Management of septic and aseptic prepatellar bursitis: a systematic review.

BACKGROUND: Despite contributing to significant morbidity in working-age adults, there is no consensus on the optimal treatment for prepatellar bursitis. Much of the existing literature combines prepatellar and olecranon bursitis. This systematic review aims to determine the optimal management of prepatellar bursitis. STUDY DESIGN AND METHODS: A primary search of electronic published and unpublished literature databases from inception to November 2019 was completed. Articles over 25 years old, case reports with less than four patients, paediatric studies, and non-English language papers were excluded. Our primary outcome was recurrence after 1 year. Comparisons included endoscopic vs open bursectomy, duration of antibiotics. Methodological quality was assessed using the Institute of Health Economics and Revised Cochrane Risk of Bias scoring systems. Meta-analyses were conducted where appropriate. RESULTS: In total 10 studies were included (N = 702). Endoscopic and open bursectomy showed no difference in recurrence after 1 year (OR 0.41, 95% CI 0.05-3.53, p = 0.67), and surgical complications (OR 1.44, 95% CI 0.34-6.08, p = 0.44). 80% endoscopically-treated patients were pain free after 1 year. Patients treated with antibiotics for less than 8 days were not significantly more prone to recurrence (2/17 vs 10/114, OR 0.66, 95% CI 0.13-3.29, p = 0.64) compared to 8 days plus at minimum 1 year post injury. CONCLUSIONS: Our study represents the largest cohort of patients evaluating management strategies for prepatellar bursitis, and includes data not previously published. Endoscopic bursectomy is non-inferior to open bursectomy, enabling a shorter hospital stay. It also offers a relatively low risk of post-operative pain. Endoscopic bursectomy is a viable option to treat both septic and aseptic prepatellar bursitis. Our small cohort suggests recurrence and hospital stay are not improved with antibiotic treatment exceeding 7 days for septic prepatellar bursitis.

On the Use of High-Resolution and Deep-Learning Seismic Catalogs for Short-Term Earthquake Forecasts: Potential Benefits and Current Limitations.

Enhanced earthquake catalogs provide detailed images of evolving seismic sequences. Currently, these data sets take some time to be released but will soon become available in real time. Here, we explore whether and how enhanced seismic catalogs feeding into established short-term earthquake forecasting protocols may result in higher predictive skill. We consider three enhanced catalogs for the 2016-2017 Central Italy sequence, featuring a bulk completeness lower by at least two magnitude units compared to the real-time catalog and an improved hypocentral resolution. We use them to inform a set of physical Coulomb Rate-and-State (CRS) and statistical Epidemic-Type Aftershock Sequence (ETAS) models to forecast the space-time occurrence of M3+ events during the first 6 months of the sequence. We track model performance using standard likelihood-based metrics and compare their skill against the best-performing CRS and ETAS models among those developed with the real-time catalog. We find that while the incorporation of the triggering contributions from new small magnitude detections of the enhanced catalogs is beneficial for both types of forecasts, these models do not significantly outperform their respective near real-time benchmarks. To explore the reasons behind this result, we perform targeted sensitivity tests that show how (a) the typical spatial discretizations of forecast experiments ( ≥ 2 km) hamper the ability of models to capture highly localized secondary triggering patterns and (b) differences in earthquake parameters (i.e., magnitude and hypocenters) reported in different catalogs can affect forecast evaluation. These findings will contribute toward improving forecast model design and evaluation strategies for next-generation seismic catalogs.

A compilation of tri-allelic SNPs from 1000 Genomes and use of the most polymorphic loci for a large-scale human identification panel.

