Emergence of adefovir-resistant mutants after reversion to YMDD wild-type in lamivudine-resistant patients receiving adefovir monotherapy

Background:  To evaluate the effect of reversion to YMDD wild-type on emergence of adefovir (ADV)-resistant mutation and antiviral activity of ADV in lamivudine (LAM)- resistant patients.
Methods:  We determined YMDD mutations and ADV-resistant mutations before and every 3 months during ADV monotherapy in 33 LAM-resistant patients using the restriction fragment mass polymorphism (RFMP) method.
Results:  Reversion to pure YMDD wild-type hepatitis B virus (HBV) occurred in 6% (2/33), 9% (3/33), 20% (4/20) and 35% (6/17) of patients after 12, 24, 36 and 48 weeks, respectively. Five (29%) patients were found to have pure YMDD mutants at 48 weeks of therapy. Among 33 patients, 4 (12%) patients developed ADV-resistant mutations at 48 weeks of therapy. Adefovir-resistant mutants emerged in all patients after reversion to YMDD wild-type HBV. The mean serum HBV reductions, evaluated at 24 weeks of therapy, were not different between patients with and without reversion to YMDD wild-type HBV (−3.1 log₁₀ copies/mL vs −3.4 log₁₀ copies/mL, P  > 0.05).
Conclusions:  ADV-resistant mutations emerged after reversion to YMDD wild-type in LAM-resistant patients who received ADV monotherapy. Thus, ADV add-on therapy may be necessary to reduce the incidence of developing ADV resistance in patients with LAM resistance.     

Distribution of dietary palm carotenes and their metabolites in the rabbit

The distributions of dietary palm carotenes and their metabolites in rabbit's plasma and organs were determined using non-aqueous reversed-phase high performance liquid chromatography and a photodiode array detector. Rabbits fed with diets enriched with palm carotenes 309 mg/kg diet were found to have the different various carotenes in varying amounts in their plasma and organ tissues, mainly in the liver and adrenal glands. Most of the supplemented α- and β-carotenes were metabolized to retinol and retinyl esters, which were mainly stored in the liver and to a lesser extent, the pancreas. Small amounts of other carotenes such as phytoene, phytofluene and ζ-carotene, were present in the rabbit's plasma and organ tissues. The contents of retinol and retinyl esters in the liver of rabbits fed diets supplemented with palm carotenes were respectively 3 and 30 times higher than that in the rabbit groups fed diets without palm carotenes. The major retinyl esters present in the organ tissues were retinyl palmitate, oleate and linoleate, whereas only retinyl palmitate and stearate were found to be in predominant in the plasma. ε-Retinyl esters, which are metabolites from α-carotene, were also found to be present in the liver and pancreas. For rabbits fed with diets enriched with palm carotenes but depleted of palm vitamin E, relatively small amounts of carotenes and retinyl esters were detected (only in the plasma and liver), indicating that vitamin E substantially affects the disposition of dietary carotenes and their metabolites in plasma and tissues of rabbits.     

Carbon dioxide embolism during transoral endoscopic thyroidectomy: A case report and literature review

The creation of the surgical space in transoral endoscopic thyroid surgery may put the anterior jugular vein at risk for injury and possibly lead to carbon dioxide (CO₂) embolism. Although rare, CO₂ embolism is potentially fatal. We report a case of a 67-year-old female who underwent transoral endoscopic thyroidectomy vestibular approach (TOETVA) for a benign thyroid disease. Intraoperatively, the anterior jugular vein was inadvertently lacerated. The end-tidal (Et)CO₂, O₂ saturation, heart rate, and blood pressure suddenly decreased. The patient eventually became asystole. Cardiopulmonary resuscitation was performed with a return of spontaneous circulation (ROSC). We successfully ligated the injured vessel and terminated the procedure. A literature review of CO₂ embolism during transoral thyroid surgery is presented, focusing on presentation, management, and prevention. Since TOETVA is still in preliminary clinical application, especially in developing countries, CO₂ embolism may not be uncommon during the initial phase of the learning curve. Surgeons and anesthesiologist should be aware of this possibility.     

Three-Dimensional Interactive and Stereotactic Human Brain Atlas of White Matter Tracts

We present a human brain atlas of white matter (WM) tracts containing 40 major tracts, which is three-dimensional (3D), segmented, labeled, interactive, stereotactic and correlated to structure and vasculature. We consider: 1) WM accuracy by correlating WM tracts to underlying neuroanatomy and quantifying them; 2) balance between realism and completeness by processing a sequence of track volumes generated for various parameters with the increasing track number to enable a tract “shape convergence”. MPRAGE and DTI in 64 directions of the same subject were acquired on 3 Tesla. The method has three steps: DTI-MPRAGE registration, 3D tract generation from DTI, to WM reconstruction from MPRAGE to parcellation into 17 components. 82 track volumes were generated for a wide spectrum of parameter values: Fractional Anisotropy threshold in [0.0125, 0.55] and trajectory angle lower than 45°,60°,65°,70°,75°,80°,85°,90°. For each tract, a sequence of track volumes was processed to create/edit contours delineating this tract to achieve its shape convergence. The parcellated tracts were grouped into commissures, associations, projections and posterior fossa tracts, and labeled following Terminologia Anatomica. To facilitate that, a dedicated tract editor is developed which processes multiple track volumes, handles tracts in three representations (tracks, contours, envelopes); provides editing/visualization simultaneously on axial, coronal, sagittal planes; enables tract labeling and coloring; and provides numerous tools (track counting, smoothing and length thresholding; representation conversion and saving; structural atlas support). A stereotactic tract atlas along with parcellated WM was developed to explore in real-time any individual tract or their groups along with surrounding neuroanatomy.     

An Examination of Gambling Behaviour in Relation to Financial Management Behaviour,Financial Attitudes,and Money Attitudes

This study was designed to examine the relationship between gambling behaviour (gambling frequency and problem gambling severity) and financial management practices (cash management, risk management, and general management), financial management attitudes, and money attitudes (materialism, achievement, budget, obsession, and anxiety) in a sample of 118 participants (45 males, 73 females) recruited from a university. The findings revealed that gambling frequency was not significantly associated with any financial management, financial attitude, or money attitude variable but that problem gambling severity was significantly positively associated with financial management attitudes and obsession and negatively associated with budget. However, problem gambling severity scores were no longer significantly correlated with these factors after controlling for demographic and socio-economic factors. It was concluded that future research evaluating multiple dimensions of practices and attitudes with reliable and valid standardised instruments in large community or clinical samples is required in order to design cognitive interventions for problem gambling that facilitate changes in general beliefs about the importance of money.