Time Trends in Causes of Death in People with HIV: Insights from the Swiss HIV Cohort Study

BACKGROUND

Advancements in access to antiretroviral therapy (ART) and human immunodeficiency virus (HIV) care have led to a decline in acquired immunodeficiency syndrome (AIDS)-related deaths among people with HIV (PWH) in Switzerland. However, data on the ongoing changes in causes of death among PWH over the past 15 years is scarce.

METHODS

We investigated all reported deaths in the Swiss HIV Cohort Study between 2005-2022. Causes of death were categorized using the Coding Causes of Death in HIV protocol. The statistical analysis included demographic stratification to identify time trends and logistic regression models to determine associated factors for the underlying cause of death.

RESULTS

In total, 1630 deaths were reported, with 23.7% of individuals assigned female at birth. Out of these deaths, 147 (9.0%) were HIV/AIDS-related, 373 (22.9%) due to non-AIDS, non-hepatic (NANH) cancers, 166 (10.2%) liver-related, and 158 (9.7%) cardiovascular-related. The median age at death increased from 45.0 [40.0,53.0] years in 2005-2007 to 61.0 [56.0,69.5] years in 2020-2022. HIV/AIDS and liver-related causes of death decreased, whereas deaths from NANH cancers increased, and cardiovascular-related deaths remained relatively stable.

CONCLUSION

The proportionally decreasing HIV/AIDS and liver-related deaths showcase the effectiveness of ART, comprehensive HIV patient care, and interventions targeting hepatitis C virus co-infection. Future research should focus on managing cancer and cardiovascular-related conditions as the new leading causes of death among PWH. Comprehensive healthcare strategies focusing on non-AIDS-related comorbidities, cancer management, and sustaining liver and cardiovascular health are needed to bridge the ongoing health disparities between PWH and the general population.

In-depth study of binary ethanol-triacetin mixtures in relation to their excellent solubilization power

A significant synergistic effect is observed when solubilizing curcumin or tetrahydrocurcumin in binary mixtures of ethanol and triacetin. The present work deals with a detailed investigation of the solvent system by means of COSMO-RS-based calculations, dynamic light scattering, small-and-wide-angle X-ray scattering, and dielectric relaxation spectroscopy. Theoretical calculations lead to the conclusion that the enhanced solubility is not primarily the result of an interaction optimum between individual surface charge densities. Scattering experiments also exclude the formation of mesoscopic structures as the main reason. However, dielectric relaxation spectra suggest that in the concentration range of 0.3 ≤ x(triacetin) ≤ 0.6, ethanol molecules are released from their living polymer ethanol network and can interact with triacetin on a molecular level. The mesoscopic aggregation, thus, decreases. The concentration range of the ethanol-triacetin complexes has a significant overlap with the range of maximum solubility of (tetrahydro)curcumin. Nevertheless, despite detailed investigations, the exact origin of the solubilization power of the solvent remains speculative.

Novel green production of natural-like vanilla extract from curcuminoids

The demand for natural vanilla extract, and vanillin in particular, by far exceeds the current production, as both the cultivation of vanilla beans and the extraction of vanillin are laborious. For this purpose, most vanillin used today is produced synthetically, contrary to the general trend toward bio-based products. The present study deals with the synthesis of nature-based vanillin, starting with the more accessible rhizomes of the plant Curcuma longa. Besides vanillin, vanillic acid and p-hydroxybenzaldehyde are synthesized that way, which are also found in the natural vanilla bean. The extraction of the curcuminoids and, finally, their conversion to the flavors are performed using visible light and food-grade chemicals only. A binary mixture of ethanol and triacetin, as well as a surfactant-free microemulsion consisting of water, ethanol, and triacetin, are investigated in this context. The results exceed the literature values for Soxhlet extraction of vanilla beans by a factor > 7.

Enforced Electronic-Donor-Acceptor Complex Formation in Water for Photochemical Cross-Coupling

The amino alcohol meglumine solubilizes organic compounds in water and enforces the formation of electron donor acceptor (EDA) complexes of haloarenes with indoles, anilines, anisoles or thiols, which are not observed in organic solvents. UV-A photoinduced electron transfer within the EDA complexes induces the mesolytic cleavage of the halide ion and radical recombination of the arenes leading, after rearomatization and proton loss to C-C or C-S coupling products. Depending on the substitution pattern selective and unique cross-couplings are observed. UV and NMR measurements reveal the importance of the assembly for the photoinduced reaction. Enforced EDA aggregate formation in water allows new activation modes for organic photochemical synthesis.

