Ve Subjects Research Articles

Albuterol Administration Is Commonly Associated With Increases in Serum Lactate in Patients With Asthma Treated for Acute Exacerbation of Asthma

Controversy exists around the incidence and cause of hyperlactatemia during asthma exacerbations. We evaluated the incidence, potential causes, and adverse events of hyperlactatemia in patients with acute asthma exacerbation. This study was a subanalysis of subjects receiving placebo from a prospective, randomized trial evaluating an IV b -adrenergic agonist in acute asthma exacerbation. Plasma albuterol, serum lactate, and bicarbonate concentrations were measured at baseline and 1.25 h, and dyspnea score and spirometry were measured at baseline and hourly for 3 h. All subjects had a therapeutic trial comprising 5 to 15 mg nebulized albuterol, 0.5 to 1 mg nebulized ipratropium, and at least 50 mg oral prednisone or its equivalent prior to initiation of the study. Following randomization, subjects were treated with continued albuterol and IV magnesium at the discretion of their treating physician. Subjects were followed to hospital admission or discharge with follow-up at 24 h and 1 week. One hundred seventy-fi ve subjects were enrolled in the parent trial, with 84 in the placebo group. Sixty-fi ve had complete data. Mean SD albuterol administration prior to baseline was 12.3 5.3 mg. Mean baseline lactate was 18.5 8.4 mg/dL vs 26.5 11.8 mg/dL at 1.25 h ( P , .001). Forty-fi ve subjects (69.2%) had hyperlactatemia. Mean baseline bicarbonate level was 22.6 2.9 mEq/L vs 21.9 4.0 mEq/L at 1.25 h ( P 5 .11). Plasma albuterol concentration correlated with lactate concentration ( b 5 0.45, P , .001) and maintained a significant association after adjusting for asthma severity ( b 5 0.41, P 5 .001). Hyperlactatemia did not increase the risk of hospitalization or relapse ( P 5 .26) or was associated with lower FEV 1 % predicted at 3 h ( P 5 .54). Plasma albuterol was significantly correlated with serum lactate concentration after adjusting for asthma severity. Hyperlactatemia was not associated with poorer pulmonary function as measured by 3-h FEV 1 % predicted or increased hospitalization or relapse at 1 week.

The prevalence of PFS and prevalence and characteristics of reported food allergy; a survey of UK adults aged 18–75 incorporating a validated PFS diagnostic questionnaire

Pollen-food syndrome (PFS), a food allergy affecting pollen-sensitized individuals, is likely to be the most prevalent food allergy in adults, estimated to affect 50-90% of people allergic to birch tree pollen. A validated PFS diagnostic questionnaire (PFSDQ2) was used to determine the prevalence of PFS and also to characterize those who report reactions to foods. Five UK General practices each sent the PFSDQ2 by post to 2000 patients aged 18-75 years randomly selected from their practice database. The validated questionnaire was accompanied by an additional set of questions to ascertain the demographic of the population, the foods involved and the age of onset. There were 3590 subjects who returned completed questionnaires, with an average return rate from each practice of 36% (range 22-47%). Of these, 73 were diagnosed with PFS according to the questionnaire (PFS+ve) giving a population prevalence of 2%. A further 482 subjects reported reactions to foods but did not fulfil the diagnostic criteria for PFS. The greatest prevalence of PFS was in the Croydon (SE England) urban practice (4.1%) and the lowest in the Aberdeen (Scotland) urban practice (0.8%) (P < 0.001).The most frequently reported trigger foods were apples, hazelnuts and kiwifruit and the majority of those with PFS first experienced symptoms below the age of 20 years. PFS+ve subjects were also more likely to be female and have a higher socio-economic status than those who did not report reactions to foods. The UK prevalence of PFS was 2%, although this varied according to the location of the practice population. The majority of PFS+ve subjects first reported symptoms in their teens. The reported age of onset has important implications for the diagnosis of primary and cross-reactive peanut and tree nut allergies in teenagers and young adults. The continuing rise in aeroallergen sensitization is likely to result in an increased frequency of PFS presenting in both primary and secondary care.