In a directed search of 1000 Genomes Phase III variation data, 271,934 tri-allelic single nucleotide polymorphisms (SNPs) were identified amongst the genotypes of 2,504 individuals from 26 populations. The majority of tri-allelic SNPs have three nucleotide substitution-based alleles at the same position, while a much smaller proportion, which we did not compile, have a nucleotide insertion/deletion plus substitution alleles. SNPs with three alleles have higher discrimination power than binary loci but keep the same characteristic of optimum amplification of the fragmented DNA found in highly degraded forensic samples. Although most of the tri-allelic SNPs identified had one or two alleles at low frequencies, often single observations, we present a full compilation of the genome positions, rs-numbers and genotypes of all tri-allelic SNPs detected by the 1000 Genomes project from the more detailed analyses it applied to Phase III sequence data. A total of 8,705 tri-allelic SNPs had overall heterozygosities (averaged across all 1000 Genomes populations) higher than the binary SNP maximum value of 0.5. Of these, 1,637 displayed the highest average heterozygosity values of 0.6-0.666. The most informative tri-allelic SNPs we identified were used to construct a large-scale human identification panel for massively parallel sequencing, designed for the identification of missing persons. The large-scale MPS identification panel comprised: 1,241 autosomal tri-allelic SNPs and 29 X tri-allelic SNPs (plus 46 microhaplotypes adapted for genotyping from reduced length sequences). Allele frequency estimates are detailed for African, European, South Asian and East Asian population groups plus the Peruvian population sampled by 1000 Genomes for the 1,270 tri-allelic SNPs of the final MPS panel. We describe the selection criteria, kinship simulation experiments and genomic analyses used to select the tri-allelic SNP components of the panel. Approximately 5 % of the tri-allelic SNPs selected for the large-scale MPS identification panel gave three-genotype patterns in single individual samples or discordant genotypes for genomic control DNAs. A likely explanation for some of these unreliably genotyped loci is that they map to multiple sites in the genome - highlighting the need for caution and detailed scrutiny of multiple-allele variant data when designing future forensic SNP panels, as such patterns can arise from common structural variation in the genome, such as segmental duplications.

Estimating Diversity Through Time Using Molecular Phylogenies: Old and Species-Poor Frog Families are the Remnants of a Diverse Past.

Estimating how the number of species in a given group varied in the deep past is of key interest to evolutionary biologists. However, current phylogenetic approaches for obtaining such estimates have limitations, such as providing unrealistic diversity estimates at the origin of the group. Here, we develop a robust probabilistic approach for estimating diversity through time curves and uncertainty around these estimates from phylogenetic data. We show with simulations that under various realistic scenarios of diversification, this approach performs better than previously proposed approaches. We also characterize the effect of tree size and undersampling on the performance of the approach. We apply our method to understand patterns of species diversity in anurans (frogs and toads). We find that Archaeobatrachia-a species-poor group of old frog clades often found in temperate regions-formerly had much higher diversity and net diversification rate, but the group declined in diversity as younger, nested clades diversified. This diversity decline seems to be linked to a decline in speciation rate rather than an increase in extinction rate. Our approach, implemented in the R package RPANDA, should be useful for evolutionary biologists interested in understanding how past diversity dynamics have shaped present-day diversity. It could also be useful in other contexts, such as for analyzing clade-clade competitive effects or the effect of species richness on phenotypic divergence.

Judgement bias testing in group-housed gestating sows.

Societal concerns about animal welfare have triggered the movement of gestating sows from individual stalls to group housing in many countries. Common methods of assessing sow welfare focus on overt physical ailments, and potentially neglect psychological stressors. A judgement bias task may allow researchers to evaluate an animal's subjective mental or affective state to provide a more comprehensive welfare assessment. Thus, group housed sows were trained to a spatial differentiation task to evaluate their ability to be assessed for individual judgement bias. A total of 45 sows were trained to the task across two replicates, with 24 successfully meeting the learning criteria required to be tested for a judgement bias. In the first replicate, 60% of sows displayed positive bias while 40% displayed negative biases. In the second replicate, 52% of sows displayed positive biases while 33% of sows displayed negative biases. A linear mixed effects model revealed that feed rank affected the latency to approach the ambiguous stimulus (χ2 (1) = 9.47, p = 0.002) with more dominant animals being more likely to exhibit a positive bias. Given that all sows in the present study were group housed, as well as fed and managed similarly, these findings highlight the complexities underlying judgement bias outcomes.

Ontogeny of behavioral traits in commercial sows.

As the number of gestating sows reared in group housing increases, a better understanding of behavioral traits needed to negotiate these more complex social interactions promises to increase animal welfare and productivity. However, little is known about different behavioral strategies or coping styles in sows, and even less is understood about their ontogeny. To study the development of coping styles in adult gestating sows, 36 sows from the same sire line and same commercial maternal genetics were followed from birth through their second parity. Each animal was observed in a battery of stress-related behavioral tests at 5 weeks, and 3 months of age as well as 24 h postpartum as a parity 1 sow, and during introduction to subsequent gestation period in group housing. The tests at different ages included response to handling, open field exploration, human interaction, litter handling and social interactions with conspecifics. Many of the observed behaviors were correlated during the same period of the animal's life and provided the motivation for a principal component analysis by age. Using principal component analysis, multiple traits were determined at each age point; at 5 weeks old: active, non-exploratory and cautious explained 82.5% of the variance; at 3 months of age: active, non-exploratory and low fear of humans explained 87.7% of the variance; and as primiparous sows: active, aggressive/dominant and submissive explained 82.0% of the variance. Several individual juvenile behaviors were associated with adult behavioral traits. For instance, the response to handling at 5 weeks was significantly predictive (ß=0.4; P<0.05) of the aggressive/dominant trait of parity 1 sows. Taken together results presented here suggest that early behavioral responses of prepuberal gilts during specific instances of elevated environmental or social stress can predict future behavioral response as gestating sows.

