Week 96 efficacy and safety results of the phase 3, randomized EMERALD trial to evaluate switching from boosted-protease inhibitors plus emtricitabine/tenofovir disoproxil fumarate regimens to the once daily, single-tablet regimen of darunavir/cobicistat/emtricitabine/tenofovir alafenamide (D/C/F/TAF) in treatment-experienced, virologically-suppressed adults living with HIV-1

Darunavir/cobicistat/emtricitabine/tenofovir alafenamide (D/C/F/TAF) 800/150/200/10 mg was investigated through 96 weeks in EMERALD (NCT02269917). Virologically-suppressed, HIV-1-positive treatment-experienced adults (previous non-darunavir virologic failure [VF] allowed) were randomized (2:1) to D/C/F/TAF or boosted protease inhibitor (PI) plus emtricitabine/tenofovir-disoproxil-fumarate (F/TDF) over 48 weeks. At week 52 participants in the boosted PI arm were offered switch to D/C/F/TAF (late-switch, 44 weeks D/C/F/TAF exposure). All participants were followed on D/C/F/TAF until week 96. Efficacy endpoints were percentage cumulative protocol-defined virologic rebound (PDVR; confirmed viral load [VL] >= 50 copies/mL) and VL = 50 copies/mL (VF) (FDA-snapshot analysis). Of 1141 randomized patients, 1080 continued in the extension phase. Few patients had PDVR (D/C/F/TAF: 3.1%, 24/763 cumulative through week 96; late-switch: 2.3%, 8/352 week 52-96). Week 96 virologic suppression was 90.7% (692/763) (D/C/F/TAF) and 93.8% (330/352) (late-switch). VF was 1.2% and 1.7%, respectively. No darunavir, primary PI, tenofovir or emtricitabine resistance-associated mutations were observed post-baseline. No patients discontinued for efficacy-related reasons. Few discontinued due to adverse events (2% D/C/F/TAF arm). Improved renal and bone parameters were maintained in the D/C/F/TAF arm and observed in the late-switch arm, with small increases in total cholesterol/high-density-lipoprotein-cholesterol ratio. A study limitation was the lack of a control arm in the week 96 analysis. Through 96 weeks, D/C/F/TAF resulted in low PDVR rates, high virologic suppression rates, very few VFs, and no resistance development. Late-switch results were consistent with D/C/F/TAF week 48 results. EMERALD week 96 results confirm the efficacy, high genetic barrier to resistance and safety benefits of D/C/F/TAF

Variaciones en el porcentaje de incapacidad antes y despúes de una cirugía de artrodesis lumbar de espalda

Cirurgia lumbar; Escala Oswestry; Cures d'infermeriaCirugía lumbar; Escala Oswestry; Cuidados de enfermeríaLumbar surgery; Oswestry Disability Index; Nursing careA partir de la nostra experiència a la planta de traumatologia i les dades obtingudes mitjançant l'escala Oswestry, hem observat que els pacients sotmesos a artròdesi lumbar no presenten una millora significativa en el grau d'incapacitat després de la cirurgia. Aquesta troballa ens va portar a explorar estratègies per millorar-ne el maneig abans, durant i després de la intervenció. Considerem que l'enfocament multidisciplinari (infermeria, medicina, fisioteràpia i psicologia) combinat amb sessions prequirúrgiques i rehabilitació personalitzada pot contribuir significativament a millorar-ne els resultats. Basant-nos en aquestes troballes i literatura rellevant, proposem intervencions dirigides a promoure hàbits saludables, optimitzar el maneig del dolor i fomentar l'autonomia funcional dels pacients.Based on our experience in the trauma unit and data obtained using the Oswestry Disability Index, we have observed that patients undergoing lumbar arthrodesis do not show significant improvement in their degree of disability after surgery. This finding prompted us to explore strategies to enhance patient management before, during, and after the intervention. We propose that a multidisciplinary approach (nursing, medicine, physical therapy, and psychology) combined with pre-surgical sessions and personalized rehabilitation can significantly contribute to improved outcomes. Drawing on these findings and relevant literature, we recommend interventions aimed at promoting healthy habits, optimizing pain management, and fostering patients' functional autonomy.A partir de nuestra experiencia en la planta de traumatología y los datos obtenidos mediante la escala Oswestry, hemos observado que los pacientes sometidos a artrodesis lumbar no presentan una mejora significativa en su grado de incapacidad tras la cirugía. Este hallazgo nos llevó a explorar estrategias para mejorar su manejo antes, durante y después de la intervención. Consideramos que el enfoque multidisciplinar (enfermería, medicina, fisioterapia y psicología) combinado con sesiones prequirúrgicas y rehabilitación personalizada, puede contribuir significativamente a mejorar los resultados. Basándonos en estos hallazgos y en literatura relevante, proponemos intervenciones dirigidas a promover hábitos saludables, optimizar el manejo del dolor y fomentar la autonomía funcional de los paciente