Long-term HIV infection and antiretroviral therapy are associated with bone microstructure alterations in premenopausal women

We evaluated the influence of long-term HIV infection and its treatment on distal tibia and radius microstructure. Premenopausal eumenorrheic HIV-positive women displayed trabecular and cortical microstructure alterations, which could contribute to increased bone fragility in those patients. Bone fragility is an emerging issue in HIV-infected patients. Dual-energy X-ray absorptiometry (DXA) quantified areal bone mineral density (BMD) predicts fracture risk, but a significant proportion of fracture risk results from microstructural alterations. We studied the influence of long-term HIV infection on bone microstructure as evaluated by high-resolution peripheral quantitative computed tomography (HR-pQCT) in 22 HIV-positive (+ve) premenopausal eumenorrheic women and 44 age- and body mass index (BMI)-matched HIV-negative (-ve) controls. All subjects completed questionnaires regarding calcium/protein intakes and physical activity, and underwent DXA and HR-pQCT examinations for BMD and peripheral skeleton microstructure, respectively. A risk factor analysis of tibia trabecular density using linear mixed models was conducted. In HIV+ve women on successful antiretroviral therapy (undetectable HIV-RNA, median CD4 cell count, 626), infection duration was 16.5 ± 3.5 (mean ± SD) years; median BMI was 22 (IQR, 21-26) kg/m². More HIV+ve women were smokers (82 versus 50 %, p = 0.013). Compared to controls, HIV+ve women had lower lumbar spine (spine T-score -0.70 vs -0.03, p = 0.014), but similar proximal femur BMD. At distal tibia, HIV+ve women had a 14.1 % lower trabecular density and a 13.2 % reduction in trabecular number compared to HIV-ve women (p = 0.013 and 0.029, respectively). HR-pQCT differences in distal radius were significant for cortical density (-3.0 %; p = 0.029). Compared with HIV-ve subjects, premenopausal HIV+ve treated women had trabecular and cortical bone alterations. Adjusted analysis revealed that HIV status was the only determinant of between group tibia trabecular density differences. The latter could contribute to increased bone fragility in HIV+ve patients.

Neurochemistry of Schizophrenia: The Contribution of Neuroimaging Postmortem Pathology and Neurochemistry in Schizophrenia

The advent of molecular neuroimaging has greatly impacted on understanding the neurochemical changes occurring in the CNS from subjects with psychiatric disorders, especially schizophrenia. This review focuses on the outcomes from studies using positron emission tomography and single photon emission computer tomography that have measure levels of neurotransmitter receptors and transporters in the CNS from subjects with schizophrenia. One outcome from such studies is the confirmation of a number of findings using postmortem tissue, but in the case of neuroimaging, using drug na�ve and drug free subjects. These findings add weight to the argument that findings from postmortem studies are not an artifact of tissue processing or a simple drug effect. However, there are some important unique findings from studies using neuroimaging studies. These include evidence to suggest that in schizophrenia there are alterations in dopamine synthesis and release, which are not accompanied by an appropriate down-regulation of dopamine D2 receptors. There are also data that would support the notion that decreased levels of serotonin 2A receptors may be an early marker of the onset of schizophrenia. Whilst there is a clear need for on-going development of neuroimaging ligands to expand the number of targets that can be studied and to increase cohort sizes in neuroimaging studies to give power to the analyses of the resulting data, current studies show that existing neuroimaging studies have already extended our understanding of the underlying pathophysiology of psychiatric disorders such as schizophrenia.

Cytokine Responses to Novel Antigens in an Indian Population Living in an Area Endemic for Visceral Leishmaniasis

BackgroundThere are no effective vaccines for visceral leishmaniasis (VL), a neglected parasitic disease second only to malaria in global mortality. We previously identified 14 protective candidates in a screen of 100 Leishmania antigens as DNA vaccines in mice. Here we employ whole blood assays to evaluate human cytokine responses to 11 of these antigens, in comparison to known defined and crude antigen preparations.MethodsWhole blood assays were employed to measure IFN-γ, TNF-α and IL-10 responses to peptide pools of the novel antigens R71, Q51, L37, N52, L302.06, J89, M18, J41, M22, M63, M57, as well as to recombinant proteins of tryparedoxin peroxidase (TRYP), Leishmania homolog of the receptor for activated C kinase (LACK) and to crude soluble Leishmania antigen (SLA), in Indian patients with active (n = 8) or cured (n = 16) VL, and in modified Quantiferon positive (EHC+ve, n = 20) or modified Quantiferon negative (EHC−ve, n = 9) endemic healthy controls (EHC).ResultsActive VL, cured VL and EHC+ve groups showed elevated SLA-specific IFN-γ, but only active VL patients produced IL-10 and EHC+ve did not make TNF-α. IFN-γ to IL-10 and TNF-α to IL-10 ratios in response to TRYP and LACK antigens were higher in cured VL and EHC+ve exposed individuals compared to active VL. Five of the eleven novel candidates (R71, L37, N52, J41, and M22) elicited IFN-γ and TNF-α, but not IL-10, responses in cured VL (55–87.5% responders) and EHC+ve (40–65% responders) subjects.ConclusionsOur results are consistent with an important balance between pro-inflammatory IFNγ and TNFγ cytokine responses and anti-inflammatory IL-10 in determining outcome of VL in India, as highlighted by response to both crude and defined protein antigens. Importantly, cured VL patients and endemic Quantiferon positive individuals recognise 5 novel vaccine candidate antigens, confirming our recent data for L. chagasi in Brazil, and their potential as cross-species vaccine candidates.

