Cross-cultural and socio-demographic correlates of homophobic attitude among university students in three European countries

PURPOSE

The aim of this study was to investigate homophobic attitudes in three European countries: Italy, Albania, and Ukraine. One thousand and forty-eight students were recruited in Italian (n = 766), Albanian (n = 180), and Ukrainian (n = 102) university centers.

METHODS

A socio-demographic questionnaire and Homophobia Scale (HS) were administered by our staff.

RESULTS

Cross-cultural and significant differences among Italian, Albanian, and Ukrainian students were found on the Homophobia Scale (HS; Italy: mean = 22.26 ± 16.73; Albania: mean = 38.15 ± 17.28; Ukraine: mean = 59.18 ± 16.23). The analysis of socio-demographic characteristics revealed that the male gender emerged as main predictor of homophobic attitude in all the three countries, although also a conservative political orientation and the religious belief predict higher homophobia levels in Italy and Albania, particularly.

CONCLUSIONS

This study revealed that in these European countries assessed, attitudes toward homosexuality are different. Ukrainians display higher levels of homophobia than Albanians and Italians, confirming the central role of cultural differences in homophobic attitudes. Nevertheless, some socio-demographic aspects such as identification as male have a similar influence on homophobic attitudes in all assessed populations.

Positive end-expiratory pressure, prone positioning, and activated protein C: a critical review of meta-analyses

The results of meta-analyses on the effectiveness of high positive end-expiratory pressure (PEEP) and prone positioning in acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) are not consistent. In addition, the meta-analyses on the activated protein C in patients with sepsis combine trials with discordant results. Therefore, the aim of this paper was to give a critical review of these meta-analyses. All relevant meta-analyses were identified by a computerized search of PubMed using combinations of the following terms: acute lung injury, acute respiratory distress syndrome, positive end-expiratory pressure, mechanical ventilation, prone position, drotrecogin, activated protein C, sepsis, and septic patients. A high level of PEEP and prone ventilation was shown to reduce the mortality in patients with severe acute hypoxemic respiratory failure. Although the evidence for the efficacy of activated protein C is not conclusive, it should be considered in patients that are at a high risk for death without any contraindications related to bleeding risk. Meta-analysis models can be very useful for clinical decisions if they include all of the similar papers on a medical topic and are correct from the methodological point of view; however, these results must be checked by a careful and well-informed reader.

Statistical methods for evidence-based medicine: the diagnostic test. Part II

Part II of this work addresses the use of likelihood ratios for the calculation of a positive predictive value (PPV) and a negative predictive value (NPV) for patient diagnosis. These two values are the most useful indices in the application of a diagnostic test in order to make a diagnosis for a patient. Furthermore, the relevance of sample size is also addressed by providing background theory and pertinent tables. These basic topics for assessing the validity of a diagnostic test and for performing appropriate and valid case vs control studies are explained in a simple way for a clinical audience with a working example.

Statistical methods for evidence-based medicine: the diagnostic test. Part I

According to evidence-based medicine (EBM), physicians must be able to assess and understand scientific evidence generated from biomedical research. Among the many statistical methods involved in the proof of the evidence, an essential area concerns how to select and interpret diagnostic tests to confirm or exclude a diagnosis. Rather surprisingly, these statistical methods are not always correctly reported or satisfactorily explained in some EBM reference books, which leads to misunderstandings and incorrect analyses of published studies in the biomedical literature. In this paper, the authors consider the methodology for performing diagnostic test studies and a correct analysis of the diagnostic test results by explaining it for a clinical audience with a working example.