Salting-in and salting-out effects of short amphiphilic molecules: a balance between specific ion effects and hydrophobicity

Salting-in or salting-out tendencies depend on a balance between headgroup-specific ion effects and the hydrophobicity of the tail.

Continuous pH monitoring in wounds using a composite indicator dressing - A feasibility study

PURPOSE

Modern burn care strives for new means to guarantee optimised wound healing. Several studies have shown a correlation between the pH value in a (burn) wound and successful wound healing. A multitude of devices to monitor pH is available, all requiring direct wound contact and removal of the dressing for pH monitoring. The aim of this feasibility study was to create a sterile and easy to handle method for pH monitoring while simultaneously using an advanced wound dressing.

MATERIALS AND METHODS

Dressing sheets of biotechnologically generated nanofibrillar cellulose (epicite^hydro) were chemically functionalised with the indicator dye GJM-534. pH-donors with increasing pH were subsequently applied to the created indicator dressing. To investigate temporal resolution and continuous monitoring we used circular pH-donors with different pH (7 and 10) and decreasing diameters that were placed on another dressing sheet. Clinically relevant spatial resolution was checked by a wound bed simulation with small areas (8 mm) of higher pH (10) on a field of lower pH (7) and vice versa.

RESULTS

The indicator dressing showed a gradual colouring from yellow to dark orange with increasing pH in steps of 0.3. After conversion of digital pictures to greyscale values, a sigmoidal distribution with a pK_a-value of 8.4 was obtained. A ring-like pattern with alternating colour change corresponding to the pH was observed in the continuous monitoring experiment and the wound bed simulation delivered excellent local resolution.

CONCLUSION

Since the pH of a (burn) wound can have a significant influence on wound healing, a pH indicator was successfully linked to an advanced, temporary, alloplastic wound dressing material. We were able to show the possibility of pH monitoring by the dressing itself. Additional testing, including studies with large case numbers for optimisation are necessary before clinical implementation.

Chalcogenide substitution in the [2Fe] cluster of [FeFe]-hydrogenases conserves high enzymatic activity

[FeFe]-Hydrogenases efficiently catalyze the uptake and evolution of H₂ due to the presence of an inorganic [6Fe-6S]-cofactor (H-cluster). This cofactor is comprised of a [4Fe-4S] cluster coupled to a unique [2Fe] cluster where the catalytic turnover of H₂/H⁺ takes place. We herein report on the synthesis of a selenium substituted [2Fe] cluster [Fe₂{μ(SeCH₂)₂NH}(CO)₄(CN)₂]^2- (ADSe) and its successful in vitro integration into the native protein scaffold of [FeFe]-hydrogenases HydA1 from Chlamydomonas reinhardtii and CpI from Clostridium pasteurianum yielding fully active enzymes (HydA1-ADSe and CpI-ADSe). FT-IR spectroscopy and X-ray structure analysis confirmed the presence of structurally intact ADSe at the active site. Electrochemical assays reveal that the selenium containing enzymes are more biased towards hydrogen production than their native counterparts. In contrast to previous chalcogenide exchange studies, the S to Se exchange herein is not based on a simple reconstitution approach using ionic cluster constituents but on the in vitro maturation with a pre-synthesized selenium-containing [2Fe] mimic. The combination of biological and chemical methods allowed for the creation of a novel [FeFe]-hydrogenase with a [2Fe2Se]-active site which confers individual catalytic features.

Veränderungen an Vulva und Vestibulum bei Mutterkühen und Färsen in den letzten sieben Tagen vor der Geburt

