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Background: Expression of programmed death ligand 1 (PD‐L1) by cutaneous squamous cell carcinomas has been shown to correlate with advanced disease and risk of metastasis. Lymphocyte activation gene 3 (LAG‐3, or CD223) is an inhibitory receptor that interacts with the PD‐L1 axis, which has been shown to be a marker of immune exhaustion and a potential immunotherapy target. However, the role of LAG‐3 in cutaneous squamous cell carcinoma has not been established. Methods: We reviewed 18 cases of locally advanced and/or metastatic cutaneous squamous cell carcinomas and assessed for PD‐L1 expression, presence or absence of tumor‐infiltrating lymphocytes (TILs), and expression of LAG‐3 by TILs. Results: PD‐L1 expression was present in 11 of 13 locally advanced primary tumors and 5 of 5 metastases. TILs were present in all 18 tumors, of which 14 cases were positive for LAG‐3 expression. In positive cases, LAG‐3 was expressed on average by 32% of TILs. Conclusions: Advanced cutaneous squamous cell carcinomas frequently express PD‐L1 and are associated with an inflammatory response. LAG‐3 expression by TILs was identified in a majority of cases. Our findings suggest that LAG‐3 positive tumor‐associated inflammatory cells may play a role in the development of advanced disease and offer another potential target for drug therapy. [ABSTRACT FROM AUTHOR]

Diagnosis: Branchio-oculo-facial syndrome (BOFS) Clinical course and dermatopathology Cytogenetic testing revealed a normal female karyotype. Both BOR and BOFS can present with hearing loss, renal anomalies, and nasolacrimal stenosis, but BOFS can be distinguished by its characteristic facial abnormalities and skin lesions.1 CHARGE syndrome may also be considered, but it can be associated with cardiac defects and choanal atresia which are not typically found in patients with BOFS, and similarly lacks the typical facial features and skin defects of BOFS.5 DATA AVAILABILITY STATEMENT Data sharing not applicable to this article as no datasets were generated or analysed during the current study. Keywords: developmental defects; genetic diseases; mechanisms EN developmental defects genetic diseases mechanisms 929 931 3 09/01/21 20210701 NES 210701 Case Presentation A 7-month-old girl status post bilateral complete cleft lip repair presented with brightly erythematous fleshy plaques located bilaterally on the neck (Figure 1A,B). [Extracted from the article]

Acute slow breathing may have beneficial effects on cardiovascular regulation by affecting hemodynamics and the autonomic nervous system. Whether breathing at the resonance frequency (RF), a breathing rate that maximizes heart rate oscillations, induces differential effects to that of slow breathing is unknown. We compared the acute effects of breathing at either RF and RF + 1 breaths per minute on muscle sympathetic nervous activity (MSNA) and baroreflex function. Ten healthy men underwent MSNA, blood pressure (BP), and heart rate (HR) recordings while breathing for 10 min at their spontaneous breathing (SB) rate followed by 10 min at both RF and RF + 1 randomly assigned and separated by a 10‐min recovery. Breathing at either RF or RF + 1 induced similar changes in HR and HR variability, with increased low frequency and decreased high frequency oscillations (p < .001 for both). Both respiration rates decreased MSNA (−5.6 and −7.3 bursts per min for RF and RF + 1 p < .05), with the sympathetic bursts occurring more often during mid‐inspiration to early expiration (+57% and + 80%) and longer periods of silence between bursts were seen (p < .05 for RF + 1). Systolic BP was decreased only during RF (−4.6 mmHg, p < .05) but the decrease did not differ to that seen during RF + 1 (−3.1 mmHg). The sympathetic baroreflex function remained unchanged at either breathing rates. The slope of the cardiac baroreflex function was unaltered but the cardiac baroreflex efficiency was improved during both RF and RF + 1. Acute breathing at either RF or RF + 1 has similar hemodynamic and sympatho‐inhibitory effects in healthy men. [ABSTRACT FROM AUTHOR]

A corrugated web beam (CWB) is a variation to the universal hot rolled or welded I section. CWBs usually comprise of wide thick plate flanges and a thin corrugated web. Due to the accordion effect shear is carried primarily by the corrugated web while bending moments are resisted by the flanges. Under shear action three different modes of shear buckling may be realised in the web – local, global or interactive. This paper describes analyses performed to investigate the local shear buckling behaviour of beams with trapezoidal corrugated webs. Finite element models of cantilever beams with different web geometries were prepared and an elastic eigenvalue buckling analysis was performed using the program ABAQUS. The influence of web thickness, panel width and web height on the local shear buckling coefficient k L was investigated. Values of k L were compared against existing equations from theory and other research. The effect of these dimensions on the local shear buckling stress was also considered. In total, 90 models were analysed. Overall, it was found that the value of k L lies between 5.34 and 8.98. This corresponds to panel boundary conditions that are between simply supported and clamped. The analysis results revealed that k L increases with stockier panels (large panel width to height ratio) but decreases with thicker webs. When the panel width was decreased, local shear buckling occurred at larger stress values. Similar results were observed when the web height was decreased and the panel thickness was increased. These results are consistent with plate buckling theory. Finally, based on these findings an equation to approximate the local shear buckling coefficient in corrugated web beams is recommended. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated the influence of distance on self-selected pacing during the swim, cycle and run disciplines of sprint, Olympic and half-Ironman (HIM) distance triathlon races. Method: Eight trained male triathletes performed the three individual races in <2 months. Participants' bikes were fitted with Schoberer Rad Meßtechnik to monitor speed, power output and heart rate during the cycle discipline. Global positioning system was worn to determine speed and heart rate during the swim and run disciplines. Result: An even swim pacing strategy was adopted across all distances. A more stochastic pacing was observed during the HIM cycle [standard deviation of exposure variation analysis (EVA) = 3.21 ± 0.61] when compared with the sprint cycle discipline (EVA = 3.84 ± 0.44, p = 0.018). Only 20.9 ± 4.1 % of the cycling time was spent more than 10 % above the mean power output in the HIM, compared with 43.8 ± 2.9 % ( p = 0.002) and 37.7 ± 11.1 % ( p = 0.039) during the sprint and Olympic distance triathlons, respectively. Conversely, 13.6 ± 5.1 % of the cycling time was spent 5-10 % below the mean power output during the HIM, compared with 5.9 ± 1.2 % ( p = 0.034) and 8.0 ± 5.1 % ( p = 0.045) during the sprint and Olympic distance triathlons, respectively. A negative pacing strategy was adopted during the sprint distance run, compared with positive pacing strategy during the Olympic and HIM. Conclusion: Results of this study suggest that pacing strategies during triathlon are highly influenced by distance and discipline, and highlight the importance of developing pacing strategies based on distance, strengths and individual fitness. [ABSTRACT FROM AUTHOR]

