In the era of antiretroviral therapy (ART), liver disease has emerged as an important cause of death among persons with human immunodeficiency virus (HIV)/hepatitis C virus (HCV)coinfection. The objective of this stud...In the era of antiretroviral therapy (ART), liver disease has emerged as an important cause of death among persons with human immunodeficiency virus (HIV)/hepatitis C virus (HCV)coinfection. The objective of this study was to estimate the burden of liver disease and evaluate determinants of liver fibrosis and necroinflammatory activity among HIV/HCV coinfected patients receiving ART. We studied 112 randomly selected and 98 referred HCV-infected patients undergoing care in the Johns Hopkins University HIV clinic. Liver disease was characterized clinically and histologically. Of the 210 individuals studied-64%of whom had received ART within 2 years of liver disease assessment-33%had no fibrosis (F0), and 26%had bridging fibrosis or cirrhosis (≥F3). The median necroinflaminatory activity score was 3 (range, 0-9 of 18). ART was not associated with fibrosis; however, significantly less hepatic necroinflammatory activity was observed among persons who had received highly active antiretroviral therapy longer (P = .02) and more effectively (defined by HIV RNA suppression; P <.01). Twelve percent of individuals had previous ART-as-sociated liver enzyme elevations (grades 3-4), but liver fibrosis was not more severe if the liver enzyme elevation resolved. On the other hand, liver fibrosis was more severe in persons with persistent liver enzyme elevations (grades 1-4). In conclusion, despite widespread exposure to ART and documented instances of ART-related hepatitis, we found no evidence that ART caused serious histological liver disease. Recognition of bridging fibrosis and cirrhosis in some but not most patients underscores the importance of identifying and treating liver disease in HIV/HCV coinfected persons.展开更多
Objective This study was undertaken to examine the relationship betwe en labor abnormalities and shoulder dystocia in nulliparous women. Study design Nulliparo us women whose delivery was complicated by shoulder dysto...Objective This study was undertaken to examine the relationship betwe en labor abnormalities and shoulder dystocia in nulliparous women. Study design Nulliparo us women whose delivery was complicated by shoulder dystocia were studied and co mpared with a control group selected based on the best possible match for race, labor type (spontaneous or induced), and birth weight. The duration of first and second stage of labor, as well as the rates of labor progress, were calculated and compared between groups. Results During this 4-year study period, there wer e 8010 nulliparous singleton deliveries of which 65 (0.8%) were complicated by shoulder dystocia. Compared with controls, there was no difference in the rate o f cervical dilation in the active phase of the first stage of labor. In the shou lder dystocia group, more patients had a second stage of labor greater than 2 ho urs (22%vs 3%; P < .05) and had operative vaginal deliveries (26%vs 1.5%; P < .001). In shoulder dystocia cases with birth weight greater than 4000 g, 33%h ad a second stage of labor greater than 2 hours. Conclusion In our population, t he combination of fetal macrosomia, second stage of labor longer than 2 hours an d the use of operative vaginal delivery were associated with shoulder dystocia i n nulliparous women.展开更多
文摘In the era of antiretroviral therapy (ART), liver disease has emerged as an important cause of death among persons with human immunodeficiency virus (HIV)/hepatitis C virus (HCV)coinfection. The objective of this study was to estimate the burden of liver disease and evaluate determinants of liver fibrosis and necroinflammatory activity among HIV/HCV coinfected patients receiving ART. We studied 112 randomly selected and 98 referred HCV-infected patients undergoing care in the Johns Hopkins University HIV clinic. Liver disease was characterized clinically and histologically. Of the 210 individuals studied-64%of whom had received ART within 2 years of liver disease assessment-33%had no fibrosis (F0), and 26%had bridging fibrosis or cirrhosis (≥F3). The median necroinflaminatory activity score was 3 (range, 0-9 of 18). ART was not associated with fibrosis; however, significantly less hepatic necroinflammatory activity was observed among persons who had received highly active antiretroviral therapy longer (P = .02) and more effectively (defined by HIV RNA suppression; P <.01). Twelve percent of individuals had previous ART-as-sociated liver enzyme elevations (grades 3-4), but liver fibrosis was not more severe if the liver enzyme elevation resolved. On the other hand, liver fibrosis was more severe in persons with persistent liver enzyme elevations (grades 1-4). In conclusion, despite widespread exposure to ART and documented instances of ART-related hepatitis, we found no evidence that ART caused serious histological liver disease. Recognition of bridging fibrosis and cirrhosis in some but not most patients underscores the importance of identifying and treating liver disease in HIV/HCV coinfected persons.
文摘Objective This study was undertaken to examine the relationship betwe en labor abnormalities and shoulder dystocia in nulliparous women. Study design Nulliparo us women whose delivery was complicated by shoulder dystocia were studied and co mpared with a control group selected based on the best possible match for race, labor type (spontaneous or induced), and birth weight. The duration of first and second stage of labor, as well as the rates of labor progress, were calculated and compared between groups. Results During this 4-year study period, there wer e 8010 nulliparous singleton deliveries of which 65 (0.8%) were complicated by shoulder dystocia. Compared with controls, there was no difference in the rate o f cervical dilation in the active phase of the first stage of labor. In the shou lder dystocia group, more patients had a second stage of labor greater than 2 ho urs (22%vs 3%; P < .05) and had operative vaginal deliveries (26%vs 1.5%; P < .001). In shoulder dystocia cases with birth weight greater than 4000 g, 33%h ad a second stage of labor greater than 2 hours. Conclusion In our population, t he combination of fetal macrosomia, second stage of labor longer than 2 hours an d the use of operative vaginal delivery were associated with shoulder dystocia i n nulliparous women.