Alport syndrome: HLA association and kidney graft outcome

Alport syndrome (AS) is a genetic disease of type IV collagen involving non-homogeneous patterns of inheritance characterized clinically by the presence of progressive haematuric nephritis leading to end-stage renal disease (ESRD), hearing loss and/or ophthalmologic abnormalities. The aim of this study was to investigate, in a cohort of AS patients who had undergone a kidney graft (KG) or who were still on a waiting list for a KG, (a) whether there is a correlation between AS and HLA antigen expression, and (b) long-term graft outcome in transplant patients. The AS cohort was represented by 34 ESRD patients, of whom 25 received a KG and the remaining nine were still on a waiting list. AS transplant patients represented 2.78% of 899 first KGs performed at our centre (Transplantation Department at S. Martino Hospital, Genoa) between 1983 and 2002. Grafts were procured from cadaveric donors in 18 cases and from living, related donors in seven cases. All AS transplant patients had a post-transplant follow-up period of at least 12 months. Results showed that: (i) the frequency of the HLA-DRB1*16 antigen was significantly increased in the whole AS cohort as compared to 128 healthy subjects (HS) (corrected P-value 0.0026; relative risk 7.20) as well as to 232 non-AS ESRD patients on a waiting list for KG (corrected P-values 0.0156; relative risk 4.67); (ii) 5- and 10-year graft survivals in the AS transplant patients were 80 and 73%, respectively, and did not differ from those of a control group represented by 25 non-AS KG recipients matched for sex, age, number of HLA mismatches and immunosuppressive treatment. Increased frequency of HLA-DRB1*16 in AS patients may reflect a linkage disequilibrium with genes coding for collagen synthesis.

Clustering of ALS patients in central Italy due to the occurrence of the L84F SOD1 gene mutation

OBJECTIVE

To study three new apparently unrelated Italian families with ALS and several sporadic ALS patients living in the same rural area.

BACKGROUND

One Italian family with ALS carrying a superoxide dismutase 1 (SOD1) gene mutation (G41S) and no regional ALS clustering has been reported in Italy.

METHODS

Genetic analysis was performed by automated and manual sequencing of the SOD1 gene in 13 family members and in 6 of 10 unrelated patients with sporadic cases of ALS living in the same area. The authors also determined SOD1 activity in erythrocytes and lymphocytes.

RESULTS

The three families included a total of 28 affected members distributed over six generations. Despite a wide variability in age at onset and disease duration, the clinical pattern is uniform, with onset in the lower limbs, ascending progression, and predominant lower motor neuron involvement in all subjects. Generational anticipation is evident in the last two generations. All familial ALS patients and one of the six sporadic patients carry the same L84F missense point mutation in exon 4 of the SOD1 gene. SOD1 enzyme activity and SOD1 protein levels were not decreased significantly in the L84F patients.

CONCLUSION

The ALS patients carrying the L84F mutation derive from a common ancestor. This mutation is responsible for ALS clustering in the area. The L84F mutation does not modify SOD1-specific activity.

The anterior subtemporal, medial transpetrosal approach to the upper basilar artery and ponto-mesencephalic junction

OBJECTIVE

To describe and anatomically analyze the amount of exposure provided by an anterior subtemporal, medial transpetrosal approach to access the upper third of the basilar artery, ventral mesencephalon, pons, and posterior cavernous sinus.

PATIENTS AND METHODS

The outcomes of six patients who underwent surgical treatment via the anterior subtemporal, medial transpetrosal approach at our institution during the past 2 years were reviewed. The series included three patients with subarachnoid hemorrhage from low-lying basilar apex aneurysms, one patient with intraparenchymal hemorrhage from a pontine cavernous malformation, and two patients with slowly progressive cranial neuropathies secondary to petroclival tumors. Thirty dry temporal bone specimens were also measured to quantify the height of petrous bone resection and added proximal basilar artery exposure.

RESULTS

The surgical exposure was greatly enhanced in each instance, allowing each lesion to be treated in a straightforward manner with minimal added morbidity (one trochlear nerve palsy, one worsening of a preexistent oculomotor nerve palsy). Our subsequent morphometric analysis indicates that an additional 1 to 1.5 cm of basilar artery, clivus, and pons exposure over that of a standard anterior subtemporal approach is provided by this technique.

CONCLUSION

This approach combines the wide view of the subtemporal approach with the more proximal exposure afforded by a medial petrosectomy. The widened visualization of the ventral pons and mesencephalon minimizes cranial nerve morbidity, greatly facilitates dissection of low-lying aneurysms, and provides proximal basilar artery control that would otherwise be obscured by the petrous ridge.