Depression is a major determinant of Health Related Quality of Life in PD, but there is limited data on physician recognition of depression and treatment efficacy. We used data obtained from the QII dataset of the National Parkinson's Foundation database to determine whether there was an association between depressive symptoms and utilization of antidepressants and/or mental health services (MHS) in a large cohort of PD patients. We found that prevalence of depressive symptoms remained high in the PD population despite improved physician recognition and treatment initiation. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to examine the influence of age on cycling efficiency and sprint power output in well-trained endurance masters athletes. Methods: The investigation was conducted on 60 healthy well-trained triathletes separated into six separate groups ( n = 10) depending on age: 20-29 years old; 30-39 years old; 40-49 years old; 50-59 years old; 60-69 years old; 70 years old. Each participant attended the laboratory on three separate occasions to perform (1) an incremental cycling test, (2) maximal peak sprint power test, involving three 5-s sprint efforts (3) and a 10-min sub-maximal cycling test for determination of cycling efficiency. Results: Cycling efficiency decreased beyond 50 years (50-59 years compared with 20-29 years: −7.3 ± 1.8 %; p < 0.05) and continued to decrease beyond 60 years (60-69 years compared with 50-59 years: −10.7 ± 2.4 %; p < 0.05), no further decrease was observed after 70 years. A continuous impairment in maximal sprint power output was observed after the age of 50 years leading to an overall decrease of 36 % between 20-29 years and >70 years. Significant positive relationships were observed between maximal sprint power output and both cycling efficiency ( r = 0.64, p < 0.05) and maximal aerobic power ( r = 0.42 and p < 0.05). Conclusion: The present data indicates a significant effect of ageing on cycling efficiency and maximal sprint power output after 50 years and a significant relationship was found between these two parameters. [ABSTRACT FROM AUTHOR]

The article discusses a court case wherein the Ninth Circuit has clearly set the parameters as to when police officers can and cannot use Tasers. The court has held that police officer Brian McPherson uses an unreasonable force against Carl Bryan. The Ninth Circuit has ruled that the use of Taser against Brian could warrant a legal action against the police who acted with intermediate quantum of force.

Abstract: In this paper, we determine optimally spaced inspection times for the two-parameter lognormal distribution for any given progressive interval censoring plan. We investigate the effect of the number of inspections and the choice of those optimally spaced inspection times based on the asymptotic relative efficiencies of the maximum likelihood estimates of the parameters. We also discuss the optimal progressive Type-I interval censoring plan when the inspection times and the expected proportions of total failures in the experiment are pre-fixed. [Copyright &y& Elsevier]

A conditional method of inference is used to derive confidence intervals for the location and scale parameters as well as the quantiles and the reliability function of the log-gamma distribution when the data are progressively Type-II censored. The method is then compared to the unconditional method of constructing confidence intervals for these parameters. Finally, we illustrate all the methods of inference discussed in this paper with a numerical example. [ABSTRACT FROM AUTHOR]

The linear hazard rate distribution (LHRD) is a two-parameter distribution that contains exponential and generalized Rayleigh distributions as special cases. It has applications in a number of fields including reliability improvement, life testing, and survival analysis. An iterative EM algorithm is presented to compute maximum likelihood estimates (MLEs) for the LHRD based on records and inter-record times. Simulation results indicate that the estimates obtained by maximum likelihood method are better than those obtained by the least-squares type estimation and by the elemental percentile method. We also evaluate the expected values and variances of the MLEs for various sample sizes in order to determine the unbiasing factors of the MLEs which can be utilized in performing tests of exponentiality and also for examining the appropriateness of Rayleigh model to data at hand. [ABSTRACT FROM AUTHOR]

Aim: Physical exercise triggers the secretion of small extracellular vesicles (sEVs) into the circulation in humans, enabling signalling crosstalk between tissues. Exercise‐derived EVs and their cargo have been proposed to mediate adaptations to exercise; however, our understanding of how exercise‐derived EV protein cargo is modulated by factors such as aerobic fitness and age of an individual is currently unknown. Here, we examined the circulating sEV proteome following aerobic exercise in healthy males of different ages and aerobic fitness to understand exercise‐induced EV response during the aging process. Methods: Twenty‐eight healthy men completed a bout of 20‐min cycling exercise at 70% estimated VO2peak. Small EVs were isolated from blood samples collected before and immediately after exercise, and then quantified using particle analysis and Western blotting. Small EV proteome was examined using quantitative proteomic analysis. Results: We identified a significant increase in 13 proteins in small plasma EVs following moderate‐to‐vigorous intensity exercise. We observed distinct changes in sEV proteome after exercise in young, mature, unfit, and fit individuals, highlighting the impact of aerobic fitness and age on sEV protein secretion. Functional enrichment and pathway analysis identified that the majority of the significantly altered sEV proteins are associated with the innate immune system, including proteins known to be damage‐associated molecular patterns (DAMPs). Conclusion: Together, our findings suggest that exercise‐evoked acute stress can positively challenge the innate immune system through the release of signalling molecules such as DAMPs in sEVs, proposing a novel EV‐based mechanism for moderate‐to‐vigorous intensity exercise in immune surveillance pathways. [ABSTRACT FROM AUTHOR]

Wolf's isotopic response describes the occurrence of a dermatologic condition at the site of a prior healed unrelated condition. Our report details a case of varicella occurring as a secondary condition at the site of a prior immunization reaction; herpesvirus infection has not been reported as a secondary condition in cases of Wolf's isotopic response before. Current hypotheses favor the involvement of neurohormonal modulation of local immunity in response to various forms of injury as a model for explaining these phenomena. [ABSTRACT FROM AUTHOR]

Skin fragility is a well-established complication of isotretinoin therapy for severe or resistant acne and presents a challenge to traditional modes of epilation such as waxing. As such, other less traumatic hair removal methods are desired. Herein we present the threading technique as an alternative form of epilation for patients in whom waxing is contraindicated secondary to concerns over skin fragility. [ABSTRACT FROM AUTHOR]

An introduction to the "Golden Gate University Law Review: Ninth Circuit Survey" is presented.

