Effect of menstrual cycle on HIV-1 levels in the peripheral blood and genital tract. WHS 001 Study Team

OBJECTIVE

To assess the variation in HIV-1 over the menstrual cycle, including RNA levels in the female genital tract, plasma HIV-1-RNA levels, CD4 cell counts, and culturable virus.

DESIGN

A prospective analysis of 55 HIV-1-infected women.

METHODS

Blood and genital tract specimens were collected weekly over 8 weeks, spanning two complete menstrual cycles. Applying repeated-measures models that used menses as the reference level, the variation in viral RNA levels was compared in endocervical canal fluid and cells (collected by Sno-strips and cytobrush, respectively) and ectocervicovaginal lavage (CVL) fluid. Repeated-measures models were also used to assess the variation in plasma CD4 cell counts and viral load.

RESULTS

Shedding patterns differed among the three sampling methods, independent of genital tract co-infections. Genital tract HIV-1-RNA levels from CVL fluid and endocervical canal cytobrush specimens were highest during menses and lowest immediately thereafter (P = 0.001 and P = 0.04). The HIV-1-RNA level in endocervical canal fluid was highest in the week preceding menses (P = 0.003). The menstrual cycle had no effect on blood levels of RNA (P = 0.62), culturable virus (P = 0.34), or CD4 cell counts (P = 0.55). HIV-1-RNA levels were higher in endocervical canal fluid than in peripheral blood plasma during the late luteal phase (P = 0.03).

CONCLUSION

HIV-1-RNA levels vary with the menstrual cycle in the female genital tract but not the blood compartment. HIV-1-RNA levels are higher in endocervical canal fluid than in blood plasma. These findings may have important implications for sex-specific pathogenesis, heterosexual transmission, and contraceptive hormone interventions in HIV-1-infected women.

Impact of sexual abuse on the HIV-risk-related behavior of adolescents in intensive psychiatric treatment

OBJECTIVE

This study compared the HIV-risk-related behaviors and attitudes of adolescents with and without a history of sexual abuse who were in intensive psychiatric treatment.

METHOD

Adolescent patients (N=208) completed measures of psychological functioning and HIV-related knowledge, attitudes, and behaviors.

RESULTS

Among sexually active adolescents in psychiatric treatment (N=116), those with a history of abuse reported significantly less condom self-efficacy (emotional ability to use condoms), less knowledge of HIV, less impulse control, less frequent use and purchase of condoms, and significantly higher rates of sexually transmitted diseases than their peers. Multiple logistic regression indicated that a history of sexual abuse was strongly associated with inconsistent condom use.

CONCLUSIONS

Sexual abuse was associated with HIV-risk-related attitudes and behaviors among adolescents in psychiatric treatment. Clinicians should thus view a history of sexual abuse as a marker for sexual behavior that puts adolescents at risk for HIV.

The impact of the ovulatory cycle on cytokine production: evaluation of systemic, cervicovaginal, and salivary compartments

To understand the impact of the menstrual cycle on immunologic parameters, we measured the level of cytokines and chemokines from plasma, cervicovaginal lavage (CVL), and saliva samples of 6 premenopausal women during the follicular and luteal phases of the ovulatory cycle. We demonstrate that the level of plasma interleukin-8 (IL-8) was 4-fold higher during the follicular phase than the luteal phase (p = 0.004), whereas plasma IL-1beta, IL-4, IL-6, IL-10, interferon-gamma (IFN-gamma), transforming growth factor-beta (TGF-beta), tumor necrosis factor-alpha (TNF-alpha), macrophage inflammatory protein-1alpha (MIP-1alpha), and TNF receptor II (TNFR II) were not altered during the ovulatory cycle. In the vaginal compartment, as measured from CVL samples, the levels of IL-6 and IL-1beta were both 5-fold higher in the follicular than the luteal phase (p = 0.0002 and 0.03, respectively). Salivary cytokine and chemokine samples were similar when measured during the luteal and the follicular phases. Additional analysis of lymphocyte subsets for phenotypic and functional markers indicated that they were not influenced by the ovulatory cycle. Collectively, these data suggest that IL-6, IL-8, and IL-1beta are differentially regulated during the ovulatory cycle.

