveals that minor polymorphic residue changes between different HLA alleles can induce significant alterations in the major histocompatibility complex-peptide interface, and introduce conformational changes in the p3-p8 peptide region. Circular dichroism analysis demonstrated the HLA-A2-peptide complexes to have a hierarchy of thermostability and binding affinity in the order of A*02:06A*02:07A*02:01A*02:03. Our findings provide structural insights into the varied HLA-A2 allele binding of the hepatitis B core antigen 18-27 epitope and the data suggest that chemical modifications of the peptide side chains could be a promising strategy to modulate and improve HLA-A2-peptide binding affinity for vaccine design.

Published
2011

36. Acupuncture for menopausal vasomotor symptoms: Study protocol for a randomised controlled trial.

Author

Pirotta M., Myers S., French S., Chondros P., Teede H., Ee C., Xue C., Pirotta M., Myers S., French S., Chondros P., Teede H., Ee C., and Xue C.

Abstract

Background: Hot flushes and night sweats (vasomotor symptoms) are common menopausal symptoms, often causing distress, sleep deprivation and reduced quality of life. Although hormone replacement therapy is an effective treatment, there are concerns about serious adverse events. Non-hormonal pharmacological therapies are less effective and can also cause adverse effects. Complementary therapies, including acupuncture, are commonly used for menopausal vasomotor symptoms. While the evidence for the effectiveness of acupuncture in treating vasomotor symptoms is inconclusive, acupuncture has a low risk of adverse effects, and two small studies suggest it may be more effective than non-insertive sham acupuncture. Our objective is to assess the efficacy of needle acupuncture in improving hot flush severity and frequency in menopausal women. Our current study design is informed by methods tested in a pilot study.Methods/design: This is a stratified, parallel, randomised sham-controlled trial with equal allocation of participants to two trial groups. We are recruiting 360 menopausal women experiencing a minimum average of seven moderate hot flushes a day over a seven-day period and who meet diagnostic criteria for the Traditional Chinese Medicine diagnosis of Kidney Yin deficiency. Exclusion criteria include breast cancer, surgical menopause, and current hormone replacement therapy use. Eligible women are randomised to receive either true needle acupuncture or sham acupuncture with non-insertive (blunt) needles for ten treatments over eight weeks. Participants are blinded to treatment allocation. Interventions are provided by Chinese medicine acupuncturists who have received specific training on trial procedures. The primary outcome measure is hot flush score, assessed using the validated Hot Flush Diary. Secondary outcome measures include health-related quality of life, anxiety and depression symptoms, credibility of the sham treatment, expectancy and beliefs about acupunctu

Published
2014

37. Acupuncture for menopausal vasomotor symptoms: study protocol for a randomised controlled trial

Author

Pirotta, M, Ee, C, Teede, H, Chondros, P, French, S, Myers, S, Xue, C, Pirotta, M, Ee, C, Teede, H, Chondros, P, French, S, Myers, S, and Xue, C

Abstract

BACKGROUND: Hot flushes and night sweats (vasomotor symptoms) are common menopausal symptoms, often causing distress, sleep deprivation and reduced quality of life. Although hormone replacement therapy is an effective treatment, there are concerns about serious adverse events. Non-hormonal pharmacological therapies are less effective and can also cause adverse effects. Complementary therapies, including acupuncture, are commonly used for menopausal vasomotor symptoms. While the evidence for the effectiveness of acupuncture in treating vasomotor symptoms is inconclusive, acupuncture has a low risk of adverse effects, and two small studies suggest it may be more effective than non-insertive sham acupuncture. Our objective is to assess the efficacy of needle acupuncture in improving hot flush severity and frequency in menopausal women. Our current study design is informed by methods tested in a pilot study. METHODS/DESIGN: This is a stratified, parallel, randomised sham-controlled trial with equal allocation of participants to two trial groups. We are recruiting 360 menopausal women experiencing a minimum average of seven moderate hot flushes a day over a seven-day period and who meet diagnostic criteria for the Traditional Chinese Medicine diagnosis of Kidney Yin deficiency. Exclusion criteria include breast cancer, surgical menopause, and current hormone replacement therapy use. Eligible women are randomised to receive either true needle acupuncture or sham acupuncture with non-insertive (blunt) needles for ten treatments over eight weeks. Participants are blinded to treatment allocation. Interventions are provided by Chinese medicine acupuncturists who have received specific training on trial procedures. The primary outcome measure is hot flush score, assessed using the validated Hot Flush Diary. Secondary outcome measures include health-related quality of life, anxiety and depression symptoms, credibility of the sham treatment, expectancy and beliefs about acupunct