Impact of Hepatitis C Virus Infection on the in-Hospital Mortality of Patients with Alcoholic Hepatitis

Background and Aim: There is limited data on the impact of hepatitis C virus (HCV) infection on alcoholic hepatitis (AH). The present study was performed to assess the effect of HCV on inhospital mortality of AH. Methods: Using Nationwide Inpatient Sample (1998-2007), AH admissions were stratified based on the presence or absence of HCV. Results: Of 111,726 AH admissions, 7,240 (6.5%) were HCV +ve. These patients were different from HCV -ve subjects in age, race, Charlston Comorbidity index, pay source, hospital characteristics, complications, and interventions needed. In-hospital mortality from AH was higher in presence of HCV (3.8% vs. 3.1%; P=0.001). On multivariate logistic regression, HCV infection independently predicted in-hospital mortality of AH after controlling for other variables including calendar year [OR 1.29 (CI: 1.12-1.49; P=0.0005)]. Other strong predictors were hepatic encephalopathy and renal failure. Conclusion: Concomitant HCV infection is an important risk factor for in-hospital mortality in AH. Further studies with longer follow up are needed to assess the impact of HCV on AH patients at 6 months and at one year.

Hepatitis B Virus Infection in Human Immunodeficiency Virus Infected Southern African Adults: Occult or Overt – That Is the Question

Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) share transmission routes and are endemic in sub-Saharan Africa. The objective of the present study was to use the Taormina definition of occult HBV infection, together with stringent amplification conditions, to determine the prevalence and characteristics of HBV infection in antiretroviral treatment (ART)-naïve HIV+ve adults in a rural cohort in South Africa. The presence of HBV serological markers was determined by enzyme linked immunoassay (ELISA) tests. HBV DNA-positivity was determined by polymerase chain reaction (PCR) of at least two of three different regions of the HBV genome. HBV viral loads were determined by real-time PCR. Liver fibrosis was determined using the aspartate aminotransferase-to-platelet ratio index. Of the 298 participants, 231 (77.5%) showed at least one HBV marker, with 53.7% HBV DNA−ve (resolved) and 23.8% HBV DNA+ve (current) [8.7% HBsAg+ve: 15.1% HBsAg−ve]. Only the total number of sexual partners distinguished HBV DNA+ve and HBV DNA−ve participants, implicating sexual transmission of HBV and/or HIV. It is plausible that sexual transmission of HBV and/or HIV may result in a new HBV infection, superinfection and re-activation as a consequence of immunesuppression. Three HBsAg−ve HBV DNA+ve participants had HBV viral loads <200 IU/ml and were therefore true occult HBV infections. The majority of HBsAg−ve HBV DNA+ve participants did not differ from HBsAg+ve HBV DNA+ve (overt) participants in terms of HBV viral loads, ALT levels or frequency of liver fibrosis. Close to a quarter of HIV+ve participants were HBV DNA+ve, of which the majority were HBsAg−ve and were only detected using nucleic acid testing. Detection of HBsAg−ve HBV DNA+ve subjects is advisable considering they were clinically indistinguishable from HBsAg+ve HBV DNA+ve individuals and should not be overlooked, especially if lamivudine is included in the ART.

성능중심의 건설VE 대상 선정 프로세스 개발 및 검증

The current VE activity is recognizing the VE object selection in job-plan simply as formal procedure. Therefore, many problems are happening in the process of selecting VE object during the preparatory stage. As a result of trying to analysis problems through literature review and expert interview, the problems were surveyed such as the lack of connectivity between preparatory stage and analytical stage, the temporal cost-based restrictions, and lack of recognition in VE team members in the existing method of selecting subjects centering on the high-cost field. Accordingly, this study suggested the improved method of selecting VE objects in order to solve this problem in the stage of selecting VE objects. An improvement method of selecting VE objects is what selects the secondary VE subjects by applying again Fish-Bone diagram and Worth technique based on the primary VE objects, which were selected by the conventional technique of selecting objects in the high-cost field. To verify effectiveness in the proposed improvement method, it tried to apply it to the actual case of the road construction VE project. As result of, the improvement method was analyzed to be considerably effective in comparison with the existing selection method of VE objects. Therefore, the Improvement method will contribute to increasing the VE performance.