Exercise has been demonstrated to have considerable effects upon haemostasis, with activation dependent upon the duration and intensity of the exercise bout. In addition, markers of coagulation and fibrinolysis have been shown to possess circadian rhythms, peaking within the morning (0600-1200 h). Therefore, the time of day in which exercise is performed may influence the activation of the coagulation and fibrinolytic systems. This study aimed to examine coagulation and fibrinolytic responses to short-duration high-intensity exercise when completed at different times of the day. Fifteen male cyclists (VO2max: 60.3 ± 8.1 ml kg-1 min-1) completed a 4-km cycling time trial (TT) on five separate occasions at 0830, 1130, 1430, 1730 and 2030. Venous blood samples were obtained pre- and immediately post-exercise, and analysed for tissue factor (TF), tissue factor pathway inhibitor (TFPI), thrombin-anti-thrombin complexes (TAT) and D-Dimer. Exercise significantly increased plasma concentrations of TF (p < .0005), TFPI (p < .0006), TAT complexes (p < .0012) and D-Dimer (p < .0003). There was a time-of-day effect in pre-exercise TF (p = .004) and TFPI (p = .031), with 0830 greater than 1730 (p .001), while 1730 was less than 2030 h (p = .008), respectively. There was no significant effect of time of day for TAT (p = .364) and D-Dimer (p = .228). Power output, TT time and heart rate were not significantly different between TTs (p > .05); however, percentage VO2max was greater at 1730 when compared to 2030 (p = .04). Due to a time-of-day effect present within TF, peaking at 0830, caution should be applied when prescribing short-duration high-intensity exercise bout within the morning in populations predisposed to hypercoagulability. [ABSTRACT FROM AUTHOR]

Abstract: This article discusses using impedance measurements of body tissue in a diagnostic device. It then reviews the theory behind using these measurements to separate normal from diseased tissue. A small amount of time is devoted to discussing the meaning of sensitivity, specificity, and the receiver operating characteristic (ROC) curve, and their meanings. It also discusses the prospects of some new clinical devices using impedance measurements. One of the devices it focuses on is the TruScreen probe made by the Australian firm, Polartechnics. [Copyright &y& Elsevier]

Part II. Offers advice to senior resident physicians about administrative details and business decisions that need to be attended to before a physician enters medical practice. When the application process for specialty board examination should be initiated; Information about applying for a Drug Enforcement Administration (DEA) number; Purchasing malpractice insurance; Advice about other related topics.

Part I. Discusses steps medical students should take prior to entering practice in order to feel more prepared. Administrative details; Practice options; Curriculum vitae; Contacts; Medical license.

Considers how many medical centers have merged or seek to merge with neighboring institutions. Examples; Pros and cons of mergers; Potential detriments to patient services and graduate medical education; Implication of mergers for physicians in training.

Zadow, EK, Edwards, KH, Kitic, CM, Fell, JW, Adams, MJ, Singh, I, Kundur, A, Johnstone, ANB, Crilly, J, Bulmer, AC, Halson, SL, and, and Wu, SSX. Compression socks reduce running-induced intestinal damage. J Strength Cond Res 36(9): 2461–2464, 2022—Exercise is associated with a reduction in splanchnic blood flow that leads to the disruption of intestinal epithelium integrity, contributing to exercise-induced gastrointestinal syndrome. Strategies that promote intestinal blood flow during exercise may reduce intestinal damage, which may be advantageous for subsequent recovery and performance. This study aimed to explore if exercise-associated intestinal damage was influenced by wearing compression garments, which may improve central blood flow. Subjects were randomly allocated to wear compression socks (n = 23) or no compression socks (control, n = 23) during a marathon race. Blood samples were collected 24 hours before and immediately after marathon and analyzed for intestinal fatty acid–binding protein (I-FABP) concentration as a marker of intestinal damage. The magnitude of increase in postmarathon plasma I-FABP concentration was significantly greater in control group (107%; 95% confidence interval [CI], 72–428%) when compared with runners wearing compression socks (38%; 95% CI, 20–120%; p = 0.046; d = 0.59). Wearing compression socks during a marathon run reduced exercise-associated intestinal damage. Compression socks may prove an effective strategy to minimize the intestinal damage component of exercise-induced gastrointestinal syndrome. [ABSTRACT FROM AUTHOR]

Tan, J, Shi, X, Witchalls, J, Waddington, G, Lun Fu, AC, Wu, S, Tirosh, O, Wu, X, and Han, J. Effects of pre-exercise acute vibration training on symptoms of exercise-induced muscle damage: a systematic review and meta-analysis. J Strength Cond Res 36(8): 2339–2348, 2022—Exercise-induced muscle damage (EIMD) normally occurs after unaccustomed high-intensity eccentric exercises. Symptoms of EIMD include delayed-onset muscle soreness (DOMS), tenderness, stiffness, swelling, reduced strength, and increased creatine kinase (CK) levels in the blood. Vibration training (VT) may be useful as a pre-exercise intervention in attenuating EIMD on the basis of tonic vibration reflex (TVR) through a more efficient distribution of contractile stress over muscle fibers. The objective of this meta-analysis is to examine the effects of acute VT on symptoms of EIMD when performed as the pre-exercise intervention. Randomized controlled trials (RCTs) published in the 8 databases of Cochrane Library, PubMed, Embase, Web of Science, EBSCO, China National Knowledge Infrastructure, Airiti Library and WanFang Data from 1966 (the earliest available time) to January 2019 were searched. A total of 2,324 records were identified and 448 articles were screened with the title and abstract. Two investigators identified eligible studies, extracted data, and assessed the risk of bias independently. Review Manager 5.3 designed by Cochrane was used for the current meta-analysis. Six RCTs involving 180 subjects were included in the analysis. A low-to-moderate methodological quality of the included studies was revealed using the physiotherapy evidence database scale. The results showed that acute VT was superior to the control group for the reduction of DOMS on pain visual analogue scale at 24, 48 hours and pressure pain threshold at 24 hours. In addition, superior effects of acute VT were also found on the indirect markers of muscle damage including CK at 24, 72 hours, and lactate dehydrogenase at 24 hours. The current meta-analysis has collated the evidence to demonstrate that receiving acute VT before unaccustomed high-intensity eccentric exercises may be effective in attenuating markers of muscle damage and the development of DOMS when compared with a control group. The possible mechanisms of this effect could be attributed to an improved synchronization of muscle fiber caused by TVR, which could result in even distribution of exterior loads and eventually attenuate disruptions of muscle fibers. In addition, increased blood flow may also be helpful to prevent accumulation of metabolic substances and attenuate subsequent symptoms of EIMD. Vibration training may be used as a pre-exercise intervention to alleviate symptoms of EIMD caused by unaccustomed high-intensity eccentric exercise. Because of the limited quantity and quality of included studies, more high-quality studies are required to ascertain the effect of VT on symptoms of EIMD. [ABSTRACT FROM AUTHOR]

