HIV status and viral loads among men testing positive for rectal gonorrhoea and chlamydia, Maricopa County, Arizona, USA, 2011-2013

OBJECTIVES

Men diagnosed with rectal gonorrhoea (GC) and chlamydia (CT) have engaged in unprotected receptive anal intercourse. We reviewed the HIV positivity and HIV viral loads (VLs) of men who had rectal GC and CT testing to evaluate potential HIV acquisition and transmission risk.

METHODS

Rectal GC and CT testing data for men attending the Maricopa County STD clinic during the period from 1 October 2011 to 30 September 2013 were cross-matched with HIV surveillance data to identify men with HIV coinfection. We examined HIV status, HIV diagnosis date, and the values of VL collected nearest to the date of reported rectal infection.

RESULTS

During the 2-year time period, 1591 men were tested for rectal GC and CT. Of the men tested, 506 (31.8%) were positive for GC (13.2%), CT (12.2%) or both (6.4%); 119 (23.5%) of those with rectal GC or CT were coinfected with HIV. Among the 275 men with HIV at the time of rectal testing, 54 (19.6%) had no reported VL; 63 (22.9%) had an undetectable VL (< 20 HIV-1 RNA copies/mL) and 158 (57.4%) had a detectable VL collected within 1 year of rectal diagnosis. Mean VL was higher among HIV and rectal GC/CT coinfected cases compared with men with HIV alone (174 316 vs. 57 717 copies/mL, respectively; P = 0.04).

CONCLUSIONS

Approximately one-third of men undergoing rectal testing were positive for GC or CT and one-quarter of men with rectal GC or CT also had HIV infection. Of the HIV-infected men tested for rectal GC or CT, more than half had a detectable VL collected near the time of rectal testing, demonstrating a risk for transmitting HIV.

Sealing Composite With Defective Margins, Good Care or Over Treatment? Results of a 10-year Clinical Trial

Purpose

The objective of this study was to clinically evaluate sealed composite restorations after 10 years and compare their behavior with respect to controls.

Methods and Materials

The cohort consisted of 20 patients aged 18 to 80 years with 80 composite restorations. All participants in the sealing and no-treatment groups presented with clinical features for the marginal adaptation that deviated from the ideal and were rated Bravo (United States Public Health Service criteria). Composites with Alfa values for the marginal adaptation were used as the positive control.

Results

The marginal adaptation behavior was similar between the sealing and control (+) groups, with a high frequency of Bravo values in the 10th year (80% and 51%, respectively). Most of the no-treatment (-) group maintained the Bravo values (91%) for 10 years, although some restorations (9%) progressed to Charlie values. The anatomy parameter differed significantly between the first and 10th years, with deterioration in all three groups (p&lt;0.05). The secondary caries parameter had a similar behavior in the three groups (p&gt;0.05).

Conclusions

Sealing the margins of the composite resin restorations had no significant effect compared with the control groups, under the conditions of this study. Sealing the restorations substantially improved the marginal staining and marginal adaptation parameters, although by the tenth year they were similar to the group without intervention.

Pediatric disaster preparedness and response and the nation's children's hospitals

OBJECTIVE

Children account for 30 percent of the US population; as a result, many victims of disaster events are children. The most critically injured pediatric victims would be best cared for in a tertiary care pediatric hospital. The Children's Hospital Association (CHA) undertook a survey of its members to determine their level of readiness to respond to a mass casualty disaster.

DESIGN

The Disaster Response Task Force constructed survey questions in October 2011.

SETTING AND PARTICIPANTS

The survey was distributed via e-mail to the person listed as an "emergency manager/disaster contact" at each association member hospital and was designed to take less than 15 minutes to complete.

MAIN OUTCOME MEASURES

The survey sought to determine how children's hospitals address disaster preparedness, how prepared they feel for disaster events, and how CHA could support their efforts in preparedness.

RESULTS

One hundred seventy-nine surveys were distributed with a 36 percent return rate. Seventy percent of respondent hospitals have a structure in place to plan for disaster response. There was a stronger level of confidence for hospitals in responding to local casualty events than for those responding to large-scale regional, national, and international events. Few hospitals appear to interact with nonmedical facilities with a high concentration of children such as schools or daycares.

CONCLUSIONS

Little commonality exists among children's hospitals in approaches to disaster preparedness and response. Universally, respondents can identify a disaster response plan and routinely participate in drills, but the scale and scope of these plans and drills vary substantially.

Síndrome del canal radial: nueva técnica de liberación endoscópica

El objetivo de este trabajo es presentar una nueva técnica endoscópica para la liberación de la rama motora del nervio radial en el síndrome del canal radial.

El síndrome del canal radial es la neuropatía compresiva de la rama motora del nervio radial que, muy a menudo, requiere la liberación quirúrgica mediante la apertura completa de las estructuras que producen la compresión.

Las vías de abordaje convencionales son amplias, requieren disecciones agresivas y laboriosas. El pequeño tamaño del nervio y su posición profunda entre vientres musculares hace que, fácilmente, pueda ser dañado durante su disección si la visualización no es correcta en todo momento.

Presentamos una nueva técnica que combina el marcaje preoperatorio de la posición del nervio mediante ecografía y liberación mediante técnica endoscópica.

Esta técnica permite un abordaje quirúrgico mucho menor, una mejor visualización del nervio en todo su recorrido y de las estructuras anatómicas durante la disección.

Se presenta una serie de 22 intervenciones en 20 pacientes intervenidos entre 2010 y 2014. En 14 casos los resultados fueron excelentes, 5 buenos y 3 regulares. Las complicaciones fueron en un caso una lesión parcial del nervio durante la cirugía y 4 casos de paresia a la extensión de los dedos que se recuperaron completamente en todos los casos entre las 3 y 6 semanas.