PWE-082 Are screen tested FOBt +ve subjects found to have colorectal cancer asymptomatic?

IntroductionThe National Bowel Cancer Screening Programme (NHSBCSP) aims to reduce mortality from bowel cancer in a defined population, by detecting cancer in asymptomatic individuals between 60 and 74 years. Current...

Placental malaria prevalence of infestation amongst febrile pregnant women in central India: maternal and perinatal outcome.

To determine the prevalence and impact of placental malaria on maternal and fetal outcome. Cross sectional observational. The Department of Obstetrics of Government NSCB Medical College Hospital, Jabalpur (Madhya Pradesh). Five hundred parturient women with fever or history of fever during the present pregnancy. Subjects were tested for peripheral and placental malaria by thick and thin smear examination. Maternal and perinatal outcome correlated with malaria results. The mean age of the studied subjects was 24.5±2.6years, 60.6% were primigravida, 87.2% had unsatisfactory antenatal care. 89.2% were not using effective malaria prevention measures. Peripheral smear positivity for malaria was detected in 1.8% subjects and placental malaria positivity in 2.2% subjects. The mean Hb was lower in malaric subjects (χ(2)=14.47, p<0.05). Maternal mortality and prematurity was significantly higher in malaria +ve subjects (p<0.001). The mean birth weight in malaria +ve subjects was significantly less (p<0.001). Poor 5min APGAR (p<0.0001) and perinatal mortality (p<0.05) was significantly more common in malaria +ve subjects. Malaria, particularly placental infestation with malarial parasites significantly increases maternal and perinatal morbidity and mortality.

A Novel Immunodominant CD8+ T Cell Response Restricted by a Common HLA-C Allele Targets a Conserved Region of Gag HIV-1 Clade CRF01_AE Infected Thais

BackgroundCD8+ T cell responses play an important role in the control of HIV-1. The extensive sequence diversity of HIV-1 represents a critical hurdle to developing an effective HIV-1 vaccine, and it is likely that regional-specific vaccine strains will be required to overcome the diversity of the different HIV-1 clades distributed world-wide. Unfortunately, little is known about the CD8+ T cell responses against CRF01_AE, which is responsible for the majority of infections in Southeast Asia.Methodology/Principal FindingsTo identify dominant CD8+ T cell responses recognized in HIV-1 clade CRF01_AE infected subjects we drew upon data from an immunological screen of 100 HIV-1 clade CRF01_AE infected subjects using IFN-gamma ELISpot to characterize a novel immunodominant CD8+ T cell response in HIV-1 Gag restricted by HLA-Cw*0102 (p24, 277YSPVSILDI285, YI9). Over 75% of Cw*0102+ve subjects targeted this epitope, representing the strongest response in more than a third of these individuals. This novel CD8 epitope was located in a highly conserved region of HIV-1 Gag known to contain immunodominant CD8 epitopes, which are restricted by HLA-B*57 and -B*27 in clade B infection. Nonetheless, viral escape in this epitope was frequently observed in Cw*0102+ve subjects, suggestive of strong selection pressure being exerted by this common CD8+ T cell response.Conclusions/SignificanceAs HLA-Cw*0102 is frequently expressed in the Thai population (allelic frequency of 16.8%), this immunodominant Cw*0102-restricted Gag epitope may represent an attractive candidate for vaccines specific to CRF01_AE and may help facilitate further studies of immunopathogenesis in this understudied HIV-1 clade.