A case study in assessing an ethnically diverse community-based aging population: a multimethod approach

Obtaining useful information to improve services for older, multi-ethnic populations requires a nontraditional approach to assessing needs that can overcome both cultural barriers and natural suspicions about research. This case study describes a multimethod needs assessment conducted in a large senior housing facility, where 58% of residents were non-English-speaking. Methods of data collection were both qualitative and quantitative. Data were gathered by focus groups, interviews, and a written survey (N = 874) on topics of need for personal care assistance, level of assistance required for instrumental activities of daily living, and mobility. Qualitative inquiry yielded information about facilities and safety, and culturally specific needs, particularly communication. The case study concludes by discussing how the research findings translated into on-site programmatic changes, and delineating the factors that contributed to the success of this approach.

Thoracic reirradiation for symptomatic relief after prior radiotherapeutic management for lung cancer

Limited information is available in the medical literature on thoracic reirradiation for patients with recurrent/persistent lung carcinoma or new primary lung tumors. Controversy exists regarding the retreatment because of concerns regarding the risk of radiation toxicity. The medical and radiotherapeutic records of more than 1,500 patients with lung cancer seen in the Department of Radiation Oncology at Thomas Jefferson University Hospital from 1982 through 1997 were searched. Twenty-three patients with history of previous thoracic radiation therapy underwent thoracic reirradiation for either biopsy-proven and/or radiographically evident tumor recurrence, metastasis, or second lung primary. Most patients were reirradiated because of progressive dyspnea, cough, thoracic pain, or hemoptysis. Each of these symptoms was evaluated separately with regard to the subjective response to reirradiation. The median follow-up time from completion of reirradiation to last correspondence with the patient and/or family was 3.2 months, with a range of 0 to 17.5 months. In six patients with hemoptysis, a decrease or resolution of this symptom was noted. Of five patients with thoracic pain attributed to carcinoma, four noted an improvement in pain after reirradiation. Of 15 patients with cough, 9 had an improvement in cough, and of 15 patients with dyspnea, 11 had an improvement. Thoracic reirradiation is an effective modality in patients with hemoptysis, thoracic pain, cough, and dyspnea attributed to a radiographically defined recurrence and/or progression of lung cancer.

Managed care and multilevel long-term care providers: reluctant partners

Managed care is reshaping our health care system, although long-term care is only beginning to feel its effects. We report on the managed care involvement of 492 multilevel, long-term care facilities (MLFs; including skilled nursing and assisted/independent living) nationally. Organizational structure and culture and especially environmental characteristics are associated with whether facilities have contracts with managed care organizations (MCOs), plan to have contracts, are only gathering information on MCOs, or intend to do nothing in the near future. Resource dependence theory best explains MCO contracting patterns with MLFs appearing to be responding more to survival than to growth.

Aberrant nodulation response of Vigna umbellata to a Bradyrhizobium japonicum NodZ mutant and nodulation signals

The (Brady)rhizobium nodulation gene products synthesize lipo-chitin oligosaccharide (LCO) signal molecules that induce nodule primordia on legume roots. In spot inoculation assays with roots of Vigna umbellata, Bradyrhizobium elkanii LCO and chemically synthesized LCO induced aberrant nodule structures, similar to the activity of these LCOs on Glycine soja (soybean). LCOs containing a pentameric chitin backbone and a reducing-end 2-O-methyl fucosyl moiety were active on V. umbellata. In contrast, the synthetic LCO-IV(C16:0), which has previously been shown to be active on G. soja, was inactive on V. umbellata. A B. japonicum NodZ mutant, which produces LCO without 2-O-methyl fucose at the reducing end, was able to induce nodule structures on both plants. Surprisingly, the individual, purified, LCO molecules produced by this mutant were incapable of inducing nodule formation on V. umbellata roots. However, when applied in combination, the LCOs produced by the NodZ mutant acted cooperatively to produce nodulelike structures on V. umbellata roots.

Enhancing managed care's role in long-term care: building on the aging network

As Medicare managed care organizations grow, they will likely enroll more functionally impaired older people, as well as individuals with special linguistic and cultural needs. Traditional aging network service providers have special expertise to serve these populations. To date, however, the aging network has only been integrated into the operations of managed care on a very limited basis, primarily by demonstration projects. This article highlights program examples of collaboration between the aging network providers and managed care organizations for case management, screening, assisted living, and adult day care. The steps managed care organizations should take to build on the expertise of the aging network are described.