Aging is associated with a loss of metabolic homeostasis, with cofactors such as nicotinamide adenine dinucleotide (NAD+) declining over time. The decrease in NAD+ production has been linked to the age‐related loss of circulating extracellular nicotinamide phosphoribosyltransferase (eNAMPT), the rate‐limiting enzyme in the NAD+ biosynthetic pathway. eNAMPT is found almost exclusively in extracellular vesicles (EVs), providing a mechanism for the distribution of the enzyme in different tissues. Currently, the physiological cause for the release of eNAMPT is unknown, and how it may be affected by age and physical exercise. Here, we show that release of small EVs into the bloodstream is stimulated following moderate intensity exercise in humans. Exercise also increased the eNAMPT content in EVs, most prominently in young individuals with higher aerobic fitness. Both mature fit and young unfit individuals exhibited a limited increase in EV‐eNAMPT release following exercise, indicating that this mechanism is related to both the age and physical fitness of a person. Notably, unfit mature individuals were unable to increase the release of eNAMPT in EVs after exercise, suggesting that lower fitness levels and aging attenuate this important signalling mechanism in the body. EVs isolated from exercising humans containing eNAMPT were able to alter the abundance of NAD+ and SIRT1 activity in recipient cells compared to pre‐exercise EVs, indicating a pathway for inter‐tissue signalling promoted through exercise. Our results suggest a mechanism to limit age‐related NAD+ decline, through the systemic delivery of eNAMPT via EVs released during exercise. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to compare the effects of 12 weeks of resistance training combined with either 5:2 intermittent fasting or continuous energy restriction on body composition, muscle size and quality, and upper and lower body strength. Methods: Untrained individuals undertook 12 weeks of resistance training plus either continuous energy restriction [20% daily energy restriction (CERT)] or 5:2 intermittent fasting [~ 70% energy restriction 2 days/week, euenergetic consumption 5 days/week (IFT)], with both groups prescribed a mean of ≥ 1.4 g of protein per kilogram of body weight per day. Participants completed 2 supervised resistance and 1 unsupervised aerobic/resistance training combination session per week. Changes in lean body mass (LBM), thigh muscle size and quality, strength and dietary intake were assessed. Results: Thirty-four participants completed the study (CERT = 17, IFT = 17). LBM was significantly increased (+ 3.7%, p < 0.001) and body weight (− 4.6%, p < 0.001) and fat (− 24.1%, p < 0.001) were significantly reduced with no significant difference between groups, though results differed by sex. Both groups showed improvements in thigh muscle size and quality, and reduced intramuscular and subcutaneous fat assessed by ultrasonography and peripheral quantitative computed tomography (pQCT), respectively. The CERT group demonstrated a significant increase in muscle surface area assessed by pQCT compared to the IFT group. Similar gains in upper and lower body strength and muscular endurance were observed between groups. Conclusion: When combined with resistance training and moderate protein intake, continuous energy restriction and 5:2 intermittent fasting resulted in similar improvements in body composition, muscle quality, and strength. ACTRN: ACTRN12620000920998, September 2020, retrospectively registered. [ABSTRACT FROM AUTHOR]

Arteriovenous fistulas (AVFs) are considered superior to arteriovenous grafts and catheters. Nevertheless, AVF prevalence in the United States remains under the established target. The complication rates and financial cost of vascular access continue to rise and disproportionately contribute to the burgeoning health care costs. The relationship between financial incentives for a type of vascular access and rate of access placement is unclear. All chronic hemodialysis patients (n=99) receiving care at Philadelphia Veterans Affairs Medical Center as of August 1, 2008 were participants. Demographic characteristics, vascular access type, and nonrelative value unit compensation were assessed as predictors, and the vascular access prevalence rate, operative times, and frequency of access interventions were analyzed. A 73.7% AVF rate was achieved in this cohort of patients with 51.5% diabetes mellitus. The number of access procedures per patient per year remained constant over time. The Philadelphia Veterans Affairs Medical Center, a single payer system, achieved superior AVF prevalence and exceeded the national AVF target. Financial incentives for arteriovenous graft placement currently exist in the United States, as there is similar Medicare reimbursement for arteriovenous graft and basilic vein transposition, despite longer operative times for basilic vein transpositions. The high AVF prevalence at the Philadelphia Veterans Affairs Medical Center may be due to the VA nonrelative value unit-driven system that allows for interdisciplinary care, priority of AVFs, and frequent use of basilic vein transposition surgery, when appropriate. We have identified an important, hypothesis-generating example of a nonrelative value unit-based approach to vascular access yielding superior results with respect to patient care and cost. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine the prevalence, severity and variables influencing postoperative pain and other sequelae in children undergoing dental rehabilitation under general anesthesia. Methods: Healthy children scheduled for dental rehabilitation having treatment on only primary teeth were included in the study. General anesthesia protocol was standardized, and patients did not receive local anesthesia intraoperatively. Pain and other postoperative sequelae were recorded for 7 days postoperatively. Results: Ninety-five percent of the 90 children had postoperative pain which was moderate in intensity and highest immediately postoperatively. Children who had extractions or were at least 4 years old and had more than 12 procedures experienced increased postoperative pain. The most common postoperative symptoms other than pain were agitation, need for analgesics, and sleepiness. Longer operative times resulted in increased postoperative sleepiness. Children whose tracheal intubations were traumatic were more likely to report sore throats. Children who were at least 4 years old required more analgesics, experienced more postoperative sleepiness, and had nausea more frequently. All postoperative problems significantly decreased by postoperative day 2 and ceased by postoperative day 4 to 5. Conclusion: Children undergoing dental rehabilitations under general anesthesia commonly experience postoperative symptoms such as pain, agitation, need for analgesics, and sleepiness. [ABSTRACT FROM AUTHOR]

