Evaluation of an HIV homecare program for lost-to-follow-up populations: a mixed methods study in Detroit, Michigan

BACKGROUND

Maintaining people living with HIV (PLWHIV) in clinical care is a global priority. In the Metro Detroit area of Michigan, approximately 30% of PLWHIV are out of care. To re-engage lost-to-follow-up patients, Wayne Health Infectious Disease clinic launched an innovative Homecare program in 2017. In addition to home healthcare delivery, the program included links to community resources and quarterly community meetings. We aimed to evaluate Homecare's impact on participants' ability to stay engaged in HIV care and reach viral suppression. We included data from PLWHIV and their healthcare workers.

METHODS

We used a convergent mixed-methods design, including first year program record review, semi-structured interviews, and a validated Likert scale questionnaire rating illness perception before and after Homecare. Interview data were collected from 15 PLWHIV in Metro Detroit and two healthcare workers responsible for program delivery. Semi-structured interviews focused on obstacles to clinic-based care, support networks, and illness perceptions. Interview data were transcribed and analyzed using a thematic approach. A fully coded analysis was used to create a conceptual framework of factors contributing to Homecare's success. Means in eight categories of the Brief Illness Perception (IPQ) were compared using paired T-tests.

RESULTS

In the first year of Homecare, 28 of 34 participants (82%) became virally suppressed at least once. The program offered (1) social support and stigma reduction through strong relationships with healthcare workers, (2) removal of physical and resource barriers such as transportation, and (3) positive changes in illness perceptions. PLWHIV worked towards functional coping strategies, including improvements in emotional regulation, acceptance of their diagnosis, and more positive perspectives of control. Brief-IPQ showed significant changes in six domains before and after Homecare.

CONCLUSION

Homecare offers an innovative system for successfully re-engaging and maintaining lost-to-follow-up PLWHIV in care. These findings have implications for HIV control efforts and could inform the development of future programs for difficult to reach populations.

Analysis of cognitive performance and polymorphisms of SORL1, PVRL2, CR1, TOMM40, APOE, PICALM, GWAS_14q, CLU, and BIN1 in patients with mild cognitive impairment and cognitively healthy controls

INTRODUCTION

Alzheimer disease risk polymorphisms have been studied in patients with dementia, but have not yet been explored in mild cognitive impairment (MCI) in our population; nor have they been addressed in relation to cognitive variables, which can be predictive biomarkers of disease.

OBJECTIVE

To evaluate cognitive performance and presence of polymorphisms of the genes SORL1(rs11218304), PVRL2(rs6859), CR1(rs6656401), TOMM40(rs2075650), APOE (isoforms ε2, ε3, ε4), PICALM(rs3851179), GWAS_14q(rs11622883), BIN1(rs744373), and CLU(rs227959 and rs11136000) in patients with MCI and healthy individuals.

METHODOLOGY

We performed a cross-sectional, exploratory, descriptive study of a prospective cohort of participants selected by non-probabilistic sampling, evaluated with neurological, neuropsychological, and genetic testing, and classified as cognitively healthy individuals and patients with MCI. Cognition was evaluated with the Neuronorma battery and analysed in relation to the polymorphic variants by means of measures of central tendency, confidence intervals, and nonparametric statistics.

RESULTS

We found differences in performance in language and memory tasks between carriers and non-carriers of BIN1, CLU, and CR1 variants and a trend towards poor cognitive performance for PICALM, GWAS_14q, SORL1, and PVRL2 variants; the APOE and TOMM40 variants were not associated with poor cognitive performance.

DISCUSSION

Differences in cognitive performance associated with these polymorphic variants may suggest that the mechanisms regulating these genes could have an effect on cognition in the absence of dementia; however, this study was exploratory and hypotheses based on these results must be explored in larger samples.