Plasma triglyceride-rich lipoprotein and high density lipoproteins disorders associated with atherosclerosis

The aforementioned epidemiological studies have played a central role in defining the importance of plasma lipoprotein disorders in the pathogenesis of atherosclerosis. More specifically, they have been instrumental in establishing plasma lipid and lipoprotein levels such as the plasma concentration of triglyceride, LDL, HDL, and Lp(a), as indicators of CAD risk. The challenge for future epidemiological studies will be to better define the link between CAD and a) the level of particular lipoprotein subfractions, b) factors affecting lipoprotein metabolism, and c) factors affecting the atherogenicity of plasma lipoproteins. For example, it is important to define which triglyceride-rich lipoprotein subfractions are most strongly associated with risk of CAD (e.g., intestinal vs hepatic TRL, large TRL vs smaller TRL remnants) or which subfractions of HDL are most protective (e.g., large vs small HDL, apoE-containing HDL vs apoAI- and All-containing HDL). The relationship between CAD and plasma levels of lipoprotein enzymes and co-factors (e.g., cholesterol ester transfer protein, LCAT), and also compounds that can potentially affect the oxidizability of lipoproteins (e.g., vitamins, paraoxanase) needs to be more clearly defined. Finally, future studies will need to focus not just on the relationship between plasma lipid disorders and atherosclerosis, but between plasma lipids and plaque stability and risk of thrombosis.

HIV quantitation in spiked vaginocervical secretions: lack of non-specific inhibitory factors. DATRI 005 Study Team. Division of AIDS Treatment Research Initiative

The objective of this study was to assess the effect of menstrual phase on the ability to quantitate HIV-1 in vaginocervical secretions (VCS) through reconstruction experiments with HIV seronegative VCS collected throughout the menstrual cycle. Measurement of HIV-1 inoculated into both fresh and frozen VCS was undertaken by quantitative micro co-culture, p24 antigen assay and polymerase chain reaction (PCR) for both HIV-1 RNA and pro-viral DNA. Two laboratories carried out these assays over a range of viral concentrations. The study involved a randomized factorial design and the factors were: (1) diluents (phases of the menstrual cycle and controls); (2) laboratories; (3) stock concentrations; and (4) frozen versus fresh VCS samples. Each assay was assessed independently using a random effects analysis of variance (ANOVA) model. No statistical differences due to menstrual cycle were seen in the assay results of p24 antigen (P = 0.08), PBMC culture (P = 0.74), plasma culture (P = 0.13), cell-free RNA (P = 0.44), cell-associated RNA (P = 0.58) and cell-associated DNA (P = 0.43). Inter-laboratory differences were statistically significant for cell-free RNA (P < 0.001), cell-associated DNA (P < 0.001) and p24 (P < 0.001). It is concluded that VCS obtained throughout the menstrual cycle from HIV-uninfected women lacks intrinsic inhibitory factors which could limit detection and quantification by antigen, culture or nucleic acid-based technologies for HIV-1 in VCS throughout the menstrual cycle. Using a standardized collection procedure, we suggest that variation in HIV quantity over time, when reported in VCS of infected women, should be attributed to HIV-associated biologic factors, rather than non-specific or other technical factors.

Effect of zafirlukast (Accolate) on cellular mediators of inflammation: bronchoalveolar lavage fluid findings after segmental antigen challenge

The effect of zafirlukast (Z) to alter the inflammatory response to segmental antigen challenge (SAC) was assessed by bronchoalveolar lavage (BAL) in this double-blind, placebo-controlled, two-period, crossover trial in 11 allergic asthmatic patients. Patients with asthma and positive skin tests to antigen received 7 d of treatment with Z (20 mg twice daily) or placebo (P) during two trial periods 14 to 21 d apart. At steady state (Day 5), patients underwent SAC followed by BAL immediately after challenge and 48 h later. Purified alveolar macrophages were analyzed ex vivo for phorbol myristate acetate (PMA)-driven superoxide release. Results were analyzed by analysis of variance (ANOVA). Forty-eight hours after SAC, Z therapy was associated with significantly reduced BAL lymphocytes and alcian blue-positive cells (presumably basophils) compared with P (p < 0.01), with a trend toward reduced numbers of alveolar macrophages (p = 0.06). PMA-driven superoxide release by purified alveolar macrophages was significantly reduced 48 h after SAC in the Z versus P arms (p < 0.05). Reduction of basophil influx, mediator release, and cellular activation may be important in attenuating the late phase of asthma. Collectively, the data suggest that zafirlukast therapy alters cellular infiltration and activation associated with antigen challenge.