Mutagenicity and clastogenicity of gas stove emissions in bacterial and plant tests

The aim of this research was to study the gaseous and particulate emissions of genotoxic substances during cooking with two types of methane stoves (a new one and an old one). The particulates were sampled both with a cascade impactor air sampler and an impinger with ice trap and analyzed by two bacterial mutagenicity tests (Ames and Kado tests) and by HPLC for polycyclic aromatic hydrocarbons (PAH). Gaseous emissions were studied in situ using the Ames test, a clastogenicity plant test (Tradescantia-micronucleus test), and in an automated system for chemical analyses. Clear indirect mutagenicity was found only with the Kado test (TA98-S9) in extracts of particulates emitted from the old methane stove and collected with the impinger. Similar mutagenicity (TA98+S9) was also found for the finest fraction of particulates (<0.5 um) collected from both stoves. Gaseous emissions of both stoves caused clastogenicity in the in situ experiments with the Tradescantia-micronucleus test. The physico-chemical analyses of the emissions showed also the presence of very fine particulates and trace amounts of PAH. The exposure of these genotoxins could be particularly important for occupationally exposed individuals in homes and businesses and for susceptible subjects living indoors for long periods (infants, children, the sick, and the elderly).

Increase of serum copper concentration in Löfgren syndrome

Chest X ray showing bilateral hilar adenopathies of the mediastinum associated with erythema nodosum suggests the diagnosis of Löfgren syndrome rather than the presence of a lymphoproliferative disorder. However, the occasional finding of high serum levels of copper can induce diagnostic doubts since serum copper increase is an index of lymphoproliferative disorders, particularly of Hodgkin's disease. We observed four patients with Löfgren syndrome presenting with fever, arthralgies, bilateral hilar adenopathies of the mediastinum and erythema nodosum. All patients underwent whole staging for sarcoidosis and serum copper levels were measured. In all cases clinical and instrumental data allowed the diagnosis of sarcoidosis and in all the patients we found high levels of serum copper with an average of 34.8 mumol/L (30.7-39.4) at the onset of the disease. Three months later, the sarcoid process spontaneously remitted and the serum copper levels returned to normal range. Although the finding of an increase of serum copper in patients with mediastinal adenopathies is usually indicative of a lymphoproliferative disorder (Hodgkin's disease), our data suggest that its increase can be related also to non neoplastic adenopathies of the mediastinum, including sarcoidosis.

Varicella in immunocompetent children in the first two years of life: role of treatment with oral acyclovir. Italian Acyclovir-Chickenpox Study Group

An open multicenter study has been carried out to evaluate efficacy and tolerability of oral acyclovir in the treatment of varicella in immunocompetent patients in the first two years of life. Fifty-three children aged 3-24 months received acyclovir at 80 mg/Kg/day in four divided doses for 4 to 6 days; 24 of them were treated in the first 24 hours following disease onset, while the remaining 29 patients were enrolled within 48 hours. The assessment of evolution of disease signs and symptoms showed a rapid resolution of fever, itching and other constitutional symptoms, with interruption of vesicle formation and acceleration of cutaneous healing processes. No statistically significant differences have been demonstrated as to disease progression between patients treated in the first 24 hours, when compared with subjects receiving acyclovir in the following 24 hours. Acyclovir confirmed its excellent clinical and laboratory safety profile. By acting favorably on both the duration and severity of disease signs and symptoms, acyclovir treatment should be recommended in young children and infants with varicella, since a higher incidence of severe and complicated disease has been observed in these patient groups.

A case of Merkel-cell carcinoma metastatic to the tonsil

Metastatic tumours are rare in the tonsil. We describe a 69-year-old male patient who had previously undergone a resection of a Merkel-cell tumour of the left forearm and subsequently presented with a left tonsillar tumour. Biopsy revealed a metastatic Merkel-cell carcinoma. Our patient is the first described case of Merkel-cell carcinoma metastasizing to the tonsil. The clinical and histopathological picture of this rare tumour is presented, along with a review of literature.