We tested the hypothesis that the magnitude of changes in indirect muscle damage markers would be greater after maximal elbow flexor eccentric exercise in the supinated (shorter biceps brachii) than neutral wrist (longer) position, and the difference in the magnitude would be associated with greater elongation over contractions for the supinated than neutral position, rather than the initial muscle length. Ten untrained men (21‐39 years) performed two bouts of 10 sets of 6 maximal isokinetic eccentric contractions of the elbow flexors in the supinated position for one arm and neutral position for the other arm separated by 2 weeks in a randomized order. Biceps brachii myotendinous junction (MTJ) movements during eccentric contractions were recorded by B‐mode ultrasonography, and the displacement from the start to end of each contraction was quantified. Peak torque (supinated: 367.8 ± 112.5 Nm, neutral: 381.5 ± 120.4 Nm) and total work (1816 ± 539 J, 1865 ± 673 J) produced during eccentric contractions were similar between conditions. The average MTJ displacement increased (P <.05) from the 1st set (8.0 ± 2.0 mm) to 10th set (15.8 ± 1.9 mm) for the supinated condition, but no such increase was found in the neutral condition (1st set: 5.1 ± 1.0 mm, 10th set: 5.0 ± 0.8 mm). Changes in indirect muscle damage markers (maximal voluntary isometric contraction torque, range of motion, serum creatine kinase activity, and muscle soreness) after exercise were greater (P <.05) for the supinated than neutral condition. These results suggest that the greater muscle damage marker changes for the supinated than neutral wrist position was associated with the greater muscle lengthening (strain). [ABSTRACT FROM AUTHOR]

Previous research has found hemispheric asymmetries in the utilization of proprioceptive information. It is undetermined, however, if there is any change in asymmetry in proprioceptive function when external stimulation, such as vibration, is presented. The present study was to investigate the immediate effects of vibration stimulation (VS) on bilateral ankle proprioception. Forty-six recreational male basketball players were included. Proprioception was assessed by using the active movement extent discrimination apparatus (AMEDA) in standing, and vibration was provided by using a vibrating form roller on the peroneal or gastrocnemius muscles. When participants were divided into high score and low score groups, according to the median of the baseline proprioceptive performance, VS (irrespective of whether vibrating the peroneal or gastrocnemius muscles) significantly improved left non-dominant ankle proprioception in the low proprioceptive performer group (p = 0.019), while significantly deteriorated right dominant ankle proprioception in the high proprioceptive performer group (p = 0.011). The results found that external stimuli reversely affect proprioception in better and worse performing groups. This suggests that there are differences in the processing of external stimulus signals on different bilateral hemispheres and in different groups (high score vs low score groups), which may be related to hemispheric asymmetry and stochastic resonance. Therefore, it is necessary to explore more specific interventions in the future. [ABSTRACT FROM AUTHOR]

Although healthcare is always changing, the inpatient rehabilitation facility has indispensable and enduring roles in patient care, medical education, and research. For patients with complex medical and functional limitations, inpatient rehabilitation facility–level care fosters recovery and community reintegration and plays a strategic role in optimizing healthcare transitions from acute and to postacute settings. It is an incomparable and distinct zone for interprofessional education: the healthcare system is dependent on the inpatient rehabilitation facility as the epicenter for instruction to healthcare professionals on how to care for patients with complex rehabilitation needs. As healthcare evolves, patients' increasing medical complexity requires ongoing research focused on patients' evolving healthcare needs. The inpatient rehabilitation facility alone offers the requisite infrastructure to support such discovery. In this Association of Academic Physiatrists Position Paper, we provide a fresh perspective on the value proposition of the inpatient rehabilitation facility and advocate for this unique clinical environment as a critical component of contemporary healthcare. [ABSTRACT FROM AUTHOR]

The proinflammatory cytokine storm associated with coronavirus disease 2019 (COVID-19) negatively affects the hematological system, leading to coagulation activation and endothelial dysfunction and thereby increasing the risk of venous and arterial thrombosis. Coagulopathy has been reported as associated with mortality in people with COVID-19 and is partially reflected by enhanced D-dimer levels. Poor vascular health, which is associated with the cardiometabolic health conditions frequently reported in people with severer forms of COVID-19, might exacerbate the risk of coagulopathy and mortality. Sedentary lifestyles might also contribute to the development of coagulopathy, and physical activity participation has been inherently lowered due to at-home regulations established to slow the spread of this highly infectious disease. It is possible that COVID-19, coagulation, and reduced physical activity may contribute to generate a "perfect storm," where each fuels the other and potentially increases mortality risk. Several pharmaceutical agents are being explored to treat COVID-19, but potential negative consequences are associated with their use. Exercise is known to mitigate many of the identified side effects from the pharmaceutical agents being trialled but has not yet been considered as part of management for COVID-19. From the limited available evidence in people with cardiometabolic health conditions, low- to moderate-intensity exercise might have the potential to positively influence biochemical markers of coagulopathy, whereas high-intensity exercise is likely to increase thrombotic risk. Therefore, low- to moderate-intensity exercise could be an adjuvant therapy for people with mild-to-moderate COVID-19 and reduce the risk of developing severe symptoms of illness that are associated with enhanced mortality. [ABSTRACT FROM AUTHOR]

Entry of HIV-1 into a cell happens only after viral envelope glycoproteins have bound to CD4 and a chemokine receptor. Generally, macrophage-tropic strains use CCR5, and T cell-line-tropic strains use CXCR4 as coreceptors for virus entry. Dual-tropic viruses can use both CCR5 and CXCR4. About 1% of white people are homozygous for a non-functional CCR5 allele, containing a 32 base pair deletion (CCR5Δ32). We studied the persistence of dual-tropic HIV-1 in an individual homozygous for this deletion. Our results suggest that structural features of the HIV-1 envelope linked to CCR5 tropism could confer a selective advantage in vivo. [ABSTRACT FROM AUTHOR]