Chlorpyrifos produces selective learning deficits in rats working under a schedule of repeated acquisition and performance

Chlorpyrifos (CPF) is a cholinesterase-inhibiting organophosphate pesticide used extensively to treat crops and domestic animals. Two experiments determined the effects of acute and repeated CPF exposure on the acquisition and performance of response sequences. Adult male Long-Evans rats (n = 16), maintained at 300 g body weight were trained using food reinforcement under a multiple schedule of repeated acquisition (RA) and performance (P). The RA component required completion of a four-response sequence on three levers (e.g., center, right, left, right) that changed with each session, while the correct sequence in the P component was invariant. In experiment I, rats were orally administered vehicle (corn oil), 12.5, 25, 37.5 and 50 mg/kg CPF. Doses of 37.5 and 50 mg/kg produced greater accuracy decreases in RA than in P, suggesting a selective learning deficit. In experiment II, the rats were divided into two groups (n = 7), and received either vehicle or 12.5 mg/kg CPF, 5 day/wk, for 8 wk. Although 12.5 mg/kg CPF was barely effective when administered acutely, when administered repeatedly it initially decreased accuracy in both RA and P. Tolerance developed to CPF effects on P accuracy but not on RA accuracy. Microanalyses of response patterns indicated the most common type of error was a progression through the sequence as if incorrect responses were actually correct. Radiometric analyses of serum cholinesterase activity showed CPF produced 90% inhibition at 3 hr and 85% inhibition at 24 hr postexposure. These results show that both acute and repeated CPF produced a selective deficit in the learning of response sequences in rats. This selectivity was most clearly expressed through the development of tolerance to the disruptive effects of repeated CPF on the performance but not the learning of response sequences.

Structural cues involved in endoplasmic reticulum degradation of G85E and G91R mutant cystic fibrosis transmembrane conductance regulator

Abnormal folding of mutant cystic fibrosis transmembrane conductance regulator (CFTR) and subsequent degradation in the endoplasmic reticulum is the basis for most cases of cystic fibrosis. Structural differences between wild-type (WT) and mutant proteins, however, remain unknown. Here we examine the intracellular trafficking, degradation, and transmembrane topology of two mutant CFTR proteins, G85E and G91R, each of which contains an additional charged residue within the first putative transmembrane helix (TM1). In microinjected Xenopus laevis oocytes, these mutations markedly disrupted CFTR plasma membrane chloride channel activity. G85E and G91R mutants (but not a conservative mutant, G91A) failed to acquire complex N-linked carbohydrates, and were rapidly degraded before reaching the Golgi complex thus exhibiting a trafficking phenotype similar to DeltaF508 CFTR. Topologic analysis revealed that neither G85E nor G91R mutations disrupted CFTR NH2 terminus transmembrane topology. Instead, WT as well as mutant TM1 spanned the membrane in the predicted C-trans (type II) orientation, and residues 85E and 91R were localized within or adjacent to the plane of the lipid bilayer. To understand how these charged residues might provide structural cues for ER degradation, we examined the stability of WT, G85E, and G91R CFTR proteins truncated at codons 188, 393, 589, or 836 (after TM2, TM6, the first nucleotide binding domain, or the R domain, respectively). These results indicated that G85E and G91R mutations affected CFTR folding, not by gross disruption of transmembrane assembly, but rather through insertion of a charged residue within the plane of the bilayer, which in turn influenced higher order tertiary structure.

Home use of a functional electrical stimulation system for standing and mobility in adolescents with spinal cord injury

OBJECTIVE

Functional electrical stimulation (FES) is a technology that may allow some patients with spinal cord injury (SCI) to integrate standing and upright mobility with wheelchair mobility. The purpose of this study was to document the patterns of home and community use of a FES system for standing and mobility.