Feasibility of hydraulic separation in a novel anaerobic-anoxic upflow reactor for biological nutrient removal

ABSTRACT : This contribution deals with a novel anaerobic-anoxic reactor for biological nutrient removal (BNR) from wastewater, termed AnoxAn. In the AnoxAn reactor, the anaerobic and anoxic zones for phosphate removal and denitrification are integrated in a single continuous upflow sludge blanket reactor, aiming at high compactness and efficiency. Its application is envisaged in those cases where retrofitting of existing wastewater treatment plants for BNR, or the construction of new ones, is limited by the available surface area. The environmental conditions are vertically divided up inside the reactor with the anaerobic zone at the bottom and the anoxic zone above. The capability of the AnoxAn configuration to establish two hydraulically separated zones inside the single reactor was assessed by means of hydraulic characterization experiments and model simulations. Residence time distribution (RTD) experiments in clean water were performed in a bench-scale (48.4 L) AnoxAn prototype. The required hydraulic separation between the anaerobic and anoxic zones, as well as adequate mixing in the individual zones, was obtained through selected mixing devices. The observed behaviour was described by a hydraulic model consisting of continuous stirred tank reactors and plug-flow reactors. The impact of the denitrification process in the anoxic zone on the hydraulic separation was subsequently evaluated through model simulations. The desired hydraulic behaviour proved feasible, involving little mixing between the anaerobic and anoxic zones (mixing flowrate 40.2% of influent flowrate) and negligible nitrate concentration in the anaerobic zone (less than 0.1 mgN L-1) when denitrification was considered

Week 96 efficacy and safety results of the phase 3, randomized EMERALD trial to evaluate switching from boosted-protease inhibitors plus emtricitabine/tenofovir disoproxil fumarate regimens to the once daily, single-tablet regimen of darunavir/cobicistat/emtricitabine/tenofovir alafenamide (D/C/F/TAF) in treatment-experienced, virologically-suppressed adults living with HIV-1

Altres ajuts: This study was sponsored by Janssen.Darunavir/cobicistat/emtricitabine/tenofovir alafenamide (D/C/F/TAF) 800/150/200/10 mg was investigated through 96 weeks in EMERALD (NCT02269917). Virologically-suppressed, HIV-1-positive treatment-experienced adults (previous non-darunavir virologic failure [VF] allowed) were randomized (2:1) to D/C/F/TAF or boosted protease inhibitor (PI) plus emtricitabine/tenofovir-disoproxil-fumarate (F/TDF) over 48 weeks. At week 52 participants in the boosted PI arm were offered switch to D/C/F/TAF (late-switch, 44 weeks D/C/F/TAF exposure). All participants were followed on D/C/F/TAF until week 96. Efficacy endpoints were percentage cumulative protocol-defined virologic rebound (PDVR; confirmed viral load [VL] ≥50 copies/mL) and VL < 50 copies/mL (virologic suppression) and ≥50 copies/mL (VF) (FDA-snapshot analysis). Of 1141 randomized patients, 1080 continued in the extension phase. Few patients had PDVR (D/C/F/TAF: 3.1%, 24/763 cumulative through week 96; late-switch: 2.3%, 8/352 week 52-96). Week 96 virologic suppression was 90.7% (692/763) (D/C/F/TAF) and 93.8% (330/352) (late-switch). VF was 1.2% and 1.7%, respectively. No darunavir, primary PI, tenofovir or emtricitabine resistance-associated mutations were observed post-baseline. No patients discontinued for efficacy-related reasons. Few discontinued due to adverse events (2% D/C/F/TAF arm). Improved renal and bone parameters were maintained in the D/C/F/TAF arm and observed in the late-switch arm, with small increases in total cholesterol/high-density-lipoprotein-cholesterol ratio. A study limitation was the lack of a control arm in the week 96 analysis. Through 96 weeks, D/C/F/TAF resulted in low PDVR rates, high virologic suppression rates, very few VFs, and no resistance development. Late-switch results were consistent with D/C/F/TAF week 48 results. EMERALD week 96 results confirm the efficacy, high genetic barrier to resistance and safety benefits of D/C/F/TAF