The mitochondrial landscape of African Americans: An examination of more than 2500 control region haplotypes from 22 U.S. locations.

The mitochondrial DNA (mtDNA) control region (16024-576) was Sanger-sequenced for a total of 2563 self-identified African Americans, using automated processing techniques and data review standards exceeding guidelines for forensic applications. Genetic diversity ranged from 0.9952 to 0.9998 in 22 population samples from 20 different states. Haplogroups of African ancestry, found in 82.48% of individuals overall, were most concentrated in the Southeast U.S. and decreased to the north and west. West African and West Central African haplotypes were well-represented in the population samples, especially in the southern U.S. states, while East African haplogroups were observed in low-frequency clusters in a handful of locations across the country. East Asian, Native American, and West Eurasian admixture was present in 3.16%, 2.93%, and 11.43% of samples, respectively. While some geographic substructure was detected across the population samples as clines in admixture frequencies, 20 of the 22 population samples were found to be statistically indistinguishable by pairwise comparisons and AMOVA calculations. Datasets from Hawaii and Idaho, however, were clear outliers. Overall, these more than 2500 control region sequences represent the most comprehensive regional sampling of African American mtDNA diversity to date, and are suitable for use in a forensic mtDNA database. The population data are made available via EMPOP (www.empop.org) and GenBank.

Temporal stability of personality traits in group-housed gestating sows.

The movement of sows (Sus scrofa domesticus) out of individual gestation stalls and into group housing can introduce new sources of stress due to the enhanced environmental and social complexity. Some sows may have the behavioral capacity to adapt to these changes better than others. However, little is known about individual differences in behavioral responses, or personality traits, in gestating sows and how they impact the animal's ability to cope with group housing. The temporal consistency in the assessment of an animal's behavior is a prerequisite to the establishment of personality traits and was addressed at an interval of approximately five months during two consecutive gestation periods in the present study. Forty-six group-housed sows from a commercially available genetic line were assessed for aggressive and social behaviors at mixing into a group, reaction to human approach, ease of handling, exploration of an open field, and reaction to a novel object. Principal component analysis revealed the presence of three traits accounting for over 60% of the variance in behaviors: aggressive/dominant, avoidant of humans and active/exploratory. Individual component scores were significantly correlated between pregnancies demonstrating temporal stability of trait assessment. Significant relationships were found between aggressive/dominant component scores and individual feed rank at electronic sow feeding stations and skin lesion scores, as well as between avoidant of humans component scores and average number of stillbirths per litter. These findings provide evidence for the temporal stability of distinct behaviors contributing to personality traits within a group of genetically similar sows and demonstrate how these traits may be useful in identifying individuals likely to succeed in group housing.

Brain-computer interface targeting non-motor functions after spinal cord injury: a case report.

STUDY DESIGN: This is a case report. OBJECTIVES: The objective of this study was to report on a brain-computer interface (BCI) paradigm that is successfully used with an inpatient spinal cord injury patient. SETTING: This study was conducted in an inpatient rehabilitation hospital. METHODS: A 25-year-old man with a C5 burst fracture and subsequent tetraplegia (The American Spinal Injury Association) participated in this case study. He completed a brief battery of psychological, pain, cognitive and other screening measures at points before and after the BCI paradigm during his rehabilitation hospitalization. RESULTS: The paradigm was easily learned and well tolerated with no adverse effects. CONCLUSIONS: This case is reflective of the trends in our ongoing feasibility study evaluating BCI technology in the inpatient rehabilitation setting. Clinical implications and challenges of using this technology in a busy hospital unit are reviewed.

Prenatal sex hormones, digit ratio, and face shape in adult males.