DESIGN

A telephone questionnaire was administered every 1 to 4 weeks for a minimum of 1 year. An interview was given at the end of the study to probe the motivators and barriers to home use.

SETTING

Training for use of the FES system was performed in an inpatient pediatric rehabilitation setting. Data collection began after the subjects were discharged to home.

PARTICIPANTS

Five adolescents with complete, thoracic-level SCI.

INTERVENTION

Subjects participated in a program of FES exercise followed by training in basic mobility skills such as standing transfers, maneuvering, level ambulation, one-handed and reaching activities, and stair ascent/descent.

MAIN OUTCOME MEASURE

The frequency with which the FES system was used at home and the activities for which it was utilized were documented. Motivators and barriers to FES home use were examined.

RESULTS

Subjects donned the FES system on the average once every 3 to 4 days. Between 51% and 84% of the times donned, the system was used for exercise. The remaining times it was used for standing activities, most commonly reaching, one-handed tasks, and standing for exercise. "Motivators" included being able to do things that would otherwise be difficult, perceiving a healthful benefit or a sense of well-being from standing and exercise, and feeling an obligation to stand as a participant in a research study. "Barriers" to FES use included not finding time to use the system, having difficulty seeing opportunities to stand, and being reluctant to wear the FES system all day.

Repeated acquisition and the assessment of centrally acting compounds

Repeated acquisition (RA) procedures are behavioral preparations in which subjects learn new sequences of responses during each experimental session. They have been used with great success to assess the effects of drugs and other compounds on learning processes. As learning can be measured over many sessions in individual subjects, RA procedures can prove invaluable when conducting studies of the effects of chronic drug administration, aging and the long-term effects of exposure to toxic compounds. Analyzing the patterns of responding during acquisition can provide insights into the behavioral mechanisms underlying the effects of drugs and other centrally acting compounds on learning. Systematic comparisons are needed on the influence of many procedural variables on RA and the extent to which they may modulate the effects of chemicals.

Medical education on violations of human rights: the responsibility of health personnel

Violation of human rights began as a subject in the Tromsø curriculum in 1994. Teaching is organized in three parts: the first part takes place in the second year of the medical curriculum during the study of medical history; the second part takes place in the fourth year under the title 'torture and the medical profession' and includes a seminar on immigrant children; and the third part takes place in the sixth year, under the title 'the violations of the human rights, especially in children'.

Ethological and experimental approaches to behavior analysis: implications for ecotoxicology

Laboratory research in toxicology has progressed far beyond reliance on measures of mortality to make use of sophisticated behavioral preparations that can evaluate the consequences of sublethal toxicant exposure. In contrast, field studies have not evolved as rapidly. Approaches developed by experimental psychologists and ethologists provide powerful and complementary methodologies to the study of environmental pollutants and behavior. Observational data collection techniques can easily be used to broaden the number of questions addressed regarding sublethal exposure to toxic agents in both field and laboratory environments. This paper provides a background in such techniques, including construction of ethograms and observational methodologies, and the use of laboratory analogues to naturally occurring activities such as social behavior, predation, and foraging. Combining ethological and experimental approaches in behavior analysis can result in a more comprehensive evaluation of the effects of environmental contaminants on behavior.

Antiretroviral monotherapy in early stage human immunodeficiency virus disease has no detectable effect on virus load in peripheral blood and lymph nodes

Initiation of antiretroviral monotherapy early in the course of infection with human immunodeficiency virus may result in a temporary slowing in the rate of disease progression; however, little is known about the virologic effects of early therapy. Virus load was measured in peripheral blood and lymph nodes from 16 antiretroviral-naive patients with a mean CD4 T lymphocyte count of 659 cells/microliter at baseline and after 8 weeks of either no treatment or zidovudine therapy. CD4 T lymphocyte counts and all virologic parameters examined remained unchanged regardless of zidovudine treatment status. Histopathology and virus distribution within lymph nodes remained constant between baseline and week 8 in each patient, indicating that the virologic and histologic parameters examined in a single lymph node are representative of a systemic process. Early antiretroviral monotherapy with zidovudine had no effect on virologic parameters in this group of patients with relatively high CD4 T lymphocyte counts and low measures of virus load at baseline.

Animal behavioral methods in neurotoxicity assessment: SGOMSEC joint report

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