High‐resolution C‐isotope, TOC and biostratigraphic records of OAE 1a (Aptian) from an expanded hemipelagic cored succession, western Tethys : a new stratigraphic reference for global correlation and paleoenvironmental reconstruction

A high-resolution carbonate C-isotope stratigraphy for the Aptian is presented for the Cau core (Spain). The biostratigraphically calibrated C-isotope stratigraphy of the core is used to refine the previously defined C-isotope segments of the Aptian. Thirteen C-isotope segments have been identified and correlated, and further subdivisions are presented. Correlation with other sections worldwide demonstrates the robustness of the C-isotope stratigraphy of the Cau core. The studied succession includes a continuous record of the early Aptian Oceanic Anoxic Event (OAE 1a). Its onset has been studied at an ultrahigh-resolution scale (0.2–0.5 kyr spacing), revealing a succession of sharp δ13Ccarb negative spikes, interpreted as a record of pulses of volcanism and methane emissions. The largest spike was rapid (<10 kyr) and marks the base of OAE 1a, which occurs within a longer-term falling δ13Ccarb trend. The C-isotope profile across OAE 1a perfectly records the negative (C3/Ap3), positive (C4/Ap4), steady (C5/Ap5), and positive (C6/Ap6) segments that were defined from Cismon (Italy) and subsequently identified worldwide. The Ap7 to Ap14 segments record a C-isotope negative excursion, coupled with high TOC contents, probably related to regional paleogeography. The links with global environmental changes, episodes of widespread deposition of organic matter, and ultimately to major volcanic episodes are discussed. We propose the Cau core as a new reference section for the Aptian, and specifically for OAE 1a, based on its expanded and well-preserved sedimentary, geochemical and biotic archives, which provide further insights into the environmental and biotic changes that occurred during this time interval.Research project CGL2014-55274-P; Research Group RNM-200 (Junta de Andalucía), and University of Jaén (FEDER-UJA 1265149

Week 96 efficacy and safety results of the phase 3, randomized EMERALD trial to evaluate switching from boosted-protease inhibitors plus emtricitabine/tenofovir disoproxil fumarate regimens to the once daily, single-tablet regimen of darunavir/cobicistat/emtricitabine/tenofovir alafenamide (D/C/F/TAF) in treatment-experienced, virologically-suppressed adults living with HIV-1