OBJECTIVES: Several reports have demonstrated a relationship between second to fourth digit ratio (2D:4D) and facial shape, suggesting that prenatal sex hormones play a role in the development of the craniofacial complex. Using 3D surface imaging and geometric morphometrics, we test the hypothesis that decreased digit ratio (indicative of increased prenatal androgen exposure) is associated with a more masculine facial phenotype. METHODS: 3D facial surface images and digit measures were collected on a sample of 151 adult males. Facial landmarks collected from the images were aligned by Procrustes superimposition and the resulting shape coordinates regressed on 2D:4D. Variations in facial shape related to 2D:4D were visualized with deformable surface warps. RESULTS: A significant statistical relationship was observed between facial shape variation and 2D:4D (p = 0.0084). Lower 2D:4D ratio in adult males was associated with increased facial width relative to height, increased mandibular prognathism, greater nasal projection, and increased upper and lower lip projection. CONCLUSIONS: A statistical relationship between 2D:4D and facial shape in adult males was observed. Faces tended to look more masculine as 2D:4D decreased, suggesting a biologically plausible link between prenatal androgen exposure and the development of male facial characteristics.

DNA Commission of the International Society for Forensic Genetics: revised and extended guidelines for mitochondrial DNA typing.

The DNA Commission of the International Society of Forensic Genetics (ISFG) regularly publishes guidelines and recommendations concerning the application of DNA polymorphisms to the question of human identification. Previous recommendations published in 2000 addressed the analysis and interpretation of mitochondrial DNA (mtDNA) in forensic casework. While the foundations set forth in the earlier recommendations still apply, new approaches to the quality control, alignment and nomenclature of mitochondrial sequences, as well as the establishment of mtDNA reference population databases, have been developed. Here, we describe these developments and discuss their application to both mtDNA casework and mtDNA reference population databasing applications. While the generation of mtDNA for forensic casework has always been guided by specific standards, it is now well-established that data of the same quality are required for the mtDNA reference population data used to assess the statistical weight of the evidence. As a result, we introduce guidelines regarding sequence generation, as well as quality control measures based on the known worldwide mtDNA phylogeny, that can be applied to ensure the highest quality population data possible. For both casework and reference population databasing applications, the alignment and nomenclature of haplotypes is revised here and the phylogenetic alignment proffered as acceptable standard. In addition, the interpretation of heteroplasmy in the forensic context is updated, and the utility of alignment-free database searches for unbiased probability estimates is highlighted. Finally, we discuss statistical issues and define minimal standards for mtDNA database searches.

[MRI investigations in patients with problems due to metal-on-metal implants]. / Magnetresonanztomographische Untersuchungen bei Problemen mit Metall-auf-Metall-Implantaten.

Until recently, metal-on-metal (MoM) hip implants were commonly used for joint replacement and resurfacings. Their use has rapidly declined following reports of Frühversagen and soft tissue disease caused by the release of metal debris from the prosthesis. Detection of these soft tissue lesions has proven difficult using conventional imaging techniques and blood metal ion tests. Current guidelines recommend the use of imaging modalities including metal artefact reduction sequence (MARS) magnetic resonance imaging (MRI), computed tomography and ultrasound but provide little indication which is best. MARS significantly reduces the susceptibility artefact induced by the presence of metal objects, thereby producing diagnostic quality images that can be shared with other physicians and compared over time. The clinical interpretation of MRI findings of solid pseudotumours and severe muscle atrophy is straightforward: revision is usually recommended. However, the most common MRI findings are of a cystic pseudotumour and minor muscle wasting. In these cases decision-making is difficult and we currently use multi-disciplinary and multi-colleague based meetings to make decisions regarding patient management. This article presents a comparison of imaging modalities and an update on the interpretation of MARS MRI for the investigation of patients with MoM hip implants.The English full-text version of this article is available at Springer Link (under "Supplemental").

Effects of ritonavir-boosted lopinavir on the pharmacokinetics of quinine.

The centuries-old antimalarial drug, quinine, continues to play a critical role in the treatment of severe falciparum malaria and uncomplicated malaria in pregnant women. It shares cytochrome P450 (CYP )-mediated metabolic pathways with several commonly used antiretroviral drugs, raising the potential for clinically important drug­drug interactions. A phase I pharmacokinetic study was conducted to assess the impact of long-term use of ritonavir-boosted lopinavir (LPV/r) on quinine pharmacokinetics in healthy volunteers. LP V/r significantly decreased the exposure of quinine and its major active metabolite, 3-hydroxyquinine, in both total and free (unbound) forms. These findings highlight the complex nature of the influence exerted by LPV/r on several of the drug-metabolizing enzymes involved in quinine disposition,including CYP 3A4, UDP-glucuronosyltransferase (UG T), and P-glycoprotein (P-gp). A decline in quinine exposure may compromise clinical efficacy. Further studies are warranted to assess changes in quinine pharmacokinetics and treatment outcomes in patients with acute malaria receiving antiretroviral therapy that includes LPV/r.