Gegenstand und Ziel: Ziel dieser Untersuchung war zu überprüfen, inwiefern die Ödematisierung der Vulva, Austritt von Sekret aus der Rima vulvae unddie Veränderung der Schleimhautfarbe im Vestibulum dazu geeignet sind, bei Mutterkühen den genauen Geburtszeitpunktzu bestimmen. Weiterhin sollte die Frage beantwortetwerden,ob ein Rasse- und ein Paritätseinfluss auf diese Parameter bestehen. Material und Methoden: An 105 Tieren (10 Färsen; 95 Kühe, davon 68 Fleckvieh-Kühe und 27 Kreuzungstiere Fleckvieh x Limousin) wurden während der letzten 168 Stunden ante partum alle acht Stunden folgende Merkmale untersucht: Grad der Vulvaödematisierung, Schleimaustritt aus der Rima vulvae und Farbe der Vestibu- larschleimhaut. Ergebnisse: Alle Tiere zeigten eine ÖdematisierteVulva. DerAnteilvon Tieren mit hochgradiger Ödematisierung nahm mit nahender Geburt zu (p <0,001). Zwischen Kühen und Färsen sowie den Rassen ließ sich kein Unterschied nachweisen. Mit zeitlicher Annäherung an den Partus erhöhte sich derAn- teil der Tiere mit Schleimaustritt aus der Rima vulvae nicht (p >0,05). Die Intensitätdes Schleimaustritts war bei Kühen stärker alsbei Färsen (p < 0,05). Rasseunterschiede bestanden nicht. Statistisch signifikante Veränderungen der Schleimhautfarbe des Vestibulums konnten nicht festgestellt werden. Zwischen Kühen und Färsen und zwischen den Rassen fanden sich keine Unterschiede. Schlussfolgerung und klinische Relevanz: Der Grad der Vulvaödematisierung zeigt eine starke zeitliche Bindung zum Abkalbetermin. Sie ist jedoch nicht dazu geeignet,den Zeitpunktdes Partus genauer zu terminieren. Keine zeitliche Bindung besteht zwischen der Veränderung der Vestibularschleimhautfarbe sowie dem Austritt vonSchleimaus der Rima vulvae in der letzten Woche ante partum und dem Geburtszeitpunkt.

Artifacts in orthodontic bracket systems in cone-beam computed tomography and multislice computed tomography

OBJECTIVES

The purpose of this study was to quantify artifacts caused by different bracket systems in cone-beam computed tomography (CBCT) and multislice computed tomography (MSCT) scans.

METHODS

Orthodontic brackets of four different systems were consecutively bonded to the surface of a residual molar on a human cadaveric mandible. One MSCT system and three CBCT units were used to scan each of the four bonded brackets, in addition to obtaining a blank reference scan of the tooth surface. All datasets were registered to the reference dataset using visualization software (Analyze 11.0® by AnalyzeDirect). Artifact-related reductions in image quality were expressed in percent of theoretical maximum standard deviations (SD) obtained for the gray values of the adjacent voxels, with higher percentages correlating more pronounced artifacts.

RESULTS

Both the SD percentages for three defined line profiles and their mean values were almost invariably higher with the MSCT system than with the CBCT units. Looking into the individual SD percentages, two of the CBCT units (Pax Zenith 3D® and Picasso Trio®; both Vatech) produced higher values than the MSCT system (SOMATOM Definition AS+®; Siemens) in some line profiles. The titanium bracket, in particular, was associated with marked differences between the two scanner technologies, as the mean artifact intensities from this bracket were particularly high with the MSCT unit and relatively low with the CBCT units. The artifact intensities observed with the other three bracket systems varied widely depending on which scanner was used.

CONCLUSION

Different artifact intensities were noted depending on the composition of the bracket system and on the scanner technology (MSCT/CBCT). While the artifacts manifested themselves differently with different scanners, their adverse effects were comparable. However, given the variable severity of the artifacts observed depending on the materials scanned and the scanners used, a blanket recommendation for or against MSCT or CBCT units cannot be given on the basis of this study.

A structural view of synthetic cofactor integration into [FeFe]-hydrogenases

Crystal structures of semisynthetic [FeFe]-hydrogenases with variations in the [2Fe] cluster show little structural differences despite strong effects on activity.

[FeFe]-hydrogenases are nature's fastest catalysts for the evolution or oxidation of hydrogen. Numerous synthetic model complexes for the [2Fe] subcluster (2Fe_H) of their active site are known, but so far none of these could compete with the enzymes. The complex Fe₂[μ-(SCH₂)₂X](CN)₂(CO)₄^2– with X = NH was shown to integrate into the apo-form of [FeFe]-hydrogenases to yield a fully active enzyme. Here we report the first crystal structures of the apo-form of the bacterial [FeFe]-hydrogenase CpI from Clostridium pasteurianum at 1.60 Å and the active semisynthetic enzyme, CpI^ADT, at 1.63 Å. The structures illustrate the significant changes in ligand coordination upon integration and activation of the [2Fe] complex. These changes are induced by a rigid 2Fe_H cavity as revealed by the structure of apoCpI, which is remarkably similar to CpI^ADT. Additionally we present the high resolution crystal structures of the semisynthetic bacterial [FeFe]-hydrogenases CpI^PDT (X = CH₂), CpI^ODT (X = O) and CpI^SDT (X = S) with changes in the headgroup of the dithiolate bridge in the 2Fe_H cofactor. The structures of these inactive enzymes demonstrate that the 2Fe_H-subcluster and its protein environment remain largely unchanged when compared to the active enzyme CpI^ADT. As the active site shows an open coordination site in all structures, the absence of catalytic activity is probably not caused by steric obstruction. This demonstrates that the chemical properties of the dithiolate bridge are essential for enzyme activity.