Direct imaging of the magnetization reversal in microwires using all-MOKE microscopy

We report a method of imaging of the magnetization reversal process using analysis of real-time images of magnetic domain structures in cylindrically shaped microwires. This method uses wide-field polarizing optical microscopy and is based on the magneto-optical Kerr effect (MOKE). The aperture diaphragm in MOKE microscope was used to control the incident angles of the light rays that reached the non-planar surface of the microwire and also determined the MOKE geometries. The movement of the non-central position of the hole in this diaphragm leads to a change in the orientation of the plane of incidence of the light along the perpendicular or the parallel direction to the axial direction of the wire. The visualization of the surface magnetic domain structures is obtained using polar and longitudinal MOKE geometries. The hysteresis loops were obtained by plotting the averaged image contrast as a function of the external magnetic field. The separation of the all-magnetization components is performed using different MOKE geometries in a microscope. We demonstrate the use of vector magnetometry to analyze the orientation of the magnetization in a cylindrically shaped microwire under the influence of an external magnetic field.

Prediction of extracapsular disease with multiparametric magnetic resonance imaging in high risk localized prostate cancer patient

OBJECTIVES

To assess the usefulness of multiparametric magnetic resonance imaging (MRI) in the staging of patients with localized prostate cancer (PC) and high risk of extracapsular disease (ECD).

METHODS

Retrospective study including 30 patients with localized PC and high risk of ECD. Pathologist and radiologist established an ECD suspicion according to the evaluation of the prostatic biopsy specimens and the multiparametric MRI analysis, respectively. Radical prostatectomy (RP) specimen analysis was used as a definitive confirmatory reference. Kappa (k)test was used to assess the degree of consistency between the initial suspicion provided by both specialists and the reference RP specimen.

RESULTS

When the prostatic gland was analyzed as a single unit, the pathological evaluation of the biopsy specimens did not correctly detect the risk of ECD in 46.6% of the patients (14/30; 10 FN; k=-0.035, 95%CI [-0.29-0.36]), while multiparametric MRI did not do in 36% of the cases (11/30, 9 FP; k=0.27, 95%CI [-0.03-0.61]). Whereas, if each side of the prostate (i.e. right and left) was considered as an independent observation, the pathologist wrongly predicted the risk of ECD in 35% of the cases (21/60; 18 FN; k=0.19, 95%CI [-0.03-0.40]), while the radiologist erred only in 18.3% of the cases (11/60; 7 FN and 4 FP; k=0, 61, 95%CI [0.40-0.81]).

CONCLUSIONS

Data from our experience suggest an added value of multiparametric MRI in the clinical staging of localized PC in cases of high risk of ECD. Multiparametric MRI may be used as a helpful tool in the surgical planning and the decision-making process regarding the management of this entity.

Paracrine factors of human mesenchymal stem cells increase wound closure and reduce reactive oxygen species production in a traumatic brain injury in vitro model

Traumatic brain injury (TBI) consists of a primary and a secondary insult characterized by a biochemical cascade that plays a crucial role in cell death in the brain. Despite the major improvements in the acute care of head injury victims, no effective strategies exist for preventing the secondary injury cascade. This lack of success might be due to that most treatments are aimed at targeting neuronal population, even if studies show that astrocytes play a key role after a brain damage. In this work, we propose a new model of in vitro traumatic brain-like injury and use paracrine factors released by human mesenchymal stem cells (hMSCs) as a neuroprotective strategy. Our results demonstrate that hMSC-conditioned medium increased wound closure and proliferation at 12 h and reduced superoxide production to control conditions. This was accompanied by changes in cell morphology and polarity index, as both parameters reflect the ability of cells to migrate toward the wound. These findings indicate that hMSC is an important regulator of oxidative stress production, enhances cells migration, and shall be considered as a useful neuroprotective approach for brain recovery following injury.

Prolactin rescues and primes autoreactive B cells directly and indirectly through dendritic cells in B6.Sle3 mice

The lupus susceptibility interval Sle3/5 confers responsiveness to prolactin in C57BL/6 (B6) mice and hyperprolactinaemia induces a lupus-like phenotype in B6.Sel3/5 mice. In this study, the immunostimulatory effects of prolactin in B6 mice containing the Sle3 portion of the Sel3/5 interval (B6.Sle3 mice) were dissected. Because of the Sle3 interval's involvement in activation of myeloid cells, the effect of dendritic cells (DCs) from prolactin-treated B6.Sle3 mice on the phenotype of B6 mice was also evaluated. B cells from prolactin-treated B6 and B6.Sle3 mice and from B6 recipients of prolactin-modulated DCs from B6.Sle3 mice were tested for DNA-reactivity and resistance to B cell receptor (BCR)-mediated apoptosis. The expression of co-stimulatory molecules on lymphocytes and myeloid cells was also evaluated. In prolactin-treated B6.Sle3 mice, transitional type 2 B cells increased while type 1 B cells decreased as a consequence of prolactin-induced resistance to BCR-mediated apoptosis leading to the survival of DNA-reactive B cells. Follicular B cells from prolactin-treated mice expressed increased levels of CD40, B7·2 and IA(b), and DCs and monocytes had higher levels of CD44 and B7·2 than placebo-treated mice. Adoptive transfer of DCs from prolactin-treated B6.Sle3 mice to B6 recipients demonstrated the intrinsic ability of prolactin-modulated DCs to induce a development of lupus-like characteristics in B6 mice. Based on these results, prolactin accelerates the breakdown of immune tolerance in B6.Sle3 mice by promoting the survival, maturation and activation of autoreactive B cells, DCs and macrophages.