Accelerator mass spectrometry measurement of intracellular concentrations of active drug metabolites in human target cells in vivo.

Accelerator mass spectrometry (AMS) is an ultrasensitive technique to detect radiolabeled compounds. We administered a microdose (100 µg) of (14)C-labeled zidovudine (ZDV) with or without a standard unlabeled dose (300 mg) to healthy volunteers. Intracellular ZDV-triphosphate (ZDV-TP) concentration was measured using AMS and liquid chromatography-tandem mass spectrometry (LC/MS/MS). AMS analysis yielded excellent concordance with LC/MS/MS and was 30,000-fold more sensitive. The kinetics of intracellular ZDV-TP formation changed several-fold over the dose range studied (100 µg-300 mg). AMS holds promise as a tool for quantifying intracellular drug metabolites and other biomediators in vivo.

Estimated activity patterns in British 45 year olds: cross-sectional findings from the 1958 British birth cohort.

OBJECTIVE: To investigate patterns of, and associations between, physical activity at work and in leisure time, television viewing and computer use. SUBJECTS: 4531 men and 4594 women with complete plausible data, age 44-45 years, participating in the 1958 British birth cohort study. METHODS: Physical activity, television viewing and computer use (hours/week) were estimated using a self-complete questionnaire and intensity (MET hours/week) derived for physical activity. Relationships were investigated using linear regression and chi(2) tests. RESULTS: From a target sample of 11,971, 9223 provided information on physical activity, of whom 75 and 47% provided complete and plausible activity data on work and leisure time activity respectively. Men and women spent a median of 40.2 and 34.2 h/week, respectively in work activity, and 8.3 and 5.8 h/week in leisure activity. Half of all participants watched television for > or =2 h/day, and half used a computer for <1 h/day. Longer work hours were not associated with a shorter duration of leisure activity, but were associated with a shorter duration of computer use (men only). In men, higher work MET hours were associated with higher leisure-time MET hours, and shorter durations of television viewing and computer use. Watching more television was related to fewer hours or MET hours of leisure activity, as was longer computer use in men. Longer computer use was related to more hours (or MET hours) in leisure activities in women. CONCLUSIONS: Physical activity levels at work and in leisure time in mid-adulthood are low. Television viewing (and computer use in men) may compete with leisure activity for time, whereas longer duration of work hours is less influential. To change active and sedentary behaviours, better understanding of barriers and motivators is needed.

Vitamin D and chronic widespread pain in a white middle-aged British population: evidence from a cross-sectional population survey.

BACKGROUND: Identified aetiological factors for chronic widespread pain (CWP) are largely related to emotional and behavioural factors, but current management leads to modest improvement in symptoms. Vitamin D deficiency has been suggested as a new modifiable risk factor for CWP. OBJECTIVE: To examine the association between vitamin D status (measured by 25-hydroxyvitamin D (25(OH)D)) and CWP in a nationwide population sample of white British adults, accounting for potential mediating and confounding lifestyle factors. METHODS: 9377 participants born 1 week in March 1958, in England, Scotland or Wales and completing a biomedical assessment at age 45; 6824 eligible participants had data on 25(OH)D and completed pain manikins. RESULTS: Prevalence of CWP varied by 25(OH)D concentration in women but not in men, with the lowest prevalence observed for women with 75-99 nmol/l (14.4% for <25 nmol/l, 14.8% for 25-49 nmol/l, 11.6% for 50-74 nmo/l, 8.2% for 75-99 nmol/l and 9.8% for participants with > or =100 nmol/l). There was an interaction between 25(OH)D concentration and gender in relation to CWP (interaction, p = 0.006), which was not fully explained by differences in lifestyle or social factors (adjusted interaction, p = 0.03). For women, the association between 25(OH)D concentration and CWP persisted after full adjustment (odds ratio (OR) for <75 nmol/l vs 75-99 nmol/l 1.57, 95% CI 1.09 to 2.26), while no evidence for an association was apparent in men (OR = 1.03, 95% CI 0.75 to 1.43). CONCLUSION: Current vitamin D status was associated with CWP in women but not in men. Follow-up studies are needed to evaluate whether higher vitamin D intake might have beneficial effects on the risk of CWP.