Darunavir/cobicistat/emtricitabine/tenofovir alafenamide (D/C/F/TAF) 800/150/200/10 mg was investigated through 96 weeks in EMERALD (NCT02269917). Virologically-suppressed, HIV-1-positive treatment-experienced adults (previous non-darunavir virologic failure [VF] allowed) were randomized (2:1) to D/C/F/TAF or boosted protease inhibitor (PI) plus emtricitabine/tenofovir-disoproxil-fumarate (F/TDF) over 48 weeks. At week 52 participants in the boosted PI arm were offered switch to D/C/F/TAF (late-switch, 44 weeks D/C/F/TAF exposure). All participants were followed on D/C/F/TAF until week 96. Efficacy endpoints were percentage cumulative protocol-defined virologic rebound (PDVR; confirmed viral load [VL] ≥50 copies/mL) and VL &lt; 50 copies/mL (virologic suppression) and ≥50 copies/mL (VF) (FDA-snapshot analysis). Of 1141 randomized patients, 1080 continued in the extension phase. Few patients had PDVR (D/C/F/TAF: 3.1%, 24/763 cumulative through week 96; late-switch: 2.3%, 8/352 week 52–96). Week 96 virologic suppression was 90.7% (692/763) (D/C/F/TAF) and 93.8% (330/352) (late-switch). VF was 1.2% and 1.7%, respectively. No darunavir, primary PI, tenofovir or emtricitabine resistance-associated mutations were observed post-baseline. No patients discontinued for efficacy-related reasons. Few discontinued due to adverse events (2% D/C/F/TAF arm). Improved renal and bone parameters were maintained in the D/C/F/TAF arm and observed in the late-switch arm, with small increases in total cholesterol/high-density-lipoprotein-cholesterol ratio. A study limitation was the lack of a control arm in the week 96 analysis. Through 96 weeks, D/C/F/TAF resulted in low PDVR rates, high virologic suppression rates, very few VFs, and no resistance development. Late-switch results were consistent with D/C/F/TAF week 48 results. EMERALD week 96 results confirm the efficacy, high genetic barrier to resistance and safety benefits of D/C/F/TAF

Week 96 efficacy and safety results of the phase 3, randomized EMERALD trial to evaluate switching from boosted-protease inhibitors plus emtricitabine/tenofovir disoproxil fumarate regimens to the once daily, single-tablet regimen of darunavir/cobicistat/emtricitabine/tenofovir alafenamide (D/C/F/TAF) in treatment-experienced, virologically-suppressed adults living with HIV-1

Darunavir/cobicistat/emtricitabine/tenofovir alafenamide (D/C/F/TAF) 800/150/200/10 mg was investigated through 96 weeks in EMERALD (NCT02269917). Virologically-suppressed, HIV-1-positive treatment-experienced adults (previous non-darunavir virologic failure [VF] allowed) were randomized (2:1) to D/C/F/TAF or boosted protease inhibitor (PI) plus emtricitabine/tenofovir-disoproxil-fumarate (F/TDF) over 48 weeks. At week 52 participants in the boosted PI arm were offered switch to D/C/F/TAF (late-switch, 44 weeks D/C/F/TAF exposure). All participants were followed on D/C/F/TAF until week 96. Efficacy endpoints were percentage cumulative protocol-defined virologic rebound (PDVR; confirmed viral load [VL] ≥50 copies/mL) and VL < 50 copies/mL (virologic suppression) and ≥50 copies/mL (VF) (FDA-snapshot analysis). Of 1141 randomized patients, 1080 continued in the extension phase. Few patients had PDVR (D/C/F/TAF: 3.1%, 24/763 cumulative through week 96; late-switch: 2.3%, 8/352 week 52–96). Week 96 virologic suppression was 90.7% (692/763) (D/C/F/TAF) and 93.8% (330/352) (late-switch). VF was 1.2% and 1.7%, respectively. No darunavir, primary PI, tenofovir or emtricitabine resistance-associated mutations were observed post-baseline. No patients discontinued for efficacy-related reasons. Few discontinued due to adverse events (2% D/C/F/TAF arm). Improved renal and bone parameters were maintained in the D/C/F/TAF arm and observed in the late-switch arm, with small increases in total cholesterol/high-density-lipoprotein-cholesterol ratio. A study limitation was the lack of a control arm in the week 96 analysis. Through 96 weeks, D/C/F/TAF resulted in low PDVR rates, high virologic suppression rates, very few VFs, and no resistance development. Late-switch results were consistent with D/C/F/TAF week 48 results. EMERALD week 96 results confirm the efficacy, high genetic barrier to resistance and safety benefits of D/C/F/TAF