Higher serum 25-hydroxyvitamin D concentrations associate with a faster recovery of skeletal muscle strength after muscular injury

The primary purpose of this study was to identify if serum 25-hydroxyvitamin D (25(OH)D) concentrations predict muscular weakness after intense exercise. We hypothesized that pre-exercise serum 25(OH)D concentrations inversely predict exercise-induced muscular weakness. Fourteen recreationally active adults participated in this study. Each subject had one leg randomly assigned as a control. The other leg performed an intense exercise protocol. Single-leg peak isometric force and blood 25(OH)D, aspartate and alanine aminotransferases, albumin, interferon (IFN)-γ, and interleukin-4 were measured prior to and following intense exercise. Following exercise, serum 25(OH)D concentrations increased (p < 0.05) immediately, but within minutes, subsequently decreased (p < 0.05). Circulating albumin increases predicted (p < 0.005) serum 25(OH)D increases, while IFN-γ increases predicted (p < 0.001) serum 25(OH)D decreases. Muscular weakness persisted within the exercise leg (p < 0.05) and compared to the control leg (p < 0.05) after the exercise protocol. Serum 25(OH)D concentrations inversely predicted (p < 0.05) muscular weakness (i.e., control leg vs. exercise leg peak isometric force) immediately and days (i.e., 48-h and 72-h) after exercise, suggesting the attenuation of exercise-induced muscular weakness with increasing serum 25(OH)D prior to exercise. Based on these data, we conclude that pre-exercise serum 25(OH)D concentrations could influence the recovery of skeletal muscle strength after an acute bout of intense exercise.

Circulating pro-inflammatory cytokines are elevated and peak power output correlates with 25-hydroxyvitamin D in vitamin D insufficient adults

The purpose of this study was to identify circulating cytokines, skeletal muscle strength, and peak power output in young adults with contrasting serum 25-hydroxyvitamin D (25(OH)D) concentrations. Serum 25(OH)D, inflammatory cytokines, muscle strength, and peak power output were, therefore, measured in young adults (25-42 years). Data were collected during the winter to avoid the seasonal influence on serum 25(OH)D. After serum 25(OH)D concentration measurements, subjects were separated into one of two groups: (1) vitamin D insufficient [serum 25(OH)D ≤32 ng/mL, n = 14], or (2) vitamin D sufficient [serum 25(OH)D >32 ng/mL, n = 14]. Following group allocation, serum 25(OH)D concentrations were significantly (p < 0.05) lower and pro-inflammatory cytokines [interleukin (IL)-2, IL-1β, tumor necrosis factor-α, and interferon-γ] were significantly (all p < 0.05) greater in vitamin D insufficient adults. An anti-inflammatory cytokine (i.e., IL-10; p > 0.05), peak isometric forces (p > 0.05), and peak power outputs (p > 0.05) were not significantly different between vitamin D groups. However, peak power outputs correlated with serum 25(OH)D concentrations in vitamin D insufficient (r = 0.55, p < 0.05) but not in vitamin D sufficient adults (r = -0.27, p = 0.36). Based on these data, we conclude that vitamin D insufficiency, in part, could result in pro-inflammatory stress without altering muscular strength or function in young adults. Future research investigating the causality of the correlation between low-serum 25(OH)D and peak power output in young adults is required.

Positive correlation between circulating cathelicidin antimicrobial peptide (hCAP18/LL-37) and 25-hydroxyvitamin D levels in healthy adults

Background

Transcription of the cathelicidin antimicrobial peptide (CAMP) gene is induced by binding of the bioactive form of vitamin D, 1,25-dihydroxyvitamin D, to the vitamin D receptor. Significant levels of the protein hCAP18/LL-37 are found in the blood and may protect against infection and/or sepsis. We hypothesized that serum vitamin D levels may modulate the circulating levels of hCAP18. Only three studies have shown a positive correlation between circulating 25-hydroxyvitamin D and hCAP18 levels. Here we provide additional evidence for such a correlation in healthy, middle-aged adults.