Greater white and grey matter changes associated with early cannabis use in adolescent-onset schizophrenia (AOS)

Background Cannabis use is associated with a higher risk of schizophrenia, however, its specific long-term effect on the structure of the brain of adolescent-onset schizophrenic patients remains unclear. Aims To study cognitive and structural (grey and white matter) changes in patients with adolescent-onset schizophrenia (AOS) with early cannabis use (CAN+ve) (more than 3 times/week for at least 6 months) and without cannabis use (CAN−ve) versus controls. Method An optimised voxel-based morphometry (VBM) and diffusion tensor imaging (DTI) MRI study of 32 adolescents with DSM IV schizophrenia—16 CAN+ve and 16 CAN−ve, and 28 healthy adolescents. Results Compared to CAN−ve subjects, CAN+ve subjects showed GM density loss in temporal fusiform gyrus, parahippocampal gyrus, ventral striatum, right middle temporal gyrus, insular cortex, precuneus, right paracingulate gyrus, dorsolateral prefrontal cortex, left postcentral gyrus, lateral occipital cortex and cerebellum. Similar group comparison showed decreased fractional anisotropy (FA) in particular in brain stem, internal capsule, corona radiata, superior and inferior longitudinal fasciculus in CAN+ve patients. No cognitive differences were apparent between CAN+ve and CAN−ve subjects, and both were impaired relative to controls. Conclusion Cannabis use in early adolescence increases WM and GM deficits in AOS, but does not appear to increase the cognitive deficit associated with this illness.

Low Prevalence of Hepatitis B and Hepatitis C Infection in Western India

© 2011, INASL 11 Conclusion: The prevalence of positive serological markers for HBV and HCV was as per the national prevalence. Conflict of Interest: None Oral Plenary Session Detection of Diagnosis Escape Variants of Hepatitis B Virus-impact on Viral Load P Balkumar Reddy*, RM Mukherjee*, J Aparna*, PN Rao**, S Mitnala*, R Gupta**, DN Reddy** *Asian Health Care Foundation, **Asian Institute of Gastroenterology, Somajiguda, Hyderabad, India Background/Objective: Hepatitis B virus (HBV) DNA in serum is measured by real time polymerase chain reaction (PCR) assay as viral load—a marker in guided antiviral therapy. Being quasispecies in nature, HBV produce replication variants, which whether escape detection by the commercially used diagnostic PCR assays and thus alter the burden of viral load has not been elucidated. We evaluated an in-house nested PCR assay to detect diagnosis escape variants (DEV) of HBV undetected by commercially available real time PCR assay. Methods: Sera of HBsAg +ve subjects (n = 178) were screened for HBV DNA by a commercially available real time TaqMan based PCR and an in-house nested PCR assay followed by direct sequencing and densitometric quantification of amplicons to obtain viral load. Serum ALT, hepatitis B virus e antigen (HBeAg) and antibody (anti-HBe) status were evaluated by standard biochemical and ELISA procedures. Result: The in-house assay detected 80% of real time PCR positive samples of which, 79.7% had single band (858 bp) and 20.3% showed mixed type (858 bp ± 192 bp). Among 70 real time PCR negative subjects, 5.7% were positive by the in-house assay having 192 bp amplicon containing A1762T and G1764A mutations with variable viral load. Conclusion: Viral load estimated on 858 bp product only showed conformity with real time assay while inclusion of 192 bp product increased the total viral load which might have significance in determining rapid or sustained virological response (RVR/SVR) in treated subjects. Detection of DEV, particularly in real time PCR negative subjects, warrant customization of the in-house assay to real time format for better diagnosis and management of HBV infection. Conflict of Interest: None Low Prevalence of Hepatitis B and Hepatitis C Infection in Western India D Amarapurkar*, N Patel** *Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India **Jivandeep Hospital, Anand, Gujarat, India Introduction: Prevalence rates of hepatitis B viral infection (HBV) in India vary from 3% to 12%, which falls in intermediate prevalence zone. Prevalence of hepatitis C viral infection (HCV) in India varies from 0.3% to 4% among blood donor population. Previous data from western India suggests HBV prevalence of 1.6–5.9% and HCV prevalence of 0.2–15.9%. Most of these data are almost 10 years old, and most are based on select population. We aimed to study HBV and HCV recent prevalence from multiple sources. Methods: Data on prevalence of HBV and HCV was collected prospectively from multiple sources like: general population, blood donor population, hospital attending population, and liver clinic population. Results: HBV prevalence was as follows: general population data: 166/17581 (0.94%); blood donor data: 2039/172316 (1.18%); hospital attending population: 133/13177 (1%); liver clinic data: 2637/12251 (21.5%). HCV prevalence was as follows: general population: 1/2388 (0.04%); blood donor data: 666/171306 (0.38%); hospital attending population: 12/2597 (0.46%); liver clinic data: 916/12251 (7.4%). Conclusion: In Western India, there is very low prevalence of HBV and HCV; making it a low prevalence area. Conflict of Interest: None 03_JCEH-Abstract.indd 11 3/18/2011 11:13:03 AM

