Teriparatide (TPTD) is often used for the treatment of patients with severe osteoporosis, but its effectiveness in this patient group has not been specifically studied. Here, we report upon the results of an observational study involving 323 patients with severe osteoporosis (bone density T-score of -4 or less) who were treated at a specialist osteoporosis clinic with TPTD (n = 217) or standard care (n = 106) over a 5.5-year period. The standard care group did not receive TPTD because they declined to self-inject (59.4%), had a contraindication (7.5%), or were already stabilized on oral bisphosphonates (33%). The two groups were matched for the severity of osteoporosis, fracture risk, and most other clinical variables. The annual percentage change in lumbar spine bone mineral density (BMD) was greater in the TPTD group (8.2 ± 6.0 vs. 5.0 ± 8.4, p = 0.002), but there was no difference in response of hip BMD. During follow-up, 3/217 (1.38%) TPTD-treated patients had new vertebral fractures compared with 7/106 (6.6%) receiving standard care (p = 0.011), but there was no difference between the groups in the rate of nonvertebral fractures (11.1 vs. 8.5%, p = 0.47). Logistic regression analysis adjusting for baseline characteristics showed that the risk of vertebral fractures in TPTD-treated patients was significantly reduced compared with standard care (odds ratio = 0.12, 95% confidence interval 0.03-0.55, p = 0.007). Treatment of severe spinal osteoporosis with TPTD substantially reduces the risk of vertebral fractures compared with standard care and may be the preferred treatment in this patient group.

ObjectiveTo compare early and late responses to highly active antiretroviral therapy (HAART) in European and non-European HIV-1 infected patients in a Dutch cohort. MethodsWe retrospectively analysed the response to HAART of 216 previously treatment-naive HIV-1-infected patients using the University Medical Centre Utrecht HIV database. African (n 5 51), Asian (n 5 7), and Central/South American (n 5 6) patients were classified as non-European, and others as European (n 5 152). Early failure was defined as a viral load that remained above 400 HIV-1 RNA copies/mL after 6 months of treatment with HAART. Late-phase failure was determined in patients who were successfully treated in the early phase and was defined as two consecutive viral load measurements above 400 copies/mL, a new AIDS-defining event or death. ResultsIn the early phase, four of 152 (2.6%) European and eight of 64 (12.5%) non-European patients failed HAART. A significant increased risk of virological failure in the early phase of treatment was observed for non-Europeans as compared to Europeans (odds ratio 4.6; 95% confidence interval 1.1-20.2). Low serum drug levels in the absence of resistant virus were often seen at the time of early failure. No difference in late-phase failure was observed between the two groups (adjusted hazard ratio 0.6; 95% confidence interval 0.3-1.2). ConclusionsNon-European patients had a 4.6 times higher risk of virological failure than their European counterparts in the first 6 months of treatment with HAART. This failure seemed to be associated with low serum drug levels at the time of failure. However, if HAART was successful in the early phase, response rates in the late phase were similar for Europeans and non-Europeans.

A high average power, OPO based system has been developed for the purpose of generating output in the 2 -5 pm mid-IR band. The system uses a cw diode arraypumped, Nd:YAG master oscillator power amplifier (MOPA) as the pump source and two tandem OPOs for wavelength conversion to the mid-IR. A Type I1 degenerate KTP OPO was used to convert the pump beam to 2.13 pm and a Type I near degenerate zinc germanium phosphite (ZGP) OPO was used to generate broadband radiation in the 3.7 -4.1 and 4.4 -4.8 ym wavelength range.Pump Laser: The pump laser consists of a cw diode-array pumped MOPA. Figure 1 shows the optical layout. The master oscillator is a stable cavity laser using two small 3 x 2.4 x 55 mm Brewster angle cut zig-zag slabs. The slabs are pumped from both sides with two 12 bar arrays running at a nominal power of 10 W per bar. A BBO Q-switch is used to generate a 20 KHz pulse train with pulse durations of 38 -40 ns. The output is typically 20 W with near diffraction limited beam quality. The output from the master oscillator is magnified by a factor of 2 and amplified by a pair of amplifiers. Each amplifier uses a normal incidence zig-zag slab and is pumped from both sides by a pair of 50 bar arrays Reprinted front Advartced Solid-state Lasers, 514 1999 Techrtical Digest, a1999 Optical Society of America