Findings

Serum levels of 25-hydroxyvitamin D [25(OH)D] and plasma levels of hCAP18 were determined in 19 healthy middle-aged (mean of 50.1 years) adult men and women. Plasma hCAP18 concentrations correlated with serum 25(OH)D concentrations in subjects with 25(OH)D levels ≤ 32 ng/ml (r = 0.81, p < 0.005) but not in subjects with concentrations > 32 ng/ml (r = 0.19, p = 0.63).

Conclusions

We conclude that plasma hCAP18 levels correlate with serum 25(OH)D levels in subjects with concentrations of 25(OH)D ≤ 32 ng/ml as opposed to those with concentrations > 32 ng/ml and that vitamin D status may regulate systemic levels of hCAP18/LL-37.

Fluctuations in the skeletal muscle power-velocity relationship and interferon-γ after a muscle-damaging event in humans

Background

Skeletal muscle power is velocity-dependent under constant load conditions. Interferon (IFN)-γ is an inflammatory cytokine that regulates skeletal muscle recovery following insult in experimental animals. It is unknown if the power-velocity relationship and IFN-γ are modulated after a muscle-damaging event in humans. Therefore, the purpose of this study was to identify the power-velocity relationship and circulating IFN-γ concentration responses to a muscle-damaging event in humans.

Methods

Nine healthy males participated in this study. Each subject had one leg randomly assigned as the control leg. The other leg served as the treatment leg and performed an intense-stretch-shortening cycling (SSC) exercise protocol to induce muscle damage. To measure muscle damage and the power-velocity relationship, unilateral peak isometric force and power output (forces and velocities) measurements were performed prior to, immediately after, and during the days following the SSC protocol. The circulating IFN-γ concentrations were measured in serum samples obtained prior to, immediately after, and during the days following the SSC protocol. Statistical significance of single-leg isometric force and power output data were assessed using a two-way (time and leg treatment) analysis of variance (ANOVA) with repeated measures, followed by a Tukey’s honestly significant difference (HSD) to test multiple pairwise comparisons. The statistical significance of the IFN-γ data were assessed using a one-way (time) ANOVA with repeated measures, followed by a Tukey’s HSD to test multiple pairwise comparisons.

Results

In the treatment leg, significant (P < 0.05) peak isometric force deficits occurred immediately and persisted several days after the SSC protocol, thereby identifying muscle damage-induced weakness. During muscle weakness in the treatment leg, peak power was significantly (P < 0.05) depressed and the velocities at peak power were significantly (P < 0.05) slower. Interestingly, circulating IFN-γ concentrations decreased at 2 and 3 days after compared to those immediately following the SSC protocol.

Conclusion

We conclude that the velocity to achieve a compromised peak power is reduced, and speculatively, the circulating IFN-γ excursion could be influential on the recovery of skeletal muscle after a muscle-damaging event in humans.

Different doses of supplemental vitamin D maintain interleukin-5 without altering skeletal muscle strength: a randomized, double-blind, placebo-controlled study in vitamin D sufficient adults

BACKGROUND

Supplemental vitamin D modulates inflammatory cytokines and skeletal muscle function, but results are inconsistent. It is unknown if these inconsistencies are dependent on the supplemental dose of vitamin D. Therefore, the purpose of this study was to identify the influence of different doses of supplemental vitamin D on inflammatory cytokines and muscular strength in young adults.

METHODS

Men (n = 15) and women (n = 15) received a daily placebo or vitamin D supplement (200 or 4000 IU) for 28-d during the winter. Serum 25-hydroxyvitamin D (25(OH)D), cytokine concentrations and muscular (leg) strength measurements were performed prior to and during supplementation. Statistical significance of data were assessed with a two-way (time, treatment) analysis of variance (ANOVA) with repeated measures, followed by a Tukey's Honestly Significant Difference to test multiple pairwise comparisons.

RESULTS

Upon enrollment, 63% of the subjects were vitamin D sufficient (serum 25(OH)D ≥ 30 ng/ml). Serum 25(OH)D and interleukin (IL)-5 decreased (P < 0.05) across time in the placebo group. Supplemental vitamin D at 200 IU maintained serum 25(OH)D concentrations and increased IL-5 (P < 0.05). Supplemental vitamin D at 4000 IU increased (P < 0.05) serum 25(OH)D without altering IL-5 concentrations. Although serum 25(OH)D concentrations correlated (P < 0.05) with muscle strength, muscle strength was not changed by supplemental vitamin D.