Published
2014

38. Predictors of trend in CD4-positive T-cell count and mortality among HIV-1 infected individuals with virological failure to all three antiretroviral-drug classes

Author

Ledergerber, B, Lundgren, Jd, Walker, As, Sabin, C, Justice, A, Reiss, P, Mussini, C, Wit, F, d'Arminio Monforte, A, Weber, R, Fusco, G, Staszewski, S, Law, M, Hogg, R, Lampe, F, Gill, Mj, Castelli, Francesco, Phillips, An, Rooney, P. q, Taylor, S. q, Couldwell, D. r, Austin, D. s, Block, M. s, Clemons, J. s, Finlayson, R. s, Petoumenos, K. s, Quan, D. s, Smith, D. s, O'Connor, C. t, Gorton, C. t, Allen, D. u, Mulhall, B. u, Mutimer, K. v, Keeffe, N. v, Cooper, D. w, Carr, A. w, Miller, J. w, Pell, C. w, Ellis, D. x, Baker, D. y, Kidd, J. y, Mcfarlane, R. y, Liang, M. T. z, Brown, Aa, K., Huffam, Ab, S., Savage, Ab, J., Morgan, Knibbs, Ab, P., Sowden, Ac, D., Walker, Ac, A., Orth, Ad, D., Lister, Ad, G., Chuah, Ae, J., Fankhauser, Ae, W., Dickson, Ae, B., Bradford, Af, D., Wilson, Af, C., Ree, Ag, H., Magon, Anderson, Ah, J., Moore, Ah, R., Russell, Ah, D., Mcgovern, Ah, G., Mcnair, Bal, Fairley, Ah, K., Roth, Ai, N., Ai, B., Strecker, Ai, S., Ai, D., Wood, Ai, H., Mijch, Aj, A., Hoy, Aj, J., Pierce, Mccormack, Aj, C., Watson, Aj, K., Medland, Ak, N., Daye, Al, J., Mallal, Am, S., French, Am, M., Skett, Am, J., Maxwel, Am, D., Cain, Am, A., Montroni, An, M., Scalise, An, G., Costantini, An, A., Giacometti, Tirelli, Ao, U., Nasti, Ao, G., Pastore, Ap, G., Ladisa, Ap, N., Perulli, M. L., Ap, Suter, Aq, F., Arici, Aq, C., Maggiolo, Chiodo, Ar, F., Gritti, F. M., Ar, Colangeli, Ar, V., Fiorini, Ar, C., Guerra, Ar, L., Carosi, As, G., Cadeo, G. P., As, Minardi, As, C., Vangi, As, D., Paraninfo, Casari, As, S., Pan, As, A., Patroni, Torti, Quiros, Roldan, As, E., Tomasoni, As, L., Moretti, As, F., Nasta, As, P., Uccelli, M. C., As, Bertelli, Rizzardini, At, G., Migliorino, At, M., Abeli, At, C., Manconi, P. E., Au, Piano, Au, P., Ferraro, Av, T., Scerbo, Av, A., Pizzigallo, Aw, E., Ricci, Aw, F., Santoro, Ax, D., Pusterla, Ax, L., Carnevale, Ay, G., Galloni, Ay, D., Viganò, Az, P., Mena, Az, M., Ghinelli, Ba, F., Sighinolfi, Ba, L., Leoncini, Bb, F., Mazzotta, Pozzi, Bb, M., Caputo, Lo, Bb, S., Angarano, Bc, G., Grisorio, Bc, B., Ferrara, Bc, S., Grima, Bd, P., Tundo, Pagano, Be, G., Piersantelli, Be, N., Alessandrini, Be, A., Piscopo, Be, R., Toti, Bf, M., Chigiotti, Bf, S., Soscia, Bg, F., Tacconi, Bg, L., Orani, Bh, A., Perini, Bh, P., Nigro, Bh, M., Scasso, Bi, A., Vincenti, Scalzini, Bj, A., Fibbia, Bj, G., Moroni, Bk, M., Lazzarin, Bk, A., Cargnel, Vigevani, G. M., Bk, Caggese, Bk, L., Tordato, Bk, F., Novati, Bk, R., Galli, Merli, Bk, S., Pastecchia, Bk, C., Moioli, Esposito, Bl, R., Abrescia, Bm, N., Chirianni, Bm, A., Izzo, Bm, C., Piazza, Bm, M., Marco, De, Montesarchio, Bm, V., Manzillo, Bm, E., Nappa, Bm, S., Colomba, Bn, A., Abbadessa, Bn, V., Prestileo, Bn, T., Mancuso, Bn, S., Ferrari, Bo, C., Pzzaferri, Bo, P., Filice, Bp, G., Minoli, Bp, L., Bruno, Bp, R., Maserati, Bp, S., Tinelli, Bp, C., Pauluzzi, Bq, S., Baldelli, Bq, F., Petrelli, Br, E., Cioppi, Br, A., Alberici, Bs, F., Ruggieri, Bs, A., Menichetti, Bt, F., Martinelli, Bt, C., Stefano, De, Bu, C., Gala, La, Bu, A., Zauli, Bv, T., Ballardini, Bv, G., Magnani, Bw, G., Ursitti, M. A., Bw, Arlotti, Bx, M., Ortolani, Bx, P., Ortona, By, L., Dianzani, By, F., Ippolito, By, G., Antinori, Bz, A., Antonucci, Bz, G., D'Elia, Bz, S., Narciso, Bz, P., Petrosillo, Bz, N., Vullo, Bz, V., Luca, De, Del, Forno, Bz, L., Zaccarelli, Bz, M., Longis, De, Ciardi, D'Offizi, Noto, Lichtner, Capobianchi, M. R., Bz, Girardi, Bz, E., Pezzotti, Rezza, Mura, M. S., Ca, Mannazzu, Ca, M., Caramello, Cb, P., Sinicco, Cb, A., Soranzo, M. L., Cb, Gennero, Cb, L., Sciandra, Cb, M., Salassa, Cb, B., Grossi, P. A., Cc, Basilico, Cc, C., Poggio, Cd, A., Bottari, Cd, G., Raise, Ce, E., Pasquinucci, Ce, S., Lalla, De, Cf, F., Tositti, Cf, G., Resta, Cg, F., Chimienti, Cg, A., Lepri, Cozzi, Ch, A., Bachmann, Fb, S., Battegay, Fb, M., Bernasconi, Fb, E., Bucher, Fb, H., Bürgisser, Fb, P., Cattacin, Egger, Erb, Fierz, Fb, W., Fischer, Flepp, Fontana, Fb, A., Francioli, Furrer, H. J., Fb, Gorgievski, Günthard, Hirschel, Fb, B., Kaiser, Fb, L., Kind, Fb, C., Klimkait, Fb, T., Lauper, Fb, U., Opravil, Paccaud, Fb, F., Pantaleo, Fb, G., Perrin, Piffaretti, J. C., Fb, Rickenbach, Rudin, Schüpbach, Fb, J., Speck, Fb, R., Tarr, Telenti, Trkola, Vernazza, Yerly, Wolf, De, Ci, F., Van, Sighem, A. I., Ci, Van, Valkengoed, Ci, I., Gras, Ci, L., Bronsveld, Ci, W., Veldkamp, Ci, A., Prins, J. M., Cj, Bos, J. C., Cj, Schattenkerk, Eeftinck, J. K. M., Cj, Godfried, M. H., Cj, Lange, J. M. A., Cj, Lowe, S. H., Cj, van der Meer, J. T. M., Cj, Nellen, F. J. B., Cj, Pogany, Cj, K., van der Poll, Cj, T., Ruys, T. A., Cj, Sankatsing, Cj, S., van der Valk, Cj, M., Van, Vonderen, M. G. A., Cj, Wit, F. W. M. N., Cj, Van, Eeden, Cj, A., Ten, Veen, J. H., Cj, Van, Dam, P. S., Cj, Hillebrand, Haverkort, M. E., Cj, Brinkman, Frissen, P. H. J., Cj, Weigel, H. M., Cj, Mulder, J. W., Cj, Van, Gorp, E. C. M., Cj, Meenhorst, P. L., Cj, Mairuhu, A. T. A., Cj, Veenstra, Cj, J., Danner, S. A., Cj, Van, Agtmael, M. A., Cj, Claessen, F. A. P., Cj, Geerlings, S. E., Cj, Perenboom, R. M., Cj, Jurriaans, Back, N. K. T., Cj, Cuijpers, Rietra, P. J. G. M., Cj, Roozendaal, K. J., Cj, Pauw, Cj, W., Van, Zanten, A. P., Cj, Smits, P. H. M., Cj, Von, Blomberg, B. M. E., Cj, Savelkoul, Cj, P., Zaaijer, Cj, H., Beijnen, Crommentuyn, K. M. L., Cj, Huitema, A. D. R., Cj, Kappelhoff, Cj, B., Maat, De, M. M. R., Cj, Richter, Ck, C., van