Stable softening bioelectronics: A paradigm for chronically viable ester-free neural interfaces such as spinal cord stimulation implants

Polymer toughness is preserved at chronic timepoints in a new class of modulus-changing bioelectronics, which hold promise for commercial chronic implant components such as spinal cord stimulation leads. The underlying ester-free chemical network of the polymer substrate enables device rigidity during implantation, soft, compliant, conforming structures during acute phases in vivo, and gradual stabilization of materials properties chronically, maintaining materials toughness as device stiffness changes. In the past, bioelectronics device designs generally avoided modulus-changing and materials due to the difficulty in demonstrating consistent, predictable performance over time in the body. Here, the acute, and chronic mechanical and chemical properties of a new class of ester-free bioelectronic substrates are described and characterized via accelerated aging at elevated temperatures, with an assessment of their underlying cytotoxicity. Furthermore, spinal cord stimulation leads consisting of photolithographically-defined gold traces and titanium nitride (TiN) electrodes are fabricated on ester-free polymer substrates. Electrochemical properties of the fabricated devices are determined in vitro before implantation in the cervical spinal cord of rat models and subsequent quantification of device stimulation capabilities. Preliminary in vivo evidence demonstrates that this new generation of ester-free, softening bioelectronics holds promise to realize stable, scalable, chronically viable components for bioelectronic medicines of the future.

AB0170 RHEUMATOID ARTHRITIS ASSOCIATED LUNG DISEASE: EXPERIENCE IN A BIOLOGICAL THERAPY UNIT

Background:

Rheumatoid arthritis (RA) associated lung disease is a relatively frequent extra articular disease manifestation, with a prevalence between 5% and 30%. The rather wide range of estimated prevalence is a result of differences in study designs and studied populations, as well as lacking diagnostic and classification criteria for lung disease in patients with RA.

Objectives:

To evaluate the prevalence of RA associated lung disease in patients with biological therapy (BT), as well as its severity, treatment changes and possible associated factors.

Methods:

Review of clinical records of 257 patients with RA treated with BT (TNFi, non-TNFi) between January 2015 to December 2020 in a single center. Patients with preexisting lung disease for other causes (asthma, smoking) have been excluded. RA diagnosis was performed according to ACR 2010 classification criteria. Epidemiological variables, clinical characteristics, type of pulmonary involvement, evolution, type of BT, changes in treatment and concomitant treatment were collected. For the analysis frequencies and percentages are used in qualitative variables, and mean ± SD in the quantitative ones. Statistical analysis was performed with IBM SPSS v 23.

Results:

We registered 21 patients (85.7% women) mean aged 70.3±11.9 years. 52.4% were never smokers. RF was positive in 100% and 20 patients were anti-CCP positive. Erosive disease was present in 13 (61.9%) patients.

At the time of lung disease diagnosis, 15 patients (66.7%) were receiving TNFi (Etanercept 7, Adalimumab 6, Infliximab 1, Golimumab 1), 2 were with non-TNFi (Rituximab) and 4 had never received BT previously. Symptoms (cough and/or dyspnea) were reported in 10 (47.6%) patients. The median time of treatment with BT until lung disease diagnosis was 33 [15.5-95.5] months. Conventional synthetic DMARDs (csDMARDs) were used in 85.7% of cases (methotrexate 72.2%, leflunomide 22.2%, other 5.6%). The inflammatory activity was mild (DAS28: 3.22±1.6). The median time until lung disease diagnosis was 104 [56.2-156] months.

After the lung disease diagnosis, BT was only modified in 1 patient. In the 4 patients who had not previously received BT, non-TNFi was started (Rituximab 2, Abatacept 1, Tocilizumab 1). csDMARD was discontinued in 1 patient.

Interstitial lung disease (ILD) was the most frequent pulmonary involvement (16 patients, 76.2%): 8 usual interstitial pneumonia (UIP), 6 non-specific interstitial pneumonia (NSIP), 1 organising pneumonia (OP) and 1 lymphocytic interstitial pneumonia (LIP). Other pulmonary manifestations observed in our patients were: nodular lung disease (2 patients) and small airways disease (bronchiectasis 2, obliterative bronchiolitis 1). Chest x-ray was normal in almost half of the patients (42.9%). Gold standard image diagnostic technique was high resolution CT.