CONCLUSION

In young adults who were vitamin D sufficient prior to supplementation, we conclude that a low-daily dose of supplemental vitamin D prevents serum 25(OH)D and IL-5 concentration decreases, and that muscular strength does not parallel the 25(OH)D increase induced by a high-daily dose of supplemental vitamin D. Considering that IL-5 protects against viruses and bacterial infections, these findings could have a broad physiological importance regarding the ability of vitamin D sufficiency to mediate the immune systems protection against infection.

Low Vitamin D Impairs Strength Recovery After Anterior Cruciate Ligament Surgery

The purpose of this study was to identify strength gains after an anterior cruciate ligament injury and surgery and during inflammatory challenge in participants with disparate vitamin D levels. Plasma samples were obtained from those who had not previously experienced an anterior cruciate ligament injury and from injured patients 2 weeks before and 3 months after anterior cruciate ligament surgery. Plasma 25-hydroxyvitamin D and cytokine concentrations were measured in each blood sample. Single-leg peak isometric forces were measured 2 weeks presurgery and 3 months postsurgery. Compared with noninjured participants, inflammatory cytokines were elevated prior to and following anterior cruciate ligament reconstruction. During this inflammatory challenge, the peak isometric force increases after surgery were significantly lower in those with plasma 25-hydroxyvitamin D concentrations <30 ng/mL compared with those with concentrations ≥30 ng/mL. The authors conclude that low vitamin D appears to hinder strength recovery after anterior cruciate ligament surgery and during inflammatory insult.

Does Vitamin E and C Supplementation Improve the Recovery From Anterior Cruciate Ligament Surgery?

Muscular (quadriceps) weakness is a predominant impairment that follows anterior cruciate ligament injury and surgery. This continued weakness impairs activities of daily living and could predispose patients to adverse conditions later in life, such as knee osteoarthritis. Vitamins E and C have potent antioxidant and anti-inflammatory activity. Herein, the authors summarize the state-of-the science and suggest directions for future research endeavors regarding the therapeutic influence of vitamins E and C, or other antioxidants, on the recovery from anterior cruciate ligament injury and surgery.

Vitamin E and C supplementation does not ameliorate muscle dysfunction after anterior cruciate ligament surgery

Muscle atrophy and weakness are predominant impairments after anterior cruciate ligament (ACL) surgical repair. We tested the hypothesis that vitamin E and C supplementation will improve recovery from ACL injury. Men undergoing elective ACL surgery were randomly assigned to twice-daily supplements of either antioxidants (AO; vitamins E and C, n=10) or matching placebos (n=10) from 2 weeks before until 3 months after surgery. Each subject provided several fasting blood draws, two muscle biopsies from the thigh muscle of the injured limb, and strength and thigh circumference measurements of the lower limbs. Muscle atrophy was apparent in both groups before and several days after surgery. Compared with baseline measurements, peak isometric force of the injured limb increased significantly (P<0.05) by 3 months postsurgery in both treatment groups; however, AO supplementation did not augment these strength gains. By contrast, baseline plasma ascorbic acid concentrations correlated (r=0.59, P=0.006) with subsequent improvement in the strength of the injured limb. In summary, vitamin E and C supplementation was ineffective in potentiating the improvement in force production by the injured limb; however, baseline vitamin C status was associated with beneficial outcomes in strength, suggesting that long-term dietary habits are more effective than short-term supplements.

