Faculty Bibliography

First-generation protease inhibitors (PIs) have yielded clinical benefit, although their use has been accompanied by a high incidence of treatment-emergent resistance as well as the transmission of drug-resistant viruses in acute infection. In addition, mutations in isolates that are resistant to PIs can often confer cross-resistance, jeopardizing class effectiveness. Despite the fact that several PIs display a high genetic barrier to resistance, diminished susceptibility to these drugs can still result from poor adherence, due to poor tolerability, high pill burden, frequent dosing, and complex food and water requirements. Two new PIs, atazanavir (ATV) and fosamprenavir (FPV, or 908), have several potential advantages over first-generation agents with regard to potency, tolerability, and convenience. Clinical trials with these agents suggest a relatively high barrier to resistance, with well-characterized mutational pathways and minimal cross-resistance with other PIs. Therefore, these new agents hold promise as first-line PIs with the added potential for salvageability. In addition, two nonpeptidic PIs in advanced development, tipranavir (TPV) and TMC-114, maintain high potency against isolates resistant to earlier-generation PIs and have each shown usefulness in salvage therapy. Thus, the availability of new PIs that combine favorable resistance profiles with improved tolerability has the potential to lead to a new paradigm of how to better utilize and sequence PIs in antiretroviral therapy. The use of these new PIs may provide improved long-term, durable viral suppression, enhancing not only therapeutic outcomes but also patient quality of life for those living with HIV infection and AIDS

Dr. [H. SHERWOOD LAWRENCE], who was known as Jerry, was also an expert in infectious diseases, and his research generated other advances in immunology. Dr. Lawrence conducted research on the way the body rejects transplanted organs and how various conditions can damage tissue. Transfer factor is a small molecule, and it has been the center of scientific mystery, in part because Dr. Lawrence and other scientists were unable to identify it precisely. Some scientists suspect that transfer factor represents bits of many molecules. Dr. Lawrence also identified a link between the way cells respond immunologically to microbes like the bacterium that causes tuberculosis and the type of immune responses involved in the rejection of transplanted organs, said Dr. Fred T. Valentine, an immunologist who worked with Dr. Lawrence at NYU

Dr. Lawrence, who was known as Jerry, was also an expert in infectious diseases, and his research generated other advances in immunology. Dr. Lawrence conducted research on the way the body rejects transplanted organs and how various conditions can damage tissue. Transfer factor is a small molecule, and it has been the center of scientific mystery, in part because Dr. Lawrence and other scientists were unable to identify it precisely. Some scientists suspect that transfer factor represents bits of many molecules. Dr. Lawrence also identified a link between the way cells respond immunologically to microbes like the bacterium that causes tuberculosis and the type of immune responses involved in the rejection of transplanted organs, said Dr. Fred T. Valentine, an immunologist who worked with Dr. Lawrence at N.Y.U

Senator John Kerry's doctor said that he found small tears on two torn tendons during surgery on Mr. Kerry's right shoulder on Wednesday but that the 45-minute procedure was completed without complications and the patient awoke from his time under general anesthesia lucid and laughing. Dr. [Bertram Zarins] said Mr. Kerry would most likely be back in handshaking shape in a couple of weeks and to resume hoisting babies on the rope line shortly after that. Mr. Kerry's habit of tossing footballs with his staff for fun and photo opportunities may have to wait a few months though, he said

Evaluation of the accuracy of ultrasound has yielded heterogeneous results. Our objective was to summarize the evidence on the accuracy of ultrasound compared to venography in asymptomatic patients, taking into account the variation due to threshold differences. Searches of journal table of contents, computer databases (Medline, Embase, Biomed, Cochrane) and conference proceedings were performed. A study was eligible if it prospectively compared ultrasound to venography for the diagnosis of DVT in asymptomatic patients. Data of studies selected for inclusion were extracted independently by two authors. High quality studies with consecutive patient enrollment, blind evaluation of the two techniques, and absence of verification bias are summarized as Level 1, while those not fulfilling one or more of these criteria are considered Level 2. Original study authors were contacted to confirm accuracy and to provide missing data. A pooled estimate of the accuracy of ultrasound was obtained according to the method of Moses and coworkers. This method gives a summary diagnostic odds ratio (DOR). The DOR is a single indicator of test performance. It varies between 0 and infinity and exceeds 1, only when ultrasound is more often positive in patients with DVT relative to those without DVT. Higher DOR indicates better discriminatory test performance. Thirty one studies were rated as potentially unbiased and graded as Level 1. The mean prevalence of DVT as determined by venography was 22%. In Level 1 studies, the odds of positive ultrasound in proximal veins was 379 times higher (95% confidence limits 65, 2,200) and in distal veins 32 times higher (7.5, 135) among patients with DVT than those without. Our results suggest that, particularly for proximal veins, ultrasound is accurate for the diagnosis of DVT in asymptomatic postoperative orthopedic patients. More research is needed in other clinical settings