der Berg, Ck, J., Van, Leusen, Ck, R., Swanink, Vriesendorp, Cl, R., Jeurissen, F. J. F., Cl, Kauffmann, R. H., Cm, Koger, E. L. W., Cm, Franck, P. F. H., Cm, Lampe, A. S., Cm, Jansen, C. L., Cm, Bravenboer, Cn, B., Ten, Napel, C. H. H., Co, Mudrikova, Co, T., Hendriks, Co, R., Sprenger, H. G., Cp, Miesen, W. M. A. J., Cp, Schirm, Cp, J., Benne, Cp, D., Ten, Kate, R. W., Cq, Veenendaal, Cq, D., Van, Houte, D. P. F., Cr, Leemhuis, M. P., Cr, Pole, Cr, M., Storm, Cr, H., Van, Zeijl, J. H., Cr, Kroon, F. P., Cs, Schippers, E. F., Cs, Kroes, A. C. M., Cs, Claas, H. C. J., Cs, Schreij, Ct, G., van de Geest, Ct, S., Verbon, Ct, A., Bruggeman, C. A. M. V. A., Ct, Goossens, V. J., Ct, Koopmans, P. P., Cu, Telgt, Cu, M., van der Ven, A. J. A. M., Cu, Burger, D. M., Cu, Hugen, P. W. H., Cu, Galama, J. M. D., Cu, Poort, Y. A. G. M., Cu, van der Ende, M. E., Cv, Gyssens, I. C., Cv, Marie, De, Cv, S., Nouwen, J. L., Cv, Niesters, M. G., Cv, Osterhaus, A. D. M. E., Cv, Schutten, Cv, M., Juttmann, J. R., Cw, Buiting, A. G. M., Cw, Swaans, C. A. M., Cw, Schneider, M. M. E., Cx, Bonten, M. J. M., Cx, Borleffs, J. C. C., Cx, Hoepelman, I. M., Cx, Jaspers, C. A. J. J., Cx, Schouten, Cx, I., Schurink, C. A. M., Cx, Boucher, C. A. B., Cx, Schuurman, Cx, R., Blok, W. L., Cy, Groeneveld, P. H. P., Cz, Boel, Da, E., Jansz, A. F., Da, Dabis, Db, F., Thiebaut, Db, R., Chêne, Db, G., Lawson, Ayayi, Db, S., Meyer, Dc, L., Boufassa, Dc, F., Hamouda, Dd, O., De, P., De, G., Touloumi, Df, G., Hatzakis, Df, A., Karafoulidou, Katsarou, Df, O., Brettle, Dg, R., Del, Amo, Dh, J., Del, Romero, Van, Asten, Di, L., Van, Benthem, Di, B., Di, M., Coutinho, Di, R., Kirk, Dj, O., Pedersen, Dj, C., Hernández, Aguado, Dk, I., Pérez, Hoyos, Dk, S., Eskild, Dl, A., Bruun, J. N., Dl, Sannes, Dl, M., Lee, Dm, C., Johnson, A. M., Dn, Babiker, Dn, A., Darbyshire, Dn, J., Gill, Dn, N., Porter, Dn, K., Do, P., Vanhems, Do, M., Cooper, Dp, D., Kaldor, Dpdq, J., Ashton, Dp, L., Dq, D., Dq, L., Vizzard, Dq, J., Muga, Dr, R., Ds, P., Dt, J., Cayla, Du, J., Garcia de Olalla, Du, P., Day, N. E., Dv, Angelis, De, Dv, D., Fb, K., Dw, A., Dw, S., Dw, J., Tyrer, Dw, F., Beral, Fb, V., Fb, N., Raffanti, Becker, Scarsella, Braun, Most, Balu, Gilbert, Fleenor, Ising, Dieterich, Fb, D., Fusco, Losso, Dx, M., Duran, Dx, A., Vetter, Dy, N., Clumeck, Dz, N., Wit, De, Dz, S., Kabeya, Dz, K., Poll, Dz, B., Colebunders, Dz, R., Machala, Ea, L., Rozsypal, Ea, H., Nielsen, Eb, J., Lundgren, Eb, O., Olsen, C. H., Eb, Gerstoft, Katzenstein, Eb, T., Hansen, A. B. E., Eb, Skinhøj, Eb, P., Eb, C., Zilmer, Ec, K., Rauka, Ec, M., Katlama, Ed, C., De, Sa, Ed, M., Viard, J. P., Ed, Saint, Marc, Ed, T., Ed, P., Pradier, Dietrich, Ee, M., Manegold, Ee, C., Van, Lunzen, Ee, J., Stellbrink, H. J., Ee, Miller, Ee, V., Goebel, F. D., Ee, Salzberger, Ee, B., Rockstroh, Kosmidis, Ef, J., Gargalianos, Ef, P., Sambatakou, Ef, H., Perdios, Panos, Ef, G., Filandras, Ef, A., Banhegyi, Eg, D., Mulcahy, Eh, F., Yust, Ei, I., Burke, Ei, M., Pollack, Ei, S., Hassoun, Ei, J., Sthoeger, Ei, Z., Maayan, Vella, Ej, S., Chiesi, Ej, A., Ej, C., Pristerá, Ej, R., Ej, F., Gabbuti, Bedini, Ej, E., Ej, V., Santopadre, Ej, P., Franci, Ej, M., Castagna, Viksna, Ek, L., Rozentale, Ek, B., Chaplinskas, El, S., Hemmer, Em, R., Staub, Em, T., En, J., Maeland, En, A., Ormaasen, En, V., Knysz, Eo, B., Gasiorowski, Eo, J., Horban, Eo, A., Prokopowicz, Eo, D., Wiercinska, Drapalo, Boron, Kaczmarska, Pynka, Eo, M., Beniowski, Trocha, Eo, H., Smiatacz, Eo, T., Antunes, Ep, F., Mansinho, Ep, K., Maltez, Duiculescu, Eq, D., Streinu, Cercel, Eq, A., Mokrás, Er, M., Staneková, Er, D., González, Lahoz, Es, J., Diaz, Es, B., García, Benayas, Es, T., Martin, Carbonero, Es, L., Soriano, Es, V., Clotet, Jou, Es, A., Conejero, Tural, Es, C., Gatell, J. M., Es, Miró, Zamora, Blaxhult, Et, A., Karlsson, Pehrson, Et, P., Eu, P., Eu, B., Schiffer, Eu, V., Eu, H., Chentsova, Ev, N., Barton, Ew, S., A. M., Ew, Mercey, Ew, D., Phillips, Ew, A., Youle, Ew, M., M. A., Ew, Mocroft, Murphy, Weber, Ew, J., Scullard, Ew, G., Fisher, Ew, R., Loveday, Ew, C., Ex, B., Ruiz, Ex, L., Helm, E. B., Fb, Carlebach, Mösch, Müller, Haberl, Korn, Stephan, Bickel, Gute, Locher, Lutz, Klauke, Doerr, H. W., Fb, Stürmer, Dauer, Jennings, Alexander, Braitstein, Chan, Cote, Gataric, Harrigan, P. R., Fb, Harris, Bonner, Montaner, O'Shaughnessy, Yip, Chaloner, Gumley, Ransom, Sabin, C. A., Fb, Lipman, Ey, J., Read, Ey, R., Ez, F., Riccio, Fa, G., Borghi, AII - Amsterdam institute for Infection and Immunity, APH - Amsterdam Public Health, Infectious diseases, Global Health, Other departments, Public and occupational health, General Internal Medicine, Center of Experimental and Molecular Medicine, Ledergerber, B, Lundgren, Jd, Walker, A, Sabin, C, Justice, A, Reiss, P, Mussini, C, Wit, F, Monforte, Ad, Weber, R, Fusco, G, Staszewski, S, Law, M, Hogg, R, Lampe, F, Gill, Mj, Castelli, F, Phillips, An, Fusco, Gp, Rooney, P, Taylor, S, Couldwell, D, Austin, D, Block, M, Clemons, J, Finlayson, R, Petoumenos, K, Quan, D, Smith, D, O'Connor, C, Gorton, C, Allen, D, Mulhall, B, Mutimer, K, Keeffe, N, Cooper, D, Carr, A, Miller, J, Pell, C, Ellis, D, Baker, D, Kidd, J, Mcfarlane, R, Liang, Mt, Brown, K, Huffam, S, Savage, J, Morgan, S, Knibbs, P, Sowden, D, Orth, D, Lister, G, Chuah, J, Fankhauser, W, Dickson, B, Bradford, D, Wilson, C, Ree, H, Magon, H, Anderson, J, Moore, R, Russell, D, Mcgovern, G, Mcnair, R, Bal, J, Fairley, K, Roth, N, Eu, B, Strecker, S, Wood, H, Mijch, A, Hoy, J, Pierce, A, Mccormack, C, Watson, K, Medland, N, Daye, J, Mallal, S, French, M, Skett, J, Maxwel, D, Cain, A, Montroni, M, Scalise, G, Costantini, A, Giacometti, A, Tirelli, U, Nasti, G, Pastore, G, Ladisa, N, Perulli, Ml, Suter, F, Arici, C, Chiodo, F, Gritti, Fm, Colangeli, V, Fiorini, C, Guerra, L, Carosi, G, Cadeo, Gp, Minardi, C, Vangi, D, Rizzardini, G, Migliorino, G, Manconi, Pe, Piano, P, Ferraro, T, Scerbo, A, Pizzigallo, E, Ricci, F, Santoro, D, Pusterla, L, Carnevale, G, Galloni, D, Vigano, P, Mena, M, Ghinelli, F, Sighinolfi, L, Leoncini, F, Mazzotta, F, Pozzi, M, Lo Caputo, S, Angarano, G, Grisorio, B, Ferrara, S, Grima, P, Tundo, P, Pagano, G, Piersantelli, N, Alessandrini, A, Piscopo, R, Toti, M, Chigiotti, S, Soscia, F, Taccooni, L, Orani, A, Perini, P, Scasso, A, Vincenti, A, Scalzini, A, Fibbia, G, Moroni, M, Lazzarin, A, Cargnel, A, Vigevani, Gm, Caggese, L, Tordato, F, Novati, R, Galli, A, Merli, S, Pastecchia, C, Moioli, C, Esposito, R, Abrescia, N, Chirianni, A, Izzo, C, Piazza, M, De Marco, M, Montesarchio, V, Manzillo, E, Nappa, S, Colomba, A, Abbadessa, V, Prestileo, T, Mancuso, S, Ferrari, C, Pzzaferri, P, Filice, G, Minoli, L, Bruno, R, Maserati, R, Pauluzzi, S, Baldelli, F, Petrelli, E, Cioppi, A, Alberici, F, Ruggieri, A, Menichetti, F, Martinelli, C, De Stefano, C, La Gala, A, Zauli, T, Ballardini, G, Magnani, G, Ursitti, Ma, Arlotti, M, Ortolani, P, Ortona, L, Dianzani, F, Ippolito, G, Antinori, A, Antonucci, G, D'Elia, S, Narciso, P, Petrosillo, N, Vullo, V, De Luca, A, Del Forno, L, Zaccarelli, M, De Longis, P, Ciardi, M, D'Offizi, G, Noto, P, Lichtner, M, Capobianchi, Mr, Girardi, E, Pezzotti, P, Rezza, G, Mura, M, Mannazzu, M, Caramello, P, Sinicco, A, Soranzo, Ml, Gennero, L, Sciandra, M, Salassa, B, Grossi, Pa, Basilico, C, Poggio, A, Bottari, G, Raise, E, Pasquinucci, S, De Lalla, F, Tositti, G, Resta, F, Chimienti, A, Lepri, Ac, Bachmann, S, Battegay, M, Bernasconi, E, Bucher, H, Burgisser, P, Cattacin, S, Egger, M, Erb, P, Fierz, W, Fischer, M, Flepp, M, Fontana, A, Francioli, P, Furrer, Hj, Gorgievski, M, Hirschel, B, Kaiser, L, Kind, C, Klimkait, T, Lauper, U, Opravil, M, Paccaud, F, Pantaleo, G, Perrin, L, Piffaretti, Jc, Rickenbach, M, Rudin, C, Schupbach, J, Speck, R, Tarr, P, Telenti, A, Trkola, A, Vernazza, P, Yerly, S, de Wolf, F, van Sighem, Ai, van Valkengoed, I, Gras, L, Bronsveld, W, Prins, Jm, Bos, Jc, Schattenkerk, Jkme, Godfried, Mh, Lange, Jma, Lowe, Sh, van