Melanomacrophages in three species of free-ranging sharks from the northwestern Atlantic, the blue shark Prionacae glauca (L.), the shortfin mako, Isurus oxyrhinchus Rafinesque, and the thresher, Alopias vulpinus (Bonnaterre)

The melanomacrophage aggregates or cells (MMC) are commonly used as biomarkers of exposure to pollution in fish, albeit their numbers and morphological characteristics can be influenced not only by environmental toxins but also by a range of physiological parameters and pathological conditions. Accordingly, before we can use MMC as biomarkers in any fish species, their normal, 'background' characteristics have to be established in apparently healthy fish. The knowledge of MMC in sharks is minimal. The aim of this study was to characterize MMC from 51 free-ranging, large pelagic sharks from the northwestern Atlantic, including shortfin mako, Isurus oxyrhinchus, thresher, Alopias vulpinus and blue shark, Prionacae glauca. The rationale of this study was twofold. First, because, sharks have life histories predisposing them to the accumulation of environmental toxins they constitute good sentinel species of the health of the global marine ecosystem. Second, because many shark populations are in decline or threatened by extinction, we need to expand our understanding of their health status in order to develop appropriate protective measures. All sharks were collected by sports fishing gear between June and August in 2007. Their health condition was assessed by necropsy, morphometrics, and by microscopic examination of gonads, livers, spleens and kidneys. Routine, haematoxylin and eosin and/or Pearl's reagent-stained paraffin embedded sections were studied by light microscopy. Our results provide the first data on the morphometric and morphological characteristics of MMC in viscera of apparently healthy free-ranging sharks from the northwestern Atlantic.

Early clinical failure of the Birmingham metal-on-metal hip resurfacing is associated with metallosis and soft-tissue necrosis

The rate and mode of early failure in 463 Birmingham hip resurfacings in a two-centre, multisurgeon series were examined. Of the 463 patients two have died and three were lost to follow-up. The mean radiological and clinical follow-up was for 43 months (6 to 90).

We have revised 13 resurfacings (2.8%) including seven for pain, three for fracture, two for dislocation and another for sepsis. Of these, nine had macroscopic and histological evidence of metallosis. The survival at five years was 95.8% (95% confidence interval (CI) 94.1 to 96.8) for revision for all causes and 96.9% (95% CI 95.5 to 98.3) for metallosis.

The rate of metallosis related revision was 3.1% at five years. Risk factors for metallosis were female gender, a small femoral component, a high abduction angle and obesity. We do not advocate the use of the Birmingham Hip resurfacing procedure in patients with these risk factors.

Modulation of inflammation by vitamin E and C supplementation prior to anterior cruciate ligament surgery

Muscle atrophy commonly follows anterior cruciate ligament (ACL) injury and surgery. Proinflammatory cytokines can induce and exacerbate oxidative stress, potentiating muscle atrophy. The purpose of this study was to evaluate the influence of prior antioxidant (AO) supplementation on circulating cytokines following ACL surgery. A randomized, double-blind, placebo-controlled trial was conducted in men undergoing ACL surgery, who were randomly assigned to either: (1) AO (200 IU of vitamin E (50% d-alpha-tocopheryl acetate and 50% d-alpha-tocopherol) and 500 mg ascorbic acid), or (2) matching placebos (PL). Subjects took supplements twice daily for 2 weeks prior to and up to 12 weeks after surgery. Each subject provided five blood samples: (1) baseline (Bsl, prior to supplementation and approximately 2 weeks prior to surgery), (2) presurgery (Pre), (3) 90 min, (4) 72 h, and (5) 7 days postsurgery. Following surgery, inflammation and muscle damage increased in both groups, as assessed by increased circulating IL-6, C-reactive protein, and creatine kinase. During AO supplementation, plasma alpha-T and AA increased while gamma-T concentrations decreased significantly (P< 0.05). At 90 min the AO group displayed a significant decrease in AA, an inverse correlation between AA and (interleukin) IL-8 (r(2)= 0.50, P< 0.05), and a significantly lower IL-10 response than that of the PL group. IL-10 was significantly elevated at 90 min and 72 h in the PL group. In summary, our findings show that circulating inflammatory cytokines increase and AO supplementation attenuated the increase in IL-10 in patients post-ACL surgery.