Introduction Cyclizine is an anti-emetic drug commonly used post-surgically throughout the UK due to its anti-histamine (H1) and anticholinergic (anti-muscarinic M1) effects. There have been reports of cyclizine dependence and health seeking behaviours, particularly when taken intravenously, for its euphoric ('high') or hallucinatory effects, leading to previous concerns especially in parenteral nutrition patients1 although there are no formal prescribing guidelines. Materials and methods We report the experience of patients on intravenous cyclizine on our gastroenterology ward in the post-Christmas ward rounds (28-31 December). We also report the informatics picture for the ward over a year and for the wider hospital. This audit was conducted at a university tertiary teaching hospital in South Birmingham, particularly after six of the 24 (25%) gastroenterology patients were requesting intravenous cyclizine specifically. The proportion of patients prescribed cyclizine on the gastroenterology ward over the past 12 months was compared with the proportion of patients prescribed cyclizine across the hospital in a similar period. Data was extracted from the hospital's electronic prescribing system. Results and discussion Of the six patients, the age ranged between 23 and 55, with 50% women; half were requiring parenteral nutrition, with length of inpatient stays varying between 1 to 10 weeks. All requested intravenous cyclizine specifically with resistance to other antiemetics and/or stopping. From 1 January to 31 December 2022, 113 patients were prescribed intravenous cyclizine regular and PRN on the gastroenterology ward over the 12-month period. In total, 4,601 patients were admitted to the gastroenterology ward over the past 12 months, meaning 2.46% of patients had intravenous cyclizine prescribed. For the same period for the whole hospital, 16,100 patients admitted were prescribed IV cyclizine regular and PRN. In total, 197,804 patients were admitted to Queen Elizabeth Hospital Birmingham over the year, meaning 8.13% of patients (with the highest proportion on day case / surgical wards) had intravenous cyclizine prescribed. Conclusion After the surprising number of patients requesting intravenous cyclizine as part of long stays in hospital post-Christmas, we wanted to express concerns of its use in inpatients to the wider physician community. Given its widespread use in hospitals, there may well be a wider issue that needs local/national regulatory evaluation as well as quality improvements in the pharmacy/medical prescribing we are conducting. [ABSTRACT FROM AUTHOR]

Background and Methods: This paper reviews the current capacity of personnel in enabling access to assistive technology (AT) as well as the systems and processes within which they work, and was reviewed, discussed, and refined during and following the Global Research, Innovation, and Education in Assistive Technology (GREAT) Summit. Findings: Key concepts addressed include a person-centred team approach; sustainability indicators to monitor, measure, and respond to needs for service design and delivery; education, research, and training for competent practice, using the six rehab-workforce challenges framework; and credentialing frameworks. We propose development of a competence framework and associated education and training programs, and development and implementation of a certification framework for AT personnel. Conclusions: There is a resolve to address the challenges faced by People globally to access assistive technology. Context specific needs assessment is required to understand the AT Personnel landscape, to shape and strengthen credentialing frameworks through competencies and certification, acknowledging both general and specific skill mix requirements. Implications for Rehabilitation: Personnel in assistive technology (AT) provision should be trained using a person-centred team approach, which emphasizes appropriate skill-mix to address multiple needs within the community. Sustainability indicators should be used which allow personnel to monitor, measure and respond to needs for service design and delivery. A competence framework with associated education and training program, coupled with the development and implementation of a certification framework for AT personnel needs, will promote quality in AT personnel training globally. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Reducing time to reperfusion for ST‐segment elevation myocardial infarction (STEMI) is essential in improving outcomes. Consequently, numerous strategies have been employed to reduce median door‐to‐balloon time (DTBT). Methods: CODE STEMI is an ED physician‐activated STEMI notification system. On activation, an announcement is made over the hospital's public announcement (PA) system. We prospectively analysed all in‐hours STEMI patients who had primary percutaneous coronary intervention (PPCI) Pre‐CODE STEMI (2014) and after CODE STEMI was implemented (2015). The primary end‐points were median DTBT and the proportion of STEMI patients achieving a DTBT ≤90 min. The secondary end‐points were in‐hospital outcomes, and a composite of major adverse cardiac events (MACE) and hospital readmission rates at 30 days and 12 months. Results: There were 41 and 42 patients in Pre‐CODE STEMI and CODE STEMI groups respectively. Baseline characteristics were similar. DTBT was significantly reduced by 22.1 min from 67.1 ± 34.9 min Pre‐CODE STEMI to 45.0 ± 22.7 min (P = 0.001) in the CODE STEMI group. Door‐to‐door time (DTDT) was also reduced from 46.3 ± 30.9 min to 29.4 ± 23.3 min (P = 0.006). A greater proportion of CODE STEMI patients achieved the target DTBT ≤90 min (95.2% vs 73.2%, P = 0.007). CODE STEMI patients had less systolic dysfunction measured by a left ventricle ejection fraction of ≤40% (10.0% vs 27.8%, P = 0.07). There were trends to lower in‐hospital mortality rates (4.8% vs 9.8%, P = 0.43), MACE at 30 days and 12 months (4.8% vs 9.8%, P = 0.43; 11.9% vs 22.0%, P = 0.25). Conclusion: The novel in‐hospital in‐hours CODE STEMI notification system significantly reduced DTBT in patients undergoing PPCI. [ABSTRACT FROM AUTHOR]

Low-power laser irradiation (LPLI) is a non-invasive and safe method for cancer treatment that alters a variety of physiological processes in the cells. Autophagy can play either a cytoprotective role or a detrimental role in cancer cells exposed to stress. The detailed mechanisms of autophagy and its role on cytotoxicity in oral cancer cells exposed to LPLI remain unclear. In this study, we showed that LPLI at 810 nm with energy density 60 J/cm2 increased the number of microtubule associated protein 1 light chain 3 (MAP1LC3) puncta and increased autophagic flux in oral cancer cells. Moreover, reactive oxygen species (ROS) production was induced, which increased RelA transcriptional activity and beclin 1 (BECN1) expression in oral cancer cells irradiated with LPLI. Furthermore, ROS scavenger or knockdown of RelA diminished LPLI-induced BECN1 expression and MAP1LC3-II conversion. In addition, pharmacological and genetic ablation of autophagy significantly enhanced the effects of LPLI-induced apoptosis in oral cancer cells. These results suggest that autophagy may be a resistant mechanism for LPLI-induced apoptosis in oral cancer cells. [ABSTRACT FROM AUTHOR]