In respiratory function tests (PFTs) at diagnosis, only 4 patients (19%) had a FVC<80% and 4 (19%) a DLCO<60%. In the following 2 years, in 2 patients the FVC worsened > 10% and in 5 there was a worsening of the DLCO > 15%. In 3 (14.3%) patients PFTs were never performed and in 7 (43.7%) were not repeated after the diagnosis.

We haven´t found association between different types of pulmonary involvement and the variables analysed.

Conclusion:

In our series, prevalence of RA associated lung disease is similar to that described in the literature. Lung involvement is asymptomatic and chest X-ray is normal in most RA patients. High resolution CT is the gold standard for diagnosis.

ILD was the most frequent pulmonary involvement. Although in most patients the diagnosis of lung disease did not imply a BT change, it had an influence on the type of BT chosen for those who started treatment. Maintenance of csDMARD was not associated with a worsening of lung disease.

Screening and treatment protocols for lung disease in patients with RA in clinical practice are needed.

Disclosure of Interests:

None declared

HAADF-STEM Image Resolution Enhancement Using High-Quality Image Reconstruction Techniques: Case of the Fe3O4(111) Surface

From simple averaging to more sophisticated registration and restoration strategies, such as super-resolution (SR), there exist different computational techniques that use a series of images of the same object to generate enhanced images where noise and other distortions have been reduced. In this work, we provide qualitative and quantitative measurements of this enhancement for high-angle annular dark-field scanning transmission electron microscopy imaging. These images are compared in two ways, qualitatively through visual inspection in real and reciprocal space, and quantitatively, through the calculation of objective measurements, such as signal-to-noise ratio and atom column roundness. Results show that these techniques improve the quality of the images. In this paper, we use an SR methodology that allows us to take advantage of the information present in the image frames and to reliably facilitate the analysis of more difficult regions of interest in experimental images, such as surfaces and interfaces. By acquiring a series of cross-sectional experimental images of magnetite (Fe3O4) thin films (111), we have generated interpolated images using averaging and SR, and reconstructed the atomic structure of the very top surface layer that consists of a full monolayer of Fe, with topmost Fe atoms in tetrahedrally coordinated sites.

Analysis of cognitive performance and polymorphisms of SORL1, PVRL2, CR1, TOMM40, APOE, PICALM, GWAS_14q, CLU, and BIN1 in patients with mild cognitive impairment and cognitively healthy controls

INTRODUCTION

Alzheimer disease risk polymorphisms have been studied in patients with dementia, but have not yet been explored in mild cognitive impairment (MCI) in our population; nor have they been addressed in relation to cognitive variables, which can be predictive biomarkers of disease.

OBJECTIVE

To evaluate cognitive performance and presence of polymorphisms of the genes SORL1(rs11218304), PVRL2(rs6859), CR1(rs6656401), TOMM40(rs2075650), APOE (isoforms ɛ2, ɛ3, ɛ4), PICALM(rs3851179), GWAS_14q(rs11622883), BIN1(rs744373), and CLU (rs227959 and rs11136000) in patients with MCI and healthy individuals.

METHODOLOGY

We performed a cross-sectional, exploratory, descriptive study of a prospective cohort of participants selected by non-probabilistic sampling, evaluated with neurological, neuropsychological, and genetic testing, and classified as cognitively healthy individuals and patients with MCI. Cognition was evaluated with the Neuronorma battery and analysed in relation to the polymorphic variants by means of measures of central tendency, confidence intervals, and nonparametric statistics.

RESULTS

We found differences in performance in language and memory tasks between carriers and non-carriers of BIN1, CLU, and CR1 variants and a trend toward poor cognitive performance for PICALM, GWAS_14q, SORL1, and PVRL2 variants; the APOE and TOMM40 variants were not associated with poor cognitive performance.