Detection of Diagnosis Escape Variants of Hepatitis B Virus-impact on Viral Load

© 2011, INASL 11 Conclusion: The prevalence of positive serological markers for HBV and HCV was as per the national prevalence. Conflict of Interest: None Oral Plenary Session Detection of Diagnosis Escape Variants of Hepatitis B Virus-impact on Viral Load P Balkumar Reddy*, RM Mukherjee*, J Aparna*, PN Rao**, S Mitnala*, R Gupta**, DN Reddy** *Asian Health Care Foundation, **Asian Institute of Gastroenterology, Somajiguda, Hyderabad, India Background/Objective: Hepatitis B virus (HBV) DNA in serum is measured by real time polymerase chain reaction (PCR) assay as viral load—a marker in guided antiviral therapy. Being quasispecies in nature, HBV produce replication variants, which whether escape detection by the commercially used diagnostic PCR assays and thus alter the burden of viral load has not been elucidated. We evaluated an in-house nested PCR assay to detect diagnosis escape variants (DEV) of HBV undetected by commercially available real time PCR assay. Methods: Sera of HBsAg +ve subjects (n = 178) were screened for HBV DNA by a commercially available real time TaqMan based PCR and an in-house nested PCR assay followed by direct sequencing and densitometric quantification of amplicons to obtain viral load. Serum ALT, hepatitis B virus e antigen (HBeAg) and antibody (anti-HBe) status were evaluated by standard biochemical and ELISA procedures. Result: The in-house assay detected 80% of real time PCR positive samples of which, 79.7% had single band (858 bp) and 20.3% showed mixed type (858 bp ± 192 bp). Among 70 real time PCR negative subjects, 5.7% were positive by the in-house assay having 192 bp amplicon containing A1762T and G1764A mutations with variable viral load. Conclusion: Viral load estimated on 858 bp product only showed conformity with real time assay while inclusion of 192 bp product increased the total viral load which might have significance in determining rapid or sustained virological response (RVR/SVR) in treated subjects. Detection of DEV, particularly in real time PCR negative subjects, warrant customization of the in-house assay to real time format for better diagnosis and management of HBV infection. Conflict of Interest: None Low Prevalence of Hepatitis B and Hepatitis C Infection in Western India D Amarapurkar*, N Patel** *Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India **Jivandeep Hospital, Anand, Gujarat, India Introduction: Prevalence rates of hepatitis B viral infection (HBV) in India vary from 3% to 12%, which falls in intermediate prevalence zone. Prevalence of hepatitis C viral infection (HCV) in India varies from 0.3% to 4% among blood donor population. Previous data from western India suggests HBV prevalence of 1.6–5.9% and HCV prevalence of 0.2–15.9%. Most of these data are almost 10 years old, and most are based on select population. We aimed to study HBV and HCV recent prevalence from multiple sources. Methods: Data on prevalence of HBV and HCV was collected prospectively from multiple sources like: general population, blood donor population, hospital attending population, and liver clinic population. Results: HBV prevalence was as follows: general population data: 166/17581 (0.94%); blood donor data: 2039/172316 (1.18%); hospital attending population: 133/13177 (1%); liver clinic data: 2637/12251 (21.5%). HCV prevalence was as follows: general population: 1/2388 (0.04%); blood donor data: 666/171306 (0.38%); hospital attending population: 12/2597 (0.46%); liver clinic data: 916/12251 (7.4%). Conclusion: In Western India, there is very low prevalence of HBV and HCV; making it a low prevalence area. Conflict of Interest: None 03_JCEH-Abstract.indd 11 3/18/2011 11:13:03 AM