Imaging the Parasinus Region with a Third-Generation Dual-Source CT and the Effect of Tin Filtration on Image Quality and Radiation Dose

BACKGROUND AND PURPOSE

CT is the imaging technique of choice in the evaluation of midface trauma or inflammatory disease. We performed a systematic evaluation of scan protocols to optimize image quality and radiation exposure on third-generation dual-source CT.

MATERIALS AND METHODS

CT protocols with different tube voltage (70-150 kV), current (25-300 reference mAs), prefiltration, pitch value, and rotation time were systematically evaluated. All images were reconstructed with iterative reconstruction (Advanced Modeled Iterative Reconstruction, level 2). To individually compare results with otherwise identical factors, we obtained all scans on a frozen human head. Conebeam CT was performed for image quality and dose comparison with multidetector row CT. Delineation of important anatomic structures and incidental pathologic conditions in the cadaver head was evaluated.

RESULTS

One hundred kilovolts with tin prefiltration demonstrated the best compromise between dose and image quality. The most dose-effective combination for trauma imaging was Sn100 kV/250 mAs (volume CT dose index, 2.02 mGy), and for preoperative sinus surgery planning, Sn100 kV/150 mAs (volume CT dose index, 1.22 mGy). "Sn" indicates an additional prefiltration of the x-ray beam with a tin filter to constrict the energy spectrum. Exclusion of sinonasal disease was possible with even a lower dose by using Sn100 kV/25 mAs (volume CT dose index, 0.2 mGy).

CONCLUSIONS

High image quality at very low dose levels can be achieved by using a Sn100-kV protocol with iterative reconstruction. The effective dose is comparable with that of conventional radiography, and the high image quality at even lower radiation exposure favors multidetector row CT over conebeam CT.

Cone beam computed tomography and low-dose multislice computed tomography in orthodontics and dentistry: a comparative evaluation on image quality and radiation exposure

OBJECTIVES

The goal of the present work was to assess various computed tomography (CT) systems in term of image quality and organ doses, namely five cone-beam CT (CBCT) scanners operated at standard settings and three multislice CT (MSCT) scanners operated at greatly dose-reduced settings.

MATERIALS AND METHODS

Radiographic volume scans were taken on a complete human cadaveric head specimen and the image quality of each was rated by four experienced examiners according to specific skeletal structures and bone-soft tissue interfaces. Radiation doses were captured by a head-and-neck phantom (Rando; Alderson Research Laboratories). Standard protocols were used for the CBCT scans. For the MSCT scans, tube voltage and current were adjusted to minimize radiation without compromising image quality.

RESULTS

Interobserver agreement was close to perfect, with iota coefficients of 0.931 (95% CI 0.807-0.978) between groups 1 and 2 and 0.959 (95% CI 0.869-1.000) between groups 1 and 3. Ratings of image quality in terms of skeletal-structure representation were slightly better for the CBCT than the MSCT scanners, although these differences were not statistically significant. The two groups of scanners applied considerably different organ doses: the lowest dose (0.03 mSv) was measured on the bone surface with a CBCT unit (Picasso Trio® from Vatech) and the highest dose (8.30 mSv) in the vicinity of the eye lens with another CBCT unit (3D Accuitomo 170® from J. Morita).

CONCLUSION

The various systems tested offer similar imaging quality but demonstrated distinct differences in organ dose levels. The decision on which approach to take is not between CBCT and MSCT but rather between specific models and parameter settings. If these are optimized, MSCT images providing useful clinical information can be obtained at much reduced levels of radiation. Depending on the model and setting used, MSCT radiation levels may even be lower than during CBCT scans.