DISCUSSION

Differences in cognitive performance associated with these polymorphic variants may suggest that the mechanisms regulating these genes could have an effect on cognition in the absence of dementia; however, this study was exploratory and hypotheses based on these results must be explored in larger samples.

Influence of the crosstalk on the intensity of HAADF-STEM images of quaternary semiconductor materials

The influence of the neighbouring atomic-columns in determining the composition at atomic column scale of quaternary semiconductor compounds, using simulated HAADF-STEM images is evaluated. The InAlAsSb alloy, a promising material in the photovoltaic field, is considered. We find that the so called 'crosstalk' effect plays an important role for the aimed compositional determination. The intensity transfer is larger from neighbouring atomic columns with higher average Z, and towards atomic columns with smaller Z. Our results show that in order to obtain precise information on the column composition, the HAADF-STEM intensities of both columns need to be taken into account simultaneously.

Evaluation of high-quality image reconstruction techniques applied to high-resolution Z-contrast imaging

High-quality image reconstruction techniques allow the generation of high pixel density images from a set of low-resolution micrographs. In general, these techniques consist of two main steps, namely, accurate registration, and formulation of an appropriate forward image model via some restoration method. There exist a wide variety of algorithms to cope with both stages and depending on their practical applications, some methods can outperform others, since they can be sensitive to the assumed data model, noise, drift, etc. When dealing with images generated by Z-contrast scanning transmission electron microscopes, a current trend is based on non-rigid approximations in the registration stage. In our work we aimed at reaching similar accuracy but addressing the most complex calculations in the reconstruction stage, instead of in the registration stage (as the non-rigid approaches do), but using a much smaller number of images. We review some of the most significant methods and address their shortcomings when they are applied to the field of microscopy. Simulated images with known targets will be used to evaluate and compare the main approaches in terms of quality enhancement and computing time. In addition, a procedure to determine the reference image will be proposed to minimise the global drift on the series. The best registration and restoration strategies will be applied to experimental images in order to point up the enhanced capability of this high quality image reconstruction methodology in this field.

Strain mapping accuracy improvement using super-resolution techniques

Super-resolution (SR) software-based techniques aim at generating a final image by combining several noisy frames with lower resolution from the same scene. A comparative study on high-resolution high-angle annular dark field images of InAs/GaAs QDs has been carried out in order to evaluate the performance of the SR technique. The obtained SR images present enhanced resolution and higher signal-to-noise (SNR) ratio and sharpness regarding the experimental images. In addition, SR is also applied in the field of strain analysis using digital image processing applications such as geometrical phase analysis and peak pairs analysis. The precision of the strain mappings can be improved when SR methodologies are applied to experimental images.

Identification of Chemical Compounds That Inhibit the Function of Glutamyl-tRNA Synthetase from Pseudomonas aeruginosa

Pseudomonas aeruginosa glutamyl-tRNA synthetase (GluRS) was overexpressed in Escherichia coli. Sequence analysis indicated that P. aeruginosa GluRS is a discriminating GluRS and, similar to other GluRS proteins, requires the presence of tRNA(Glu) to produce a glutamyl-AMP intermediate. Kinetic parameters for interaction with tRNA were determined and the k(cat) and KM were 0.8 s(-1) and 0.68 µM, respectively, resulting in a k(cat)/KM of 1.18 s(-1) µM(-1). A robust aminoacylation-based scintillation proximity assay (SPA) assay was developed and 800 natural products and 890 synthetic compounds were screened for inhibitory activity against P. aeruginosa GluRS. Fourteen compounds with inhibitory activity were identified. IC50s were in the low micromolar range. The minimum inhibitory concentration (MIC) was determined for each of the compounds against a panel of pathogenic bacteria. Two compounds, BT_03F04 and BT_04B09, inhibited GluRS with IC50s of 21.9 and 24.9 µM, respectively, and both exhibited promising MICs against Gram-positive bacteria. Time-kill studies indicated that one compound was bactericidal and one was bacteriostatic against Gram-positive bacteria. BT_03F04 was found to be noncompetitive with both ATP and glutamic acid, and BT_04B09 was competitive with glutamic acid but noncompetitive with ATP. The compounds were not observed to be toxic to mammalian cells in MTT assays.