Evolution of HLA class I epitopes defined by murine monoclonal antibodies: distribution in macaques

Murine anti-HLA monoclonal antibodies (MoAbs) to monomorphic and polymorphic epitopes were compared for their reactivity in humans vs. pigtailed macaques (Macaca nemestrina). Five MoAbs to monomorphic class I epitopes in humans displayed distinct patterns in macaques: two were unreactive, one reacted with 93% of animals tested, another with 17%, and one with only 8% of animals tested. Thus, epitopes that are monomorphic in one species can be highly polymorphic in another. Most of the 23 MoAbs (91%) against polymorphic epitopes in humans also detected polymorphisms in macaques. The epitopes detected by MoAbs could be divided roughly into two groups: epitopes that were expressed at the same frequency in both species, i.e., monomorphic, public, or private epitopes in both species, or epitopes that had quite different expression in the two species, e.g., a "public" epitope in one species expressed as a "private" epitope in the other. The genes encoding some of these polymorphisms were shown to segregate in families and thus some anti-HLA MoAbs are useful typing reagents for macaques. Two MoAbs thought to detect the same specificity in humans were found to react in macaques with different animals. Thus, reactivity patterns of anti-HLA class I MoAbs in primate populations enabled MoAbs to closely associated epitopes to be distinguished.

Further studies on the epitopes of HLA-B7 defined by murine monoclonal antibodies

Monoclonal antibodies reactive with polymorphic epitopes of HLA-B7 were analyzed by direct and indirect cytotoxicity assays on established panels of HLA typed lymphocytes. This permitted further refinement of their specificity and the identification of various novel reactions. The topographic relationship of polymorphic epitopes on the surface of the B7 molecule was assessed with various serological assays using cell surface B7 or papain solubilized B7 as the antigenic target. These studies focused on monoclonal antibodies recognizing B27 and B7. The results, in combination with those of previously published studies, are used to provide a current assessment of the epitope map of HLA-B7 as defined with mouse monoclonal antibodies. This is compared to the results obtained with alloantisera.

Six variants of HLA-B27 identified by isoelectric focusing

Six variant forms of HLA-B27 were identified among 68 unrelated B27-positive donors by isoelectric focusing (IEF) gel analysis. Each of the six IEF variants was distinguished by charge heterogeneity of desialated B27 heavy chains immunoprecipitated with specific monoclonal antibody (MAb). Charge differences varied from single to several charge units, indicating that these variants may have substantially different amino acid compositions. Informative family study showed that three B27 variant molecules were genetically determined. The uniqueness of these variant molecules was also demonstrable using a panel of alloantisera and MAbs recognizing B27-associated epitopes. Six distinct serological reactivity patterns were observed. Five of these serological patterns correlated with four of the IEF-defined variants, two of these patterns being associated with one IEF variant form. The sixth serological pattern was shared by the remaining two IEF variants. Combining the results of the electrophoretic and serological analyses, it is apparent that there are more than six structural variants within the B27 alloantigen family. Some B27 variant forms were found only in individuals of particular racial origin, indicating that unique genetic variations might occur in different racial groups. In a preliminary analysis of patients with ankylosing spondylitis, no apparent correlation was observed between any specific B27 variants and disease susceptibility.

A monoclonal antibody recognizing a determinant shared by HLA-A2 and HLA-Aw69 (A28* variant)

A cytotoxic murine monoclonal antibody, designated P5.1, was tested against 613 unrelated donors and found to react with 401 who were positive for HLA-A2 (sensitivity = 100%) and with 8 of 82 positive for HLA-A28. The latter split of A28 corresponds to the "A28* variant" that in the Ninth International Histocompatibility Workshop (9WS) was designated Aw69(28*). The epitope recognized by antibody P5.1 is distinct from the alloantisera-defined determinants that characterize HLA-A2 and A28. Immunoprecipitation of specific antigens with selected monoclonal antibodies and isoelectric focusing gel electrophoresis demonstrated that A2, Aw68(28) and Aw69(28*) are distinct polypeptides. Thus, the A2-A28 antigen family consists of at least three different alleles definable using alloantiserums specific for A2 and A28, and monoclonal antibodies such as P5.1 recognizing the A2,Aw-69(28*)-epitope.