Metric precision via soft-tissue landmarks in three-dimensional structured-light scans of human faces

OBJECTIVES

The goal of the current work was to investigate the suitability of ten facial soft-tissue landmarks (trichion, glabella, nasion, left and right orbital, subnasal, left and right porion, pogonion, gnathion) as reference points for metric facial analysis by analyzing their intra- and interserial precision in all three dimensions.

METHODS

The faces of 32 volunteers were scanned using a standardized protocol with a structured-light scanner (FaceSCAN(3D) Scientific Photolab 60 Hz; 3D Shape, Erlangen, Germany). Three examiners placed the landmarks twice within a 2-week interval. Image processing (Onyx Ceph(3); Image Instruments; Chemnitz, Germany) and statistical (SAS 9.2; SAS Institute, Cary, NC, USA) software was used for analysis. All measurements were corrected for mean values per patient and analyzed for intraserial and interserial error by model II ANOVA for a simple classification with random effects.

RESULTS

Median intraserial precision was 0.40 mm (range 0.05-1.01 mm) overall, including 0.40 mm (0.33-0.85 mm) on the x-axis, 0.64 mm (0.36-0.87 mm) on the y-axis, and 0.27 mm (0.05-1.01 mm) on the z-axis. Interserial precision was substantially lower at a median of 0.05 mm (0-0.22 mm), often not statistically assessable with intraserial precision. We observed no landmark-associated differences; in particular, the medians of the bilateral landmarks orbital (intraserial: 0.40 mm; interserial: 0.02 mm) and porion (intraserial: 0.36 mm; interserial: small and not assessable) were in the middle of the range of our results. Trichion (intraserial: 0.73 mm; interserial: 0.05 mm) and gnathion (intraserial: 0.87 mm; interserial: 0.20 mm) revealed the highest degrees of intraserial measurement imprecision. Outliers were identified in 1.2% (64 of 5400) of measurements.

CONCLUSION

All selected landmarks offer suitably high levels of intra- and interserial precision for the three-dimensional (3D) metric assessment of facial soft-tissue parameters. No difference between (bi)lateral and facial midline landmarks was noted.

[Cerebral venous thrombosis and subdural haematoma: complications of spontaneous intracranial hypotension]

We report on the case of a spontaneous intracranial hypotension with subdural hygroma, as well as cerebral venous thrombosis (CVT), both known complications of intracranial hypotension. The 45-year-old patient was subsequently treated - according to current guidelines for CVT - with anticoagulation, but developed subdural haematoma (SDH), which required neurosurgical treatment. Our case highlights the complex pathophysiological sequelae of intracranial hypotension, as well as the occasionally difficult treatment decisions. Subdural hygroma probably predisposes patients to SDH during anticoagulation. Thus, the potential benefit of anticoagulation needs to be weighed against the risk of SDH on an individual basis.

Three-year follow-up of a patient with early-onset Alzheimer's disease with presenilin-2 N141I mutation - case report and review of the literature

Autosomal dominant early-onset Alzheimer disease (EOAD) is a heterogeneous condition that has been associated with mutations in 3 different genes: the amyloid precursor protein (APP), presenilin 1 (PSEN1), and presenilin 2 (PSEN2) genes. Most cases are due to mutations in the PSEN1 gene, whereas mutations in the APP and PSEN2 genes are rare. Mutation analysis of the APP, PSEN1 and PSEN2 genes was performed. We herein report the case of a German EOAD patient with a family history of dementia and a missense mutation at codon 141 (N141I) of the PSEN2 gene. To our knowledge, this is the first German EOAD patient without a Volga-German ancestry and a positive family history for dementia carries the mutation PSEN-2 N141I. The patient came to our clinic for the first time when she was 47 years old. During the following 3 years, her Mini-Mental State Examination (MMSE) score dropped from 28 to 0. Mild cognitive impairment (MCI) was an early symptom that was already present during the first consultation. The concentration in cerebrospinal fluid (CSF) of tau-protein (1151 pg/ml) was increased, whereas the concentration of beta-amyloid protein (Abeta1-42) was decreased (335 pg/ml). Magnetic resonance imaging (MRI) revealed only slight changes in the early stage of the disease and positron emission tomography with (18F) fluoro-2-deoxy-D-glucose (18F-FDG PET) demonstrated glucose reduction left parietal and in the precuneus region. Follow-up MRI and 18F-FDG PET studies showed progression of atrophy of the left entorhinal cortex with relative sparing of the hippocampus and progressive hypometabolism of both temporoparietal lobes and left frontal lobe.