In the quest for a functional cure or eradication of HIV infection, we need to know how large the reservoirs are from which infection rebounds when treatment is interrupted. To that end, we quantified SIV and HIV tissue burdens in tissues of infected non-human primates and lymphoid tissue (LT) biopsies from infected humans. Before antiretroviral therapy (ART), LTs harbor more than 98 percent of the SIV RNA+ and DNA+ cells. While ART substantially reduced their numbers, vRNA+ cells were still detectable and their persistence was associated with relatively low drug concentrations in LT compared to peripheral blood. Prolonged ART also reduced the level of SIV and HIV-DNA+ cells, but the estimated size of the residual tissue burden of 108 vDNA+ cells that potentially harbor replication competent proviruses, along with the evidence for continuing virus production in LT despite ART, identify two important sources for rebound following treatment interruption. The large sizes of these tissue reservoirs underscore the challenges in developing “HIV cure” strategies that target multiple sources of virus production.

Background: The role of peer teachers in interprofessional education has not been extensively studied. This study is designed to determine if peer-teacher-led problem-based seminars can influence medical and pharmacy students' perceptions of interprofessional education. Methods: Undergraduate medical and pharmacy students participated in one-hour problem-based learning seminars held over the course of 16 weeks. A caseÁcontrol study design was used to compare perceptions of interprofessional education between students who participated in seminars and students who did not participate in seminars. The validated Interdisciplinary Education Perception Scale (IEPS) was used to assess perceptions of interprofessional education and was distributed to medical and pharmacy students at the conclusion of 16 weeks of seminars. A two-tailed t-test was used to determine significance between groups. A survey was also distributed to all students regarding perceived barriers to involvement in interprofessional education training. Results: In total, 97 students responded to IEPS (62 medical, 35 pharmacy). Data showed significantly higher perception of professional cooperation among medical students (p 00.006) and pharmacy students (p 00.02) who attended interprofessional seminars compared to those who did not attend. One hundred and nine students responded to the survey regarding perceived barriers to interprofessional education, with the two most common barriers being: 'I am not aware of interprofessional education opportunities' (61.5%) and 'I do not have time to participate' (52.3%). Conclusion: Based on this data we believe peer-teacher-led problem-based interprofessional seminars can be used to increase medical and pharmacy students' perceived need for professional cooperation. Currently, major barriers to interprofessional education involvement are awareness and time commitment. Undergraduate health professions education can incorporate student-led seminars to improve interprofessional education.

Gastrointestinal: Recurrent urothelial cancer of the remnant ureter invading the ileal conduit: PET/CT imaging A 68-year-old man complained of hematuria for three months. His past history was remarkable for urinary bladder cancer treated initially with cystectomy and ileal conduit urinary diversion, and nephroureterectomy 5 years later from high-grade urothelial carcinoma of the right renal pelvis and right ureter. For the present hematuria 6 years after the right nephroureterectomy, 18 F FDG PET/CT demonstrated a hypermetabolic lesion of the right ureteral stump with involvement of the uretero-ileal anastomosis and ileal conduit ( Fig. 1). Contemporary CT showed a 2.9 × 5.8 × 2.3 cm tubular mass in the lower right retroperitoneum extending as a filling defect into the ileal conduit. PET/CT and CT exams were consistent with a recurrent urothelial carcinoma confirmed by tissue sampling (Figs 1, 2a). The patient received 2 cycles of carboplatin and gemcitabine neoadjuvant therapy with a favorable response as evidenced by a significant reduction of the ureteroileal lesion (Fig. 2b). Subsequent radiotherapy was planned.Standard practice for patients with bladder urothelial carcinoma with invasion into the muscularis propria is cystectomy. There are many surgical approaches to urinary diversion. One of the most common is the ileal conduit, a procedure in which a 15-cm portion of the ileum is diverted, thus creating a reservoir for urine. The ureters are then anastamosed to the proximal end of this conduit. Patients with cystectomy have a local tumor recurrence rate of 3-16%. One longitudinal study found the tumor re-occurrence rate involving the upper tract to be 4% at 3 years and 7% at 5 years after cystectomy. In another multicentric retrospective study patients with ileal urinary diversion were found to have a secondary tumor rate involving the ileal conduit of .02%. The study also suggested that ileal conduit diversion has a lower rate of cancer recurrence than colonic diversion methods of urinary diversion. Unlike many other post-cystectomy diversion methods, where the secondary tumor recurrence is often gastrointestinal in origin, ileal conduits were found to be almost exclusively urothelial in origin. Additionally, most of the recurrences occurred at the site of uretero-ileal anastomosis.PET/CT is usually limited for the evaluation of urinary malignancy involving the urinary tract because of presence of physiologic 18 F FDG urine activity interfering with the detection of any potential tracer-avid lesion. The use of forced diuresis with furosemide and delayed PET/CT imaging may be effective, in certain instances, in un-masking underlying hypermetabolic urothelial diseases. In our case, the remnant right ureteral stump, free of any urine, offers an excellent target-to-background activity ratio for the FDG-avid tumor with extension to the uretero-ileal anastomosis and ileal conduit. These PET features correspond to the tumor filling defects seen on contemporary CT. Figure 1 Fused PET/CT images (in the axial, sagi...

We detail what we believe to be the first reported case of a congenital ‘Cervical Left Pulmonary Artery’ in which an aberrant left pulmonary artery courses cranially into the mid-cervical neck before descending back into the thorax to the left pulmonary hilum. Due to the location and course of the artery, we believe that this anomaly is likely due to a developmental error of the sixth pharyngeal arch. Ultimately, the use of a reconstructed 3D computed tomography image provided detailed characterization of the unique anatomical variant, aiding in a successful surgical repair of the defect.