Peak power of muscles injured by lengthening contractions

Excessive or extreme lengthening contractions have a well-characterized depressive effect on skeletal muscle isometric force. In addition to producing force, active muscles must often shorten in order to meet the power requirements of locomotion and other physical activities. However, the impact of lengthening contractions on muscle power is poorly understood. We evaluated the effect of 20 isometric contractions or 20 lengthening contractions (20% strain at 1.5 fiber lengths/s) on the force-velocity-power relationships of mouse soleus muscles in vitro at 35 degrees C. Pre- and posttreatment data were obtained as the muscles shortened through their optimal length (Lo). The isometric treatment did not alter Lo, the curvature of the force-velocity relationship (a/Po), or soleus maximal shortening velocity (Vmax), whereas peak force (Po) displayed a slow, time-dependent decline of 10% across the experiments. Following the lengthening treatment, Lo increased by 6%, a/Po increased by 22%, and Vmax and Po fell by 24% and 26%, respectively. Under optimal conditions for producing power, muscles damaged by lengthening contractions attained 22% less force and shortened 20% more slowly than before damage. Consequently, soleus peak power fell 37% after lengthening, a 2.5-fold greater decline than noted for the isometric treatment. Under the conditions studied here, the excessive power loss following lengthening contractions was due to force and velocity deficits of approximately equal relative magnitude. Because power represents the ability of the muscle to perform work, reductions in both force and shortening velocity should be considered when evaluating and treating lengthening-induced skeletal muscle injuries.

Human critical power-oxygen uptake relationship at different pedalling frequencies

Critical power (CP) is lower at faster rather than slower pedalling frequencies and traditionally reported in watts (W). Faster pedalling frequencies also engender a greater metabolic rate (VO2) at low work rates, but with progressive increases in power output, the initial difference in VO2 between fast and slower pedalling frequencies is reduced. We tested the hypothesis that CP represents a unique metabolic rate for any given individual which would be similar at different pedalling frequencies. Eleven collegiate athletes (five cross-country runners, END; six sprinters, SPR), aged 18-23 years, performed exhaustive rides at either 60 or 100 r.p.m. on separate days for the determination of the pedal rate-specific CP. The VO2 at CP (CP-VO2) was determined from an 8 min ride at the CP for each pedal frequency. The group mean CP was significantly lower at 100 r.p.m. (189 +/- 50 W) compared to 60 r.p.m. (207 +/- 53 W, P < 0.05). However, the group mean CP-VO2 values at 60 (2.53 +/- 0.60 l min(-1)) and 100 r.p.m. (2.58 +/- 0.53 l min(-1)) were not significantly different. Critical power was significantly higher in the END athletes (242 +/- 50 W at 60 r.p.m.; 221 +/- 56 W at 100 r.p.m.) compared to SPR athletes at both pedal frequencies (177 +/- 38 W at 60 r.p.m.; 162 +/- 27 W at 100 r.p.m., P < 0.05), but the CP-VO2 was not (P > 0.05). However, when the CP-VO2 was scaled to body weight, the END athletes had a significantly greater CP-VO2 (41.3 +/- 4.1 ml min(-1) kg(-1) at 60 r.p.m.; 40.8 +/- 5.5 ml min(-1) kg(-1) at 100 r.p.m.) compared to the SPR athletes at both pedal frequencies (27.7 +/- 4.6 ml min(-1) kg(-1) at 60 r.p.m.; 29.4 +/- 2.8 ml min(-1) kg(-1) at 100 r.p.m., P < 0.05). We conclude that CP represents a specific metabolic rate (VO2) which can be achieved at different combinations of power outputs and pedalling frequencies.

Regional migratory osteoporosis: a review illustrated by five cases

Regional migratory osteoporosis is an uncommon self-limiting disease characterized by an arthralgia which migrates between the weight-bearing joints of the lower limb. The radiological features of the disease obtained by conventional radiography, CT, MRI and radionuclide scintigraphy are illustrated by means of five case reports. These range from the most common presentation of sequential, proximal to distal spread in the lower limb to the rare intra-articular form, and disease involving the axial skeleton is also recognized. Clinical and radiographical features often overlap with those of diseases such as transient osteoporosis of the hip and transient bone marrow oedema syndrome, which is reflected in confusing terminology. Histological sampling is usually unnecessary; the radiological features are characteristic and the histological findings are not specific. Regional migratory osteoporosis is associated with systemic osteoporosis. This association is probably under-recognized, and has implications for the pathophysiology of the disease and for treatment.