Persistency of Priors-Induced Bias in Decision Behavior and the fMRI Signal

It is well known that people take advantage of prior knowledge to bias decisions. To investigate this phenomenon behaviorally and in the brain, we acquired fMRI data while human subjects viewed ambiguous abstract shapes and decided whether a shape was of Category A (smoother) or B (bumpier). The decision was made in the context of one of two prior knowledge cues, 80/20 and 50/50. The 80/20 cue indicated that upcoming shapes had an 80% probability of being of one category, e.g., B, and a 20% probability of being of the other. The 50/50 cue indicated that upcoming shapes had an equal probability of being of either category. The ideal observer would bias decisions in favor of the indicated alternative at 80/20 and show zero bias at 50/50. We found that subjects did bias their decisions in the predicted direction at 80/20 but did not show zero bias at 50/50. Instead, at 50/50 the subjects retained biases of the same sign as their 80/20 biases, though of diminished magnitude. The signature of a persistent though diminished bias at 50/50 was also evident in fMRI data from frontal and parietal regions previously implicated in decision-making. As a control, we acquired fMRI data from naïve subjects who experienced only the 50/50 stimulus distributions during both the pre-scan training and the fMRI experiment. The behavioral and fMRI data from the naïve subjects reflected decision biases closer to those of the ideal observer than those of the prior knowledge subjects at 50/50. The results indicate that practice making decisions in the context of non-equal prior probabilities biases decisions made later when prior probabilities are equal. This finding may be related to the “anchoring and adjustment” strategy described in the psychology, economics, and marketing literatures, in which subjects adjust a first approximation response – the “anchor” – based on additional information, typically applying insufficient adjustment relative to the ideal observer.

Discriminating the biological motion of animals

Research into biological motion perception has revealed that the human visual system is sensitive to the movement patterns created by both humans and non-human animals when locomoting. In order to further assess the ability of the human visual system to detect the biological motion of animals with different locomotory patterns, observers were required to discriminate between point light displays depicting an animal in motion and point light displays containing dots moving in ways constrained by the properties present in the biological motion displays, but containing no biological motion themselves. Initial results indicated that naA¯ ve subjects could accurately discriminate between the displays containing biological motion and those containing motion of a non-biological nature. In order to assess this effect further, a second experiment was carried out to investigate the ability of naA¯ve observers to discriminate between biological and non-biological point light displays as a) a function of random punctate visual interference density and b) a function of stimulus duration. To allow further investigation into how biological motion information concerning animals might be utilised by the visual system in naturalistic situations, subjects were tested for simple animal phobias in order to assess whether those subjects with a high fear of certain target animals (snakes and spiders, chosen for the sake of general prevalence of fear) would be able to distinguish the target animal from non-biological trials in the presence of a) greater density of noise and b) shorter stimulus duration. Results indicated that noise density had a significant effect on discrimination performance for both groups even at the lowest level.

A Review of HIV Related Burkitt's Lymphoma/Leukemia in Sub Saharan Africa.

Abstract 5016 IntroductionBurkitt's malignancies have increased substantially in frequency In HIV infected patients regardless of CD4 count. There is limited information about the clinical presentation and outcome of adult HIV+ patients with Burkitt's malignancies (BM) outside the endemic areas of Africa. MethodsPatients with histologically confirmed BM were treated with antiretroviral medication and intense, anthracycline containing combinations (HyperC-VAD, COP-ADM). A retrospective review of the clinical characteristics and prognostic factors relevant for outcome was conducted comparing to an HIV –ve cohort. ResultsBetween 1999 and 2009, 32 HIV positive patients and 9 HIV negative individuals with Burkitt's malignancy were referred to a single centre. The median age was 33 (13-61) years, 19 were female; 18 patients had leukemia while 23 patients had Burkitt's lymphoma. Extranodal disease was seen in 16 patients, the presentation serum median LDH was 1902 (292-45100) i.u., CNS disease was present in 7. In the HIV+ population, the median presentation CD4 count was 193 (10-967)/uL, 18% were on HAART prior to diagnosis but in the majority the malignancy led to the initial presentation. Of the 32 HIV+ve subjects who received intense cytotoxic therapy, at median follow up of 261 (146-2564) days, 14 (44%) survive, 12 longer than 1 year. The main cause of death was disease progression, relapse (particularly in CNS) and opportunistic infections. Male gender (p= 0.02), nodal presentation (p= 0.01), higher Hb (p= 0.001) and platelets (p= 0.03) predicted for better outcome. Cox analysis confirmed that male gender (p= 0.03), lower LDH (p= 0.02), and nodal presentation (p=0.03) were independent factors for survival. Non parametric statistics showed that HIV-ve Burkitt's patients were predominantly male (p= 0.01), Caucasian (p= 0.02), had significantly higher presentation serum albumin (p= 0.01) and lower creatinine (p= 0.02). In the HIV-ve group 78% survive longer than 1 year (log Rank p= 0.01). ConclusionsIn South Africa there are distinct clinical differences between HIV+ve and negative patients who present with Burkitt's malignancies. While outcome in the HIV –ve population is favourable, it is significantly worse in the HIV+ve cohort. For this group, a different strategy is required to improve outcome. DisclosuresNo relevant conflicts of interest to declare.