Context: Delayed-onset muscle soreness (DOMS) is a common muscle pain that many people experience and is often used as a model of acute muscle pain. Researchers have reported the effects of various interventions on DOMS, but different DOMS assessment protocols used in these studies make it difficult to compare the effects. Objective: To investigate DOMS characteristics after elbow- flexor eccentric exercise to establish a standardized DOMS assessment protocol. Design: Descriptive laboratory study. Setting: Research laboratory. Patients or Other Participants: Ten healthy, untrained men (21-39 years). Intervention(s): Participants performed 10 sets of 6 maximal isokinetic eccentric contractions of the elbow flexors. Main Outcome Measure(s): Indirect muscle-damage markers were maximal voluntary isometric contraction torque, range of motion, and serum creatine kinase activity. Muscle pain was assessed before exercise, immediately postexercise, and 1 to 5 days postexercise using (1) a visual analog scale (VAS), (2) a category ratio-10 scale (CR-10) when applying static pressure and palpation at different sites (3, 9, and 15 cm above the elbow crease), and (3) pressure-pain thresholds (PPTs) at 50 sites (pain mapping). Results: Maximal voluntary isometric contraction and range of motion decreased and creatine kinase activity increased postexercise, indicating muscle damage. Palpation induced greater pain than static pressure, and longitudinal and transverse palpations induced greater pain than circular palpation (P < .05). The PPT was lower in the medial region before exercise, but the pain-sensitive regions shifted to the central and distal regions of the biceps brachii at 1 to 3 days postexercise (P, .05). The VAS was correlated with the CR-10 scale (r = 0.91, P < .05) but not with the PPT (r = -0.28, P = .45). Conclusions: The way in which muscles are assessed affects the pain level score. This finding suggests that pain level and pain threshold cannot be used interchangeably and that the central and distal regions of the biceps brachii should be included in DOMS assessment using the VAS, CR-10 scale, and PPT after elbow-flexor eccentric exercise. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated changes in electrical pain threshold (EPT) after repeated eccentric exercise bouts to test the hypothesis that fascia would become more sensitive than muscle when greater delayed onset muscle soreness (DOMS) is induced. Methods: Ten young men performed two eccentric exercise bouts (ECC1, ECC2) consisting of ten sets of six maximal isokinetic eccentric contractions of the elbow flexors with the same arm separated by 4 weeks. Maximal voluntary isometric contraction torque, range of motion, muscle soreness assessed by a visual analogue scale (VAS) and pressure pain threshold (PPT) were measured before, immediately after and 1-5 days after exercise. EPT was assessed in the biceps brachii fascia (BBF), biceps brachii muscle, and brachialis fascia (BF) 1 day before, immediately after, and 1, 2 and 4 days after exercise. Results: All measures showed smaller changes ( P < 0.05) after ECC2 than ECC1. EPT decreased after both bouts and the largest decreases were evident at 2 days post-exercise ( P < 0.05). The decreases in EPT after ECC1 were greater ( P < 0.05) for both BBF (Baseline: 1.45 ± 0.23 mA, 2 days post-exercise: 0.13 ± 0.11 mA) and BF (1.64 ± 0.29 mA, 0.26 ± 0.2 mA) than muscle (1.56 ± 0.29 mA, 0.69 ± 0.33 mA). Changes in EPT were correlated with the changes in PPT ( r = 0.63-0.87, P ≤ 0.05) but not with VAS ( r = −0.01 to 0.50). Conclusion: These results show that fascia becomes more sensitive than muscle to electrical stimulation after the initial eccentric exercise, suggesting that damage inflammation to fascia than muscle fibres is more associated with DOMS. [ABSTRACT FROM AUTHOR]

Deep brain stimulation (DBS) has become an important option for medication-refractory essential tremor (ET), but may contribute to worsened gait and falling. This study evaluates impaired gait in a cohort of patients treated with DBS with a retrospective review of ET patients before and after DBS implantation. Factors examined included: age, duration of symptoms, pre-morbid gait difficulties/falls, Fahn-Tolosa-Marin tremorrating scale (TRS) scores at baseline, 6 months post-unilateral DBS implantation, and 6 or 12 months post-bilateral implantation. All implantations targeted the nucleus ventralis intermediate (Vim). Thirty-eight patients (25 males, 13 females) were included. Twenty-five patients (65.8%) underwent unilateral DBS implantation and 13 (34.2%) bilateral. The mean age at surgery was 67.1 years ± 11.4 (range 34-81). The mean disease duration was 31 years ± 18.3 (range 6-67). Fifty-eight percent of patients had worsened gait post-operatively. Seventy percent of patients with unilateral Vim DBS experienced gait worsening while 55% of bilateral DBS patients experienced gait worsening. Patients with worsened gait post-DBS had higher baseline pre-operative TRS scores than those without worsened gait (43.1 points ± 8.4 vs. 33.1 points ± 10.1, p = 0.002) (odds ratio 2.5, p = 0.02). Gait/balance may worsen following DBS for medication refractory ET. Higher baseline TRS score may factor into these issues, although a larger prospective study will be required with a control population. The larger percentage of difficulties observed in unilateral versus bilateral cases likely reflected the bias to not proceed to second-sided surgery if gait/balance problems were encountered. [ABSTRACT FROM AUTHOR]

Background: Prior promising results have been reported with deep brain stimulation (DBS) of the anterior limb of the internal capsule in cases with severe obsessive compulsive disorder (OCD) who had exhausted conventional therapies. Methods: In this pilot study, six adult patients (2 male; 4 female) meeting stringent criteria for severe (minimum Yale-Brown Obsessive Compulsive Scale [Y-BOCS] of 28) and treatment-refractory OCD had DBS electrode arrays placed bilaterally in an area spanning the ventral anterior limb of the internal capsule and adjacent ventral striatum referred to as the ventral capsule/ventral striatum. Using a randomized, staggered-onset design, patients were stimulated at either 30 or 60 days following surgery under blinded conditions. Results: After 12 months of stimulation, four (66.7%) of six patients met a stringent criterion as “responders” (≥35% improvement in the Y-BOCS and end point Y-BOCS severity ≤16). Patients did not improve during sham stimulation. Depressive symptoms improved significantly in the group as a whole; global functioning improved in the four responders. Adverse events associated with chronic DBS were generally mild and modifiable with setting changes. Stimulation interruption led to rapid but reversible induction of depressive symptoms in two cases. Conclusions: This pilot study suggests that DBS of the ventral capsule/ventral striatum region is a promising therapy of last resort for carefully selected cases of severe and intractable OCD. Future research should attend to subject selection, lead location, DBS programming, and mechanisms underpinning therapeutic benefits. [Copyright &y& Elsevier]