Walking and running inter-limb asymmetry for Paralympic trans-femoral amputees, a biomechanical analysis

The aim of this project was to further the research and understanding of the trans-femoral amputee's ability to walk and run by comparing the changes in walking and running inter-limb asymmetry. An objective biomechanical analysis was conducted on four male transfemoral amputees, all members of the Australian Paralympic training squad for the 1996 Atlanta Paralympic Games. The data was collected in the biomechanics laboratories at Queensland University of Technology and the Australian Institute of Sport. The main outcomes measure a synchronised 3D kinematic (200 Hz), kinetic (600 Hz) and temporal analysis of walking at self-selected (1.1-1.3 m/s), and at maximal running speed (2.5-4.3 m/s). The walking and running biomechanical data was summarised into 27 indices of symmetry. The results showed that for all subjects the inter-limb asymmetry was significantly different at running speed, when compared to the walking speed. Using indices of symmetry 79% of the kinematic, 67% of the kinetic, and 67% of the temporal measurements identified better inter-limb asymmetry when the subjects walked, compared to running. This study objectively identified that when Paralympic level amputees ran on their standard running prosthesis, the inter-limb asymmetry was exacerbated.

Optimising the trans-femoral prosthetic alignment for running, by lowering the knee joint

For amputees to perform an everyday task, or to participate in physical exercise, it is crucial that they have an appropriately designed functional prosthesis. The aim of this study was to investigate the optimal trans-femoral prosthetic alignment configuration for running. A case study design was implemented as the method to collect data on four male Paralympic level trans-femoral amputee runners. In total 28 synchronised 3D kinematic, kinetic, and temporal biomechanical measures were analysed. A new prosthetic alignment, in which the prosthetic knee axis was lowered longitudinally (moved distally), was evaluated for running. The performance of the symmetry indices and running time for a total of three new modified alignments were compared to the standard prosthetic alignment. The interlimb asymmetry was found to improve when the subjects ran on the modified prosthetic alignment, and most importantly a one way ANOVA found a statistically significant increase in running velocity. This study identified that for all four subjects, who used the same prosthetic components, lowering the prosthetic knee joint centre improved their interlimb symmetry, and subsequently their running velocity by an average of 26%.

Treatment of sialorrhea with glycopyrrolate: A double-blind, dose-ranging study

OBJECTIVE

To determine the safety and efficacy of glycopyrrolate in the treatment of developmentally disabled children with sialorrhea.

DESIGN

Placebo-controlled, double-blind, crossover dose-ranging study.

SETTING

Outpatient facilities in 2 pediatric hospitals.

PATIENTS

Thirty-nine children with both developmental disabilities and excessive and bothersome sialorrhea.

MAIN OUTCOME MEASURES

Parent and investigator evaluation of change in sialorrhea and adverse effects.

RESULTS

Glycopyrrolate in doses of 0.10 mg/kg per dose is effective at controlling sialorrhea. Even at low doses, 20% of children may exhibit adverse effects severe enough to require discontinuation.

CONCLUSIONS

Glycopyrrolate is effective in the control of excessive sialorrhea in children with developmental disabilities. Approximately 20% of children given glycopyrrolate may experience substantial adverse effects, enough to require discontinuation of medication. Arch Pediatr Adolesc Med. 2000;154:1214-1218.

Caries prediction and indicators using a pediatric risk assessment teaching tool

The goals of this study were to determine both predictability and risk indicators in a young pediatric population seen in a dental school clinic using a Caries Risk Assessment teaching tool. Assigned risk categories and factors for 140 patients were analyzed for relationships with future caries development using Logistic Regression (p < 0.01) and Chi-square analysis (p < 0.05). Among the group developing caries, variables and disease were analyzed using ANOVA Independent Samples Test (p < 0.05). Assigned-risk categories were significantly predictive with odds ratios (OR) of Moderate- and High-risk developing new caries being 5.41 and 28.64 respectively when compared with Low-risk. Significant risk indicators were diet, oral hygiene and the presence of caries and decalcifications. The risk assessment tool used in this study predicted future caries development. Through this method of assessment, caries risk indicators in the population studied were determined to be diet, oral hygiene and past caries experience.