Electrophoretic variation between class II molecules expressed on HLA-DRw8 homozygous typing cells reveals multiple distinct haplotypes

Two-dimensional (2D) gel electrophoresis of immunoprecipitated HLA-DR antigens from eight homozygous typing cells (HTC) expressing the HLA-DRw8 specificity revealed a clustering of polymorphic beta chain patterns into distinct electrophoretic variants. The variant patterns correlate with three discrete HLA-D clusters that are defined in the mixed leukocyte culture reaction (MLR) using DRw8-positive HTC. These HLA-D clusters have been provisionally designated Dw"8.1", detected primarily in Caucasoids, Dw"8.2", detected primarily in American Indians, and Dw"8.3", detected predominantly in Orientals. All three HLA-Dw"8.1" cell lines express a single DR-locus product as defined by immunoprecipitation with a DR-specific monoclonal antibody, P4.1. This DR beta chain is identical among the Dw"8.1" cell lines and different from the DR beta chains of the Dw"8.2" and Dw"8.3" cell lines. Two separate Dw"8.2" HTC express a shared DR beta chain that is slightly more basic than the 8.1 DR molecule; interestingly, one of these lines also expresses an additional DR-like beta chain not found in the other cells. Thus, the two lines defining the Dw"8.2" cluster share one distinct class II molecule, but differ in another and therefore are not biochemically HLA-identical. Cells from the Dw"8.3" cluster are likewise distinct from all other Dw8 clusters. One additional DRw8-positive HTC has been analyzed and found to be distinct from the Dw"8.1", "8.2" and "8.3" clusters by both MLR and 2D gels. Immunoprecipitates using monoclonal antibody 1B5 [anti-DR and anti-DQ(DS)] identify additional polymorphic class II variants among the cell lines tested. These data indicate that HLA-DRw8 is a public serologic specificity present on class II molecules expressed on multiple distinct haplotypes. These haplotypes differ from each other in expression of polymorphic class II molecules encoded by at least two HLA loci. They also differ in HLA-D, even though they all type as HLA-DRw8 homozygous. In Dw"8.2", variation in expressed beta chains is not reflected in variation in HLA-D, indicating that MLR, as well as serologic typing, does not detect the full degree of allelic polymorphism within HLA.

Recognition by a murine monoclonal antibody of a unique epitope specific for the human alloantigen HLA-B8

A cytotoxic murine monoclonal antibody recognizing a specific HLA alloantigen was produced from the spleen cells of a BALB/c immunized with partially purified class I glycoproteins from an HLA-A1,B8 homozygous B-lymphoblastoid cell line. The antibody, designated P8.1, was tested against cells from 521 unrelated donors. It reacted with each of the 83 donors known to be HLA-B8 positive and with no HLA-B8 negative donors (sensitivity, 100%; specificity, 100%). Immunoprecipitation with antibody P8.1 and polyacrylamide gel electrophoresis confirmed that the antigen recognized was a class I structure. Although most murine monoclonal anti-HLA antibodies previously described have recognized "public" or supertypic specificities, the identification of a monoclonal antibody specific for a "private" HLA alloantigen indicates first that the BALB/c mouse has the appropriate immune response repertoire for recognizing certain HLA allospecificities and second that HLA-B8 can be defined by a single unique epitope.

Multiple Ia-like molecules characterize HLA-DR2-associated haplotypes which differ in HLA-D

Two-dimensional gel electrophoresis of immunoprecipitated human Ia-like molecules was used to investigate the structural relationship between HLA-D and HLA-DR2. Eight different lymphoblastoid lines derived from HLA-DR2-associated homozygous typing cells, representing five distinct HLA-D clusters, were compared. Two or three distinct beta chain molecules from DR-like loci were identified in the DR2 homozygous cell lines studied. Furthermore, one of these molecules was present in all lines tested, while the others were highly variable. The electrophoretic mobility of these variable DR-like molecules correlated very well with HLA-D typing studies, suggesting that the HLA-DR specificity and the HLA-D specificity on these DR2 cells may be present on separate, but related, molecules.