der Meer, Jtm, Nellen, Fjb, Pogany, K, van der Poll, T, Ruys, Ta, Sankatsing, S, van der Valk, M, van Vonderen, Mga, Wit, Fwmn, van Eeden, A, ten Veen, Jh, van Dam, P, Hillebrand Haverkort, Me, Brinkman, K, Frissen, Phj, Weigel, Hm, Mulder, Jw, van Gorp, Ecm, Meenhorst, Pl, Mairuhu, Ata, Veenstra, J, Danner, Sa, Van Agtmael, Ma, Claessen, Fap, Geerlings, Se, Perenboom, Rm, Richter, C, van der Berg, J, van Leusen, R, Vriesendorp, R, Jeurissen, Fjf, Kauffmann, Rh, Koger, Elw, Bravenboer, B, ten Napel, Chh, Mudrikova, T, Sprenger, Hg, Miesen, Wmaj, ten Kate, Rw, van Houte, Dpf, Leemhuis, Mp, Pole, M, Kroon, Fp, Schippers, Ef, Schreij, G, van de Geest, S, Verbon, A, Koopmans, Pp, Telgt, M, van der Ven, Ajam, van der Ende, Me, Gyssens, Ic, de Marie, S, Nouwen, Jl, Juttmann, Jr, Schneider, Mme, Bonten, Mjm, Borleffs, Jcc, Hoepelman, Im, Jaspers, Cajj, Schouten, I, Schurink, Cam, Blok, Wl, Groenveld, Php, Jurriaans, S, Back, Nkt, Cuijpers, T, Rietra, Pjgm, Roozendaal, Kj, Pauw, W, van Zanten, Ap, Smits, Phm, von Blomberg, Bme, Savelkoul, P, Zaaijer, H, Swanink, C, Franck, Pfh, Lampe, A, Jansen, Cl, Hendriks, R, Schirm, J, Benne, D, Veenendaal, D, Storm, H, van Zeijl, Jh, Kroes, Acm, Claas, Hcj, Bruggeman, Camva, Goossens, Vj, Galama, Jmd, Poort, Yagm, Niesters, Mg, Osterhaus, Adme, Schutten, M, Buiting, Agm, Swaans, Cam, Boucher, Cab, Schuurman, R, Boel, E, Jansz, Af, Veldkamp, A, Beijnen, Jh, Crommentuyn, Kml, 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Subjects
Male, HAART, Human immunodeficiency virus (HIV), CD4 cell count, HIV Infections, CLINICAL PROGRESSION, medicine.disease_cause, THERAPY, HAART REGIMEN, Cohort Studies, Risk Factors, Adult, Anti-Retroviral Agents, CD4 Lymphocyte Count, Cohort Studies, Female, Follow-Up Studies, HIV Infections, HIV Protease Inhibitors, HIV-1, Humans, Male, Middle Aged, Proportional Hazards Models, Reverse Transcriptase Inhibitors, Risk Factors, Treatment Failure, Viral Load, Medicine, Treatment Failure, Mortality rate, Medicine (all), INHIBITOR, General Medicine, Middle Aged, HUMAN IMMUNODEFICIENCY VIRUS TYPE 1 (HIV-1), BLIND CONTROLLED-TRIAL, medicine.anatomical_structure, Anti-Retroviral Agents, Cohort, HUMAN-IMMUNODEFICIENCY-VIRUS, Reverse Transcriptase Inhibitors, Female, Off Treatment, Viral load, Cohort study, Adult, medicine.medical_specialty, Settore MED/17 - Malattie Infettive, T cell, Internal medicine, Humans, COHORT, Proportional Hazards Models, business.industry, Proportional hazards model, DISEASE PROGRESSION, HIV Protease Inhibitors, HIV-INFECTED INDIVIDUALS, CD4 Lymphocyte Count, VIRAL LOAD, Immunology, HIV-1, business, Follow-Up Studies
Abstract