Metaplastic carcinoma of the breast arising within complex sclerosing lesion: a report of five cases

AIMS

This study presents a series of five cases in which metaplastic carcinoma, predominantly low-grade adenosquamous carcinoma, of the breast is seen arising within a background of a complex sclerosing lesion. This association has been recognized previously but has not been documented in detail. This study describes the characteristics of the components present in each case and discusses the existing literature. This observation adds further evidence to support an association between some types of invasive breast carcinoma and sclerosing lesions of the breast.

METHODS AND RESULTS

Four of these cases were received as referral cases for opinion. The fifth was received as part of the routine surgical workload within our own institution. Two patients presented following mammographic screening and three symptomatically; their mean age was 62 years (range 49-68). The mean lesion size was 16 mm (range 7-24). All five lesions showed features of a complex sclerosing lesion/radial scar in the form of central sclerosis with elastosis and radiating benign entrapped tubules. One had associated benign papillary structures and two had focal benign squamous metaplasia. Four cases showed coexisting but distinct areas of low-grade adenosquamous carcinoma with glandular and squamous epithelial differentiation in a spindle cell background. One case had associated undifferentiated spindle cell carcinoma. Detailed immunophenotypic characteristics of two cases are presented.

CONCLUSIONS

This series illustrates a postulated but previously unconfirmed association between an unusual form of metaplastic breast carcinoma (adenosquamous carcinoma) and complex sclerosing lesions. The mechanisms of induction of breast carcinoma are poorly understood but these observations further emphasize the potential for sclerosing lesion of the breast to be associated with, and possibly give rise to, invasive carcinoma of different types. The precise nature of the interaction between the pathological processes remains unclear.

Patient motivation

This paper addresses the important issue of patient motivation. Research indicates that non-compliance is a major problem for healthcare professionals, with between a third and a half of all patients failing to comply with recommended healthcare instructions. The paper outlines some of the misconceptions associated with motivation and discusses six factors, together with some brief additional factors, which it is hoped will contribute to a deeper understanding of the subject and the improved dental health of patients.

Investigating the relationship between economic status and HIV risk

Although anecdotal information suggests that there is a relationship between socioeconomic status and HIV risk, there have been few investigations of that possible relationship. Understanding that relationship can have important implications for designing and implementing prevention programs. This study investigated the relationship between indicators of socioeconomic status and HIV prevalence in Massachusetts using seroprevalence data from publicly funded test sites. HIV seroprevalence was found to differ depending on demographic groups and the health care insurance/provider. Those who had no insurance or were Medicaid recipients had higher rates of HIV infection. Homeless individuals were also at higher risk. Further, low-income ZIP codes in Massachusetts were four times more likely to have high seroprevalence rates among residents voluntarily testing for HIV. Thus, HIV seroprevalence appears to be associated with socioeconomic status in this group of voluntarily tested individuals.

Sex, drugs and HIV counseling and testing: a prospective study of behavior-change among methadone-maintenance clients in New England

OBJECTIVES

To determine whether changes in injecting drug use and sexual behavior over a 12-month follow-up are associated with HIV counseling and testing (C and T) of injecting drug users in methadone maintenance treatment programs (MMTP) in Massachusetts and Connecticut.

METHODS

Clients were invited to participate in a longitudinal study involving five interviews. Data were also obtained by ethnographers and from clinical records. Behavioral outcomes of interest were number of drug injections, sharing of unclean 'works' (injecting equipment), number of unprotected sex partners, and number of unprotected sexual episodes. Data analyses included multiple regression, odds ratios, and quantitative analysis of text-based data.

RESULTS

Subjects reported reductions in both injecting drug use and sexual behavior Primary associations with reduced injecting drug use were remaining in the MMTP and attending HIV-positive support groups. A reduction in high-risk sexual behavior was associated with an HIV-positive test result and duration of HIV counseling in the MMTP. Increase in drug injecting use was associated with an HIV-positive test result. Inconsistent condom use was associated with enrollment in the MMTP where condoms were available only upon request and abstinence and monogamy between uninfected partners were promoted.