Specific HLA-DR4-associated histocompatibility molecules characterize patients with seropositive juvenile rheumatoid arthritis

The structural and functional heterogeneity of HLA-DR4-associated specificities was investigated in patients with seropositive juvenile rheumatoid arthritis, a DR4-associated disease. Using a combination of HLA-D analysis by mixed lymphocyte culture and electrophoretic analysis of immunoprecipitated Ia molecules by two-dimensional polyacrylamide gels, we observed a surprisingly homogeneous pattern of HLA-D antigen expression. All patients expressed common structural products of the DR and DS loci, and 7/12 homozygous DR4 patients expressed a rare and subtle HLA-D heterozygous phenotype.

The HLA-DR4 family of haplotypes consists of series of distinct DR and DS molecules

Among DR4-associated HLA-D antigens, distinct and consistent structural variations were found for the products of two human "Ia-like" loci, DR and DS. Analysis of neuraminidase-treated immunoprecipitated DR molecules from 15 HLA-DR4-associated HLA-D homozygous B-lymphoblastoid cell lines by two dimensional polyacrylamide gel electrophoresis identified five distinct DR beta chains. In addition, gel analysis of immunoprecipitated DS molecules identified three distinct DS beta chains. Altogether, five distinct DR4 haplotypes were defined according to the observed structural diversity of the DR and DS beta chains. These gene products presumably contribute the dominant polymorphisms recognized by T cells in mixed lymphocyte reaction (MLR). Thus, these studies indicate that the serologic specificity known as HLA-DR4 is not a single haplotype, but a determinant present on products of individual loci arrayed into distinctly different haplotypes. These findings suggest that distinct products of individual loci, rather than conventional HLA specificities defined by alloimmune sera, may represent the genetic markers relevant to HLA-D/DR associated diseases.

Electrophoretic analysis of human HLA-DR antigens from HLA-DR4 homozygous cell lines: correlation between beta-chain diversity and HLA-D

Two-dimensional gel electrophoresis of immunoprecipitated human HLA-DR antigens from cells expressing the HLA-DR4 haplotype shows distinct clustering of beta-chain patterns. Six unique electrophoretic variants were observed among 17 HLA-DR4 homozygous cell lines (HCL) analyzed. These patterns correlate precisely with the HLA-D phenotype of the HCL donor as determined by reactivity in mixed lymphocyte culture. All DR4 HCL that belong to one of the well-defined HLA-D antigen groups (Dw4, Dw10, LD "40", LD "DYT", LD "KT2", or LD "TAS") have identical DR beta-chain patterns; DR4 HCL belonging to different HLA-D antigen groups do not. The concordance of the functional expression in mixed lymphocyte culture of a specific D phenotype with a distinct DR beta-chain pattern on gel analysis provides a direct structural basis for understanding the genetic control of HLA-D polymorphisms; HLA-D specificities as revealed by T-cell recognition in mixed lymphocyte culture thus might be accounted for by DR beta-chain polymorphisms. The extent of this beta-chain diversity within a single DR haplotype may aid in understanding variations in Ia-regulated functions, such as Ir gene control and certain disease susceptibilities.

Natural cytotoxicity of peripheral blood lymphocytes and regional lymph node cells in breast cancer in women

Natural cytotoxicity was studied before surgery or other treatment in 83 women with primary, untreated breast cancer. Peripheral blood lymphocytes (PBL) and cytotoxicity of regional lymph node cell(s) (RLNC) were examined in a 4-hour 51Cr release assay against the target cell K-562. Results indicated that greater than one-third of breast cancer patients have more negative lymphocyte cytotoxic activity toward K-562 than do the other two-thirds. Similar results were observed for PBL of 25 patients found to have benign breast lesions. Of these patients, 23 had fibrocystic disease. The difference between these findings and findings with normal control lymphocytes studied in parallel was highly significant (P less than 0.001). The study of RLNC cytotoxicity in patients with breast cancer showed that 25% of the patients' RLNC had significant natural cytotoxic activity toward K-562. Incubation of RLNC with interferon in vitro before addition of labeled K-562 cells did not induce cytotoxicity in RLNC that did not have this activity initially.