Background Treatment strategies for patients in whom HIV replication is not suppressed after exposure to several drug classes remain unclear. We aimed to assess the inter-relations between viral load, CD4-cell count, and clinical outcome in patients who had experienced three-class virological failure.Methods We undertook collaborative joint analysis of 13 HIV cohorts from Europe, North America, and Australia, involving patients who had had three-class virological failure (viral load >1000 copies per mL for >4 months). Regression analyses were used to quantify the associations between CD4-cell-count slope, HIV-1 RNA concentration, treatment information, and demographic characteristics. Predictors of death were analysed by Cox's proportional-hazards models.Findings 2488 patients were included. 2118 (85%) had started antiretroviral therapy with single or dual therapy. During 5015 person-years of follow-up, 276 patients died (mortality rate 5.5 per 100 person-years; 3-year mortality risk 15.3% (95% Cl 13.5-17.3). Risk of death was strongly influenced by the latest CD4-cell count with a relative hazard of 15.8 (95% CI 9.28-27.0) for counts below 50 cells per muL versus above 200 cells per muL. The latest viral load did not independently predict death. For any given viral load, patients on treatment had more favourable CD4-cell-count slopes than those off treatment. For patients on treatment and with stable viral load, CD4-cell counts tended to be increasing at times when the current viral load was below 10 000 copies per mL or 1.5 log(10) copies per mL below off-treatment values.Interpretation In patients for whom viral-load suppression to below the level of detection is not possible, achievement and maintenance of a CD4-cell count above 200 per muL becomes the primary aim. Treatment regimens that maintain the viral load below 10 000 copies per mL or at least provide 1.5 log(10) copies per mL suppression below the off-treatment value do not seem to be associated with appreciable CD4-cell-count decline.

Published
2004

41. Development of an Assisting Detection System for Early Infarct Diagnosis.

Author

Sim, K. S., Nia, M. E., and Ee, C. S.

Subjects
BRAIN tomography, COMPUTED tomography, BRAIN imaging, PIXELS, IMAGE converters
Abstract

In this paper, a detection assisting system for early infarct detection is developed. This new developed method is used to assist the medical practitioners to diagnose infarct from computed tomography images of brain. Using this assisting system, the infarct could be diagnosed at earlier stages. The non-contrast computed tomography (NCCT) brain images are the data set used for this system. Detection module extracts the pixel data from NCCT brain images, and produces the colourized version of images. The proposed method showed great potential in detecting infarct, and helps medical practitioners to make earlier and better diagnoses. [ABSTRACT FROM AUTHOR]

Published
2015
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