Acute Tubular Necrosis (ATN) causes severe damage to the kidney epithelial tubular cells and is often associated with severe renal dysfunction. Stem-cell based therapies may provide alternative approaches to treating of ATN. We have previously shown that clonal c-kitpos stem cells, derived from human amniotic fluid (hAFSC) can be induced to a renal fate in an ex-vivo system. Herein, we show for the first time the successful therapeutic application of hAFSC in a mouse model with glycerol-induced rhabdomyolysis and ATN. When injected into the damaged kidney, luciferase-labeled hAFSC can be tracked using bioluminescence. Moreover, we show that hAFSC provide a protective effect, ameliorating ATN in the acute injury phase as reflected by decreased creatinine and BUN blood levels and by a decrease in the number of damaged tubules and apoptosis therein, as well as by promoting proliferation of tubular epithelial cells. We show significant immunomodulatory effects of hAFSC, over the course of ATN. We therefore speculate that AFSC could represent a novel source of stem cells that may function to modulate the kidney immune milieu in renal failure caused by ATN. [ABSTRACT FROM AUTHOR]

Few studies exist in the literature investigating the impact of idiopathic Parkinson's Disease (IPD) on swallow-related quality of life. We therefore aimed in this project to: (1) evaluate swallow-specific quality of life in IPD; (2) delineate potential relationships between IPD duration and severity with swallow-specific quality of life; (3) investigate relationships between swallow-specific quality of life and general health-related quality of life; and (4) investigate relationships between swallow-specific quality of life and depression. Thirty-six patients diagnosed with IPD with and without dysphagia filled out self-report assessments of the SWAL-QOL, Parkinson's Disease Questionnaire-39 (PDQ-39), and Beck Depression Inventory (BDI). A series of Mann Whitney U tests were performed between non-dysphagic and dysphagic groups for the total SWAL-QOL score and the 10 SWAL-QOL domains. Spearman's Rho correlation analyses were performed between the SWAL-QOL and (1) PDQ-39; (2) Hoehn and Yahr stage; (3) PD disease duration; (4) UPDRS 'on' score; and (5) the BDI. The dysphagia swallowing group reported significant reductions compared to the non-dysphagic group for the total SWAL-QOL score ( P = 0.02), mental health domain score ( P = 0.002) and social domain score ( P = 0.002). No relationships existed between swallow-specific quality of life and disease duration or severity. Significant relationships existed between swallow-specific quality of life and general health-related quality of life ( rs =−0.56, P = 0.000) and depression ( rs = −0.48, P = 0.003). These exploratory data highlight the psychosocial sequelae that swallowing impairment can have in those with IPD and suggest a possible association between swallowing, social function, and depression. © 2009 Movement Disorder Society [ABSTRACT FROM AUTHOR]

The article presents an exploratory randomized controlled trial which aims to test the potential effect of repetitive transcranial magnetic stimulation (rTMS) on motor learning of stoke survivors undergoing constraint-induced therapy (CIT) for upper-limb hemiparesis. The authors state that rTMS produced a change in the excitability of the motor system. They conclude that further studies are needed to address the overall utility of rTMS as an adjuvant to stroke rehabilitation.

The article presents a study which aims to determine whether the combination of botulinum toxin A (BTX-A) treatment and exercise therapy could improve motor function of patients with poststroke hemiparesis and spasticity which allows them to be enrolled in constraint-induced movement therapy (CIMT). It concludes that BTX-A plus exercise therapy shows potential to improve function for those poststroke patients. It notes that neuromuscular stimulation may yield more potential effect.

Dentists are a potentially valuable resource for initial patient screening for signs of osteoporosis, as individuals with osteoporosis have altered architecture of the inferior border of the mandible as seen on panoramic radiographs. Our aim was to evaluate the efficacy of combining clinical and dental panoramic radiographic risk factors for identifying individuals with low femoral bone mass. Bone mineral density was measured at the femoral neck and classified as normal, osteopenic or osteoporotic using WHO criteria in 227 Japanese postmenopausal women (33-84 years). Panoramic radiographs were made of all subjects. Mandibular cortical shape and width was determined and trabecular features were measured in each ramus. Mean subject age, height, and weight were significantly different in the three bone-density groups (P<0.0001). A classification and regression trees (CART) analysis using just clinical risk factors identified 136 (87%) of the 157 individuals with femoral osteopenia or osteoporosis. Mean mandible cortical width (P<0.0001), cortical index (P<0.0001) and trabecular features (P=0.02) were also significantly different in the three bone density groups. A CART analysis considering only radiographic features found 130 (83%) of the 157 individuals with femoral osteopenia or osteoporosis, although none of the subjects with osteoporosis was correctly identified. A CART analysis using both clinical and radiographic features found that the most useful risk factors were thickness of inferior border of the mandible and age. This algorithm identified 130 (83%) of the 157 individuals with femoral osteopenia or osteoporosis. The results of this study suggest that 1) clinical information is as useful as panoramic radiographic information for identifying subjects having low bone mass, and 2) dentists have sufficient clinical and radiographic information to play a useful role in screening for individuals with osteoporosis. [ABSTRACT FROM AUTHOR]

PURPOSE: To investigate the combined usefulness of CD4 lymphocyte counts and human immunodeficiency virus type 1 (HIV-1) p24 antigen in predicting progression to the acquired immunodeficiency syndrome (AIDS). PATIENTS AND METHODS: CD4 lymphocyte counts and HIV-1 p24 antigen status were evaluated over a 4-year period in 518 HIV-1-seropositive men enrolled in the Multicenter AIDS Cohort Study in Chicago. RESULTS: Twenty-six percent (134 of 518) of the HIV-1-seropositive cohort had detectable p24 antigen during the study period. Men with p24 antigenemia experienced a more rapid decline in CD4 lymphocyte counts than men who were persistently p24 antigen-negative (p <0.01). Mean CD4 lymphocyte counts at first detection of p24 antigen were 406 and 455 cells/µL for men with incident and prevalent antigenemia, respectively. Antigen was detected in 61% (63 of 103) of the men who progressed to AIDS and in only 17% (71 of 415) of the men who did not (p <0.0001). The 4-year estimated cumulative AIDS incidence was 86%, 63%, and 21% for men with entry CD4 counts less than 200, 200 to 399, and 400 or more cells/µL, respectively. Presence of p24 antigenemia was strongly associated with more rapid disease progression within each of these CD4 groupings (p <0.0001). CONCLUSION: Our data indicate that p24 anti-genemia can first be detected with moderate CD4 cell depletion, is associated with a more rapid decline in the CD4 lymphocyte population, and combined with CD4 lymphocyte counts is useful in identifying individuals at significantly greater risk of disease progression. Our findings provide important information for assessing HIV-1 disease prognosis over a 4-year period. [ABSTRACT FROM AUTHOR]