CONCLUSIONS

Injecting drug users who self-select to participate in MMTP and HIV C and T, two public health HIV-prevention interventions, reduce their HIV-risk behaviors. Clients should be encouraged to remain in MMTP and HIV-infected clients should attend support groups for HIV-positive persons. MMTP staff should promote a variety of safer sex behaviors and provide condoms without request.

Retention in methadone maintenance treatment programs, Connecticut and Massachusetts, 1990-1993

The goal of this study was to identify factors associated with six- and 12-month retention in methadone maintenance treatment programs (MMTPs) in Massachusetts and Connecticut. Data was obtained from 674 participants, clinic records, and clinic staff. Ethnographic and logistic regression analyses were conducted. Overall, 69% and 48% of the clients remained in treatment at six months and 12 months, respectively. The MMTPs were categorized as either a 12-Step, case management, or primary care model. Factors independently associated with retention in treatment at six months were each one-year increase in age of client (OR 1.05), injecting at three months (OR 0.47), and enrollment in the primary care model (OR 2.10). The same factors were associated with 12-month retention in treatment. To retain clients in MMTPs-which should, in turn, help reduce drug use and prevent HIV transmission among IDUs-younger IDUs and clients still injecting at three months after entering drug treatment may need additional services from the staff, or alternative treatment regimens. MMTP directors should consider differences between these programs and, if appropriate, make changes to increase retention in treatment.

Cytokine regulation of HIV replication induced by dendritic cell-CD4-positive T cell interactions

It has been established that human immunodeficiency virus (HIV) replication occurs throughout the course of disease in the lymphoid tissue. We have developed a model system to study the effect of cytokines and other agents on HIV replication using cocultures of DCs and T cells that reflect the cell-to-cell interactions that occur in the microenvironment of lymphoid tissue. Dendritic cells from peripheral blood, when pulsed with small amounts of HIV, induce infection in autologous, unstimulated CD4-positive T cells. Using this system, cytokines, anti-cytokine antibodies, and inhibitors of cellular activation were added to cultures and the effects on cellular proliferation and activation and HIV production were measured. Cytokines that increased T cell proliferation, such as IL-2 and IL-4, enhanced HIV replication, while the effect of IL-12 was more complex. HIV production was inhibited by blocking endogenously produced IL-2, as well as by adding IL-10, which blocks IL-2 secretion, antigen-presenting cell function, and T cell activation. Proinflammatory cytokines induced modest enhancement of viral replication in cocultures of HIV-pulsed DCs and CD4-positive T cells. Thus, using a model of HIV replication that more closely mimics the in vivo microenvironment of lymphoid tissue may allow a better analysis of the effect of cytokines and cytokine networks, as well as agents that modify immune activation on HIV replication.

Role of health beliefs in patient compliance with preventive dental advice

Lack of patient compliance with health recommendations is a well known fact. What is less well understood are the reasons why. This study used the Health Belief Model (HBM) to investigate the role of patients' health beliefs in patient compliance with preventive dental advice. A questionnaire was constructed to explore the four beliefs of "seriousness", "susceptibility", "benefits" and "self-efficacy" and this was administered to 43 adult patients attending the conservation department of a large teaching hospital for routine examination. Patients were seen twice, 1 month apart. At visit one, plaque was disclosed and plaque and bleeding scores were recorded. Patients were taught the modified Bass technique of plaque removal. Plaque and bleeding scores were repeated on visit two, 1 month later. Compliance was defined as any reduction in these scores at visit two. The health belief of "benefits" taken as a single variable showed a significant correlation with compliance and the combined beliefs of "susceptibility" and "benefits" were also found to be significantly related to compliance.

t(8;13) (p11;q12) translocation in a myeloproliferative disorder associated with a T-cell non-Hodgkin lymphoma

An unusual cytogenetic translocation, t(8;13) (p11;q12), is described in a patient presenting with a CML-like myeloproliferative disorder associated with a high-grade T-cell lymphoma. Evidence is presented suggesting that the breakpoint region in the translocation involves a site implicated in both the T cell malignancy and the abnormal granulocyte proliferation.