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INTRODUCTION AND OBJECTIVE:BPH is a common condition in older men.Several techniques use laser energy to resect, enucleate or ablate hyperplastic prostate tissue. Holmium laser is used for HoLEP (H...

INTRODUCTION AND OBJECTIVES:The endoscopic technique of enucleation of the prostatic adenoma with Holmium laser (HoLEP) was introduced in 1998 by Peter Gilling. The enucleation technique and holmiu...

Background Prevalence and factors associated with etravirine (ETV) resistance mutations among patients failing on first-generation non-nucleoside reverse transcriptase inhibitors (NNRTI) merit investigation. Methods The study comprised an analysis of all sequential patients attending the Institute of Infectious Diseases (Brescia, northern Italy) who performed a genotypic resistance testing (GRT) after ≥3 months of a stable NNRTI-based regimen between 2001 and 2006. Multivariable ordinal logistic regression analysis was performed to assess predictors of ETV resistance mutations. Results Out of 248 strains, 153 (61.7%) harboured ≥1 ETV resistance mutations. In particular, 88 (35.5%), 53 (21.4%) and 12 (4.8%) harboured one, two and three mutations, respectively. The most frequent mutations were G190A (23%), Y181C (23%) and K101E (14.1%). Use of nevirapine (odds ratio [OR] 2.73; 95% confidence level [CI] 1.62–4.62; P500 copies/ml and GRT (per month, OR 1.05; 95% CI 1.01–1.09; P=0.012) were associated with a greater number of ETV resistance mutations. Conversely, higher CD4+ T-cell counts at nadir (per 100 cells/mm3, OR 0.81; 95% CI 0.67–0.98; P=0.029) and use of lamivudine/emtricitabine (OR 0.57; 95% CI 0.37–0.87; P=0.009) were protective. Accumulation of ETV resistance-associated mutations was demonstrated by sequential GRT in 4/35 patients (all treated with nevirapine). Conclusions Mutations associated with ETV resistance were common among patients failing on NNRTI, but prevalence of viral strains harbouring three mutations was low. Use of efavirenz and co-administration of lamivudine reduced the risk of ETV resistance. The continued use of the current NNRTI in a failing regimen may select for additional resistant variants.

Continuous surveillance of HIV primary resistance mutations is highly important due to their potential clinical impact. All patients naive to antiretrovirals who had ≥1 genotypic resistance testing at the Institute of Infectious Diseases (Brescia, Northern Italy) between 2001 and 2006 were analyzed. Primary resistance mutations were defined using epidemiological and clinical criteria. Mutations were interpreted using the Stanford University Algorithm. Logistic regression analysis was used to assess possible predictors of primary resistance mutations. Among 569 patients, 11% presented ≥1 mutation. Prevalence of primary resistance mutations to nucleoside reverse-transcriptase inhibitors (NRTI), non-nucleoside reverse-transcriptase inhibitors (NNRTI), and protease inhibitors (PI) was 6.3%, 6%, and 1.6%, respectively. The most frequent mutations to NRTI were substitutions at position 215 (215Y in 3 patients, and 215 revertants in 16), 41L (13), 219Q (12), and 210W (10). Among mutations to NNRTI, 103N was found in 21 patients, while 181C, 188L, and 190A/S in 8, 3, and 4 patients, respectively. Fifty-one patients (9%) had high-to-intermediate resistance to ≥1 antiretroviral drug before starting the treatment. Regarding the new generation drugs, nine patients had intermediate resistance to etravirine, five patients had intermediate resistance to tipranavir, while five, one, and seven patients had low resistance to etravirine, tipranavir, and darunavir. Homosexuals were more likely to harbor a virus with primary resistance mutations (OR:2.68; 95% CI:1.44-5.00; P=0.002) while non-Italian nationality was protective (OR:0.38; 95% CI:0.17-0.86; P=0.020). Prevalence of primary resistance mutations suggests that genotypic resistance testing should be performed before starting treatment in naïve patients in Italy, particularly when NNRTI are prescribed. © 2008 Wiley-Liss, Inc.

(i) To compare early decrease of HIV plasma viral load (pVL) after two standard-combinations of highly active antiretroviral therapy (HAART) (ii) To evaluate variations of proviral HIV-DNA load on conditions of sustained pVL undetectability. Two different sub-studies of a multicentre prospective randomized controlled trial which compared two first-line HAART (i.e., zidovudine+lamivudine+lopinavir/ritonavir versus tenofovir+lamivudine+ efavirenz). Only patients enrolled at the coordinating centre (University of Brescia) were included in the two sub-studies. In the first sub-study, we calculated pVL decrease with respect to baseline at any of the following time-point: days 1, 3, 7, 14 and 28. Decreases of the pVL were compared between the two treatment groups. In the second sub-study, we'analyzed, variation of proviral HIV-DNA load in CD4+ T-cells from baseline to week 52 only in patients who maintained the same treatment regimen and had sustained undetectable pVL. In either studies, linear regression analysis was used to investigate what factors could influence variations of pVL and of proviral HIV-DNA load. (i) 64 patients were studied. A significant decrease of pVL was found from day 3 on, without statistically significant differences between the two study groups. However, after adjusting for possible confounders, tenofovir+lamivudine+efavirenz resulted to be associated with greater pVL decreases. (ii) 45 patients were studied. Mean proviral HIV-DNA load decreased from 1,610 (95%CI: 879-2,341) to 896 (95% CI 499-1,293) copies/106 cells (P=0.05). Linear regression analysis showed that the decrease of proviral DNA load during follow-up was independently and inversely correlated with age. Further studies are needed to compare pVL decay between antiretroviral regimens and assess whether proviral HIV-DNA load is a surrogate marker of treatment effectiveness. © 2008 Bentham Science Publishers Ltd.

INTRODUCTION AND OBJECTIVES: to prospectively test the Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) classification in a cohort of patients submitted to open nephron sparing surgery (NSS) and to correlate the PADUA score to ischemia time. METHODS: from December 2009 and September 2010, 112 consecutive patients were treated with open NSS with the technique of hilar arterial clamping. Tumor were reclassified according to the PADUA classification. Complication were graded according to the modified Clavien system. Univariable and multivariable logistic regression analyses tested the predictive value of PADUA score on overall complication rate and on the ischemic time. RESULTS: Sixty-one patients underwent extraperitoneal NSS through a flank incision, while 51 patients underwent transperitoneal approach. Mean patients age was 61.8 °A 13.3 years. The median tumor diameter was 3.4–1.5 cm. The median PADUA score was 8 (range 6–13). Mean ischemia time was 20–10 min. Overall complication rate was 18.7% (n 21). On univariable analysis, the PADUA score correlated with complication rate (p 0.027) and with increased ischemia time, considered as a continuous variable as well as categorical one (°U 25 min vs 25 min) (p 0.001 and p 0.03, respectively). On multivariable analysis PADUA score achieved the independent predictor status of complication rate, after adjusting for body mass index and surgical approach. Patients with PADUA score 8–9 had a 4-fold risk of complication, while patients with PADUA score 10 had a 15-fold risk compared to those with scores of 6–7 (p 0.013). Moreover. patients with PADUA score 10 had a 6-fold risk of ischemic time 25 minutes (p 0.002). CONCLUSIONS: our study confirms that PADUA score can reliably predict risk complication and ischemic time in patients treated with NSS, independently from the extra or transperitoneal approach. PADUA classification can help the selection of patients who may benefit from additional techniques such as hypothermic procedure.