Forensic typing of autosomal SNPs with a 29 SNP-multiplex--results of a collaborative EDNAP exercise.

We report the results of an inter-laboratory exercise on typing of autosomal single nucleotide polymorphisms (SNP) for forensic genetic investigations in crime cases. The European DNA Profiling Group (EDNAP), a working group under the International Society for Forensic Genetics (ISFG), organised the exercise. A total of 11 European and one US forensic genetic laboratories tested a subset of a 52 SNP-multiplex PCR kit developed by the SNPforID consortium. The 52 SNP-multiplex kit amplifies 52 DNA fragments with 52 autosomal SNP loci in one multiplex PCR. The 52 SNPs are detected in two separate single base extension (SBE) multiplex reactions with 29 and 23 SNPs, respectively, using SNaPshot kit, capillary electrophoresis and multicolour fluorescence detection. For practical reasons, only the 29 SBE multiplex reaction was carried out by the participating laboratories. A total of 11 bloodstains on FTA cards including a sample of poor quality and a negative control were sent to the laboratories together with the essential reagents for the initial multiplex PCR and the multiplex SBE reaction. The total SNP locus dropout rate was 2.8% and more than 50% of the dropouts were observed with the poor quality sample. The overall rate of discrepant SNP allele assignments was 2.0%. Two laboratories reported 60% of all the discrepancies. Two laboratories reported all 29 SNP alleles in all 10 positive samples correctly. The results of the collaborative exercise were surprisingly good and demonstrate that SNP typing with SBE, capillary electrophoresis and multicolour detection methods can be developed for forensic genetics.

Diagnosing post-mortem treatments which inhibit DNA amplification from US MIAs buried at the Punchbowl.

The US military is committed to recovering and identifying the remains of unknown military service members. Casualties of the Korean War were exhumed from the National Memorial Cemetery of the Pacific, or Punchbowl, and submitted to the Armed Forces DNA Identification Laboratory (AFDIL) for mtDNA sequencing. Contrary to AFDIL's experience on other samples from this era, most failed to yield amplifiable DNA. Suspicion fell on mortuary practices that may have been applied to the remains, evidenced by a white powder found with the bones, and general records suggesting the use of formaldehyde-based stablizing agents. To improve the chances of successful identification of the unknown individuals, we looked for the causes underlying this failure. We did this by examining the state of the collagen, the most abundant biomolecule in bone, by using differential scanning calorimetry (DSC) and transmission electron microscopy (TEM). The DSC analyses showed collagens with a range of different thermal stabilities. When these results were compared with the DNA amplification results, a clear correlation between elevated thermal stability and amplification failure was evident. TEM analysis revealed that fibril integrity was maintained after thermal and acid treatments in the samples which failed amplification. Together these two approaches implicate a stabilization agent as the cause of problems with DNA analysis, presumably due to excessive cross-linking. Following the initial study, the ability of DSC to rapidly identify problem samples was tested in a blind study of 14 samples, the method successfully identifying all the problematic samples from Punchbowl. Within this unusual context, DSC analysis is a useful method to assess the likelihood of successful DNA extraction and amplification.

Effect of semen sampling frequency on seminal antiretroviral drug concentration.

Study of male genital tract (MGT) pharmacology is relevant to the treatment of prostatitis, prostate cancer, infertility, and seminal human immunodeficiency virus transmission. However, the time course of drug concentrations in the MGT is largely unknown. To determine the feasibility of frequent semen sampling in assessing the pharmacokinetics of the MGT, we administered efavirenz, indinavir, and zidovudine to subjects to achieve steady-state levels and then collected semen samples at sequentially decreasing ejaculation intervals. The volume of seminal plasma decreased from 4.0 (1.2-5.1) ml (median with range) at 48 h after the baseline ejaculation to 0.72 (0.45-1.6) ml 1 h after a previous ejaculation, which was still adequate for drug concentration assessment. The seminal fructose concentration also decreased. However, the concentration of prostate-specific antigen and all three drugs did not decrease, even if the ejaculation intervals decreased to 1 h. Thus, semi-intensive semen sampling can be used to assess MGT pharmacokinetics.