A MCh Test Pre-post Esophageal Acidification in Detecting GER-related Asthma

The direct effect of gastro-esophageal reflux (GER) on lung function is still debated. Objective. To investigate the role of esophageal acidification in affecting airway response to MCh in GER-related versus atopic asthmatics and to assess specificity and sensitivity of events. Subjects. A total of 56 never-smoking, mild asthmatics: 27 non-atopic asthmatics and acid GER (GER+ve) and 29 atopic asthmatics without any GER (GER–ve). Methods. Each subject performed an MCh challenge in baseline (MChb), and 30 minutes after an acid drink (125 mL at pH = 2; MChac), one day apart. PD20FEV1 MChb and MChac were compared by estimating the area under the ROC curve (AU-ROC). Results. GER+ve and GER-ve subjects (well matched in baseline) had a different duration of esophageal acid contact (24-hour monitoring; pH-24h AU4), and PD20FEV1 MChac (both p < 0.001). AU-ROC was 86.3% (76% to 97%, 95%CI). Sensitivity and specificity of changes were 82.8% (72.9% to 92.7%, 95%CI) and 85.2% (75.9% to 94.5%, 95%CI), respectively. The difference in MCh threshold that maximized both the sensitivity and specificity level was 100 μ g. Conclusions. The esophageal acidification identified GER-related asthma with a good level of both sensitivity and specificity by enhancing the MCh response only in the presence of acid GER. Data are supporting the effectiveness of this procedure for clinical purposes.

De los sistemas de prefabricación cerrada a la industrialización sutil de la edifi cación: algunas claves del cambio tecnológico

The present article discusses facts as well as possible assumptions relating to the evolution of building in Europe in general and Spain in particular, and the development of the technologies used in the industrialization of construction over a long period: essentially from 1970 to date. It is, then, an overview of the events that have occasioned or affected housing construction, ranging from closed system precasting, consisting primarily in large concrete panels, to the new design and building methods that entail the use of construction components and subsystems of different origins. The paper is organized around fi ve subjects that at least partially refl ect and update contributions previously published by the author on the following: chronological evolution of the most common construction technologies used in the last three decades; changes in precast and prefabricated member production; joints as invariants in industrialized construction; the new approach to modular coordination; and the economic impact of functional elements on housing construction budgets.

Efficacy of Pre-S-containing HBV Vaccine Combined with Lamivudine in the Treatment of Chronic HBV Infection

Treatment of chronic hepatitis B (CHB) is difficult. The response rate to interferon (IFN) as well as nucleoside analogs is not more than 30% in general. While interferon has many side effects, development of resistance in most of the nucleoside analogs precludes long-term use. Both groups of drugs are most efficacious in patients who already had or develop strong cellular immunity with treatment. A pre-S2-containing vaccine was shown to enhance cellular immunity and suppress hepatitis B virus (HBV)-DNA in subjects with chronic hepatitis B. We aimed to test the efficacy of short-term use of a nucleoside analog in combination with a pre-S2-containing vaccine in patients with CHB. In this open study, 48 consecutive patients (32 males and 16 females, mean age +/- SD: 33 +/- 12 years) with CHB without cirrhosis were treated with 100 mg/day lamivudine and four weekly intramuscular injections of Genhevac B 20 mcg (six doses) for 24 weeks. While 19 patients were hepatitis B e antigen (HBeAg) positive (+ve), 29 patients were Anti-HBe/HBV-DNA +ve at the outset. Response was defined as seroconversion to anti-HBe in HBeAg +ve subjects and normalization of alanine aminotransferase (ALT) with loss of HBV-DNA in anti-HBe/HBV-DNA +ve subjects. HBeAg seroconversion occurred in 5/19 subjects (26%). Eighteen of 29 anti-HBe/HBV-DNA +ves responded. In the follow-up, while relapse was not observed in any of the patients who seroconverted, 11/18 from the anti-HBe/HBV-DNA +ve group relapsed, resulting in a sustained response (SR) rate of 24% in this group. All the relapses happened in the first 48 weeks of follow-up, with no relapse thereafter. Pretreatment high serum HBV-DNA was a strong negative predictor of sustained response (SR) in HBeAg +ve group. Pretreatment serum ALT over 2 x upper limit of normal and HBV-DNA less than 200 pg/ml appeared positive predictors. None of HBeAg +ve previous interferon failures responded. Twenty-four weeks of lamivudine and hepatitis B vaccine treatment induces SR in around 1/4 of the patients with CHB. Most of the responders had high ALT and relatively low DNA.