Optimizing preoperative haemoglobin in major orthopaedic surgery using intravenous iron with or without erythropoietin. An epidemiologic study

AIM

To evaluate the effectiveness of intravenous iron treatment, with or without associated erythropoietin (rHuEPO), measured as haemoglobin (Hb) increase. The relationships between the Hb increase and parameters used to evaluate anaemia were analysed.

MATERIAL AND METHOD

Retrospective observational study carried out in two third-level hospitals between January 2005 and December 2009. The study included patients with iron deficiency anaemia scheduled for elective orthopaedic surgery and treated with intravenous iron sucrose alone or associated with rHuEPO. Treatment efficacy was analysed based on the Hb increase from baseline to just before surgery.

RESULTS

A total of 412 patients who received a median of 800mg of iron sucrose were included; 125 of them (30.4%) additionally received 2.4 vials of rHuEPO. The Hb increase was 0.8 (1.1) g/dL in patients treated with intravenous iron and 1.5 (1.3) g/dL in those additionally given rHuEPO(P<.01). The percentage of hypochromic red blood cells (r=0.52) and soluble transferrin receptor (r=0.59) value were significantly correlated to the Hb increase in patients receiving iron.

CONCLUSIONS

In patients with iron deficiency anaemia, the effectiveness of iron sucrose treatment to optimize Hb before surgery was moderate; adjuvant administration of erythropoietin improved the results. Determination of functional iron status parameters may improve the treatment effectiveness.

Note: a sample holder design for sensitive magnetic measurements at high temperatures in a magnetic properties measurement system

A sample holder design for high temperature measurements in a commercial MPMS SQUID magnetometer from Quantum Design is presented. It fulfills the requirements for the simultaneous use of the oven and reciprocating sample option (RSO) options, thus allowing sensitive magnetic measurements up to 800 K. Alternating current susceptibility can also be measured, since the holder does not induce any phase shift relative to the ac driven field. It is easily fabricated by twisting Constantan© wires into a braid nesting the sample inside. This design ensures that the sample be placed tightly into a tough holder with its orientation fixed, and prevents any sample displacement during the fast movements of the RSO transport, up to high temperatures.

Quantitative Distribution Analysis of Phosphorus with Sims in the Layer System SiO2/Si

The measurement technique for quantitative distribution analysis of P in the layer system SiO2/Si was optimized. Oxygen primary ions and an increased oxygen pressure ( 5.10E-5mbar) in the sample chamber were used for elimination of the matrix effect.A computer routine for precise adjustment of the mass spectrometer during depth profiling with high mass resolution was developed. Charging effects were compensated by flooding the sample with electrons, optimized biasing of the accelerating potential of the secondary ions and normalization to a reference signal. The improved measurement technique was used for determination of segregation coefficients which are used as input parameters for process modeling in MOS transistor production.

[Anesthetic management of sacroiliac-vertebral echinococcosis]

Bone echinococcosis affects the spine and pelvis in 60% of cases. Bone lesions may be silent for between 10 and 20 years. The capsules progress aggressively through the medullary canal and replace the trabecular bone without forming cysts, as occurs in the organs, thus making anaplylaxis rare. The combination of chemotherapy and surgery facilitates anesthetic management and reduces the incidence of anaphylactic events and disease recurrence.

Surface plasmon resonance and magnetism of thiol-capped gold nanoparticles

Surface plasmon resonance measurements and magnetic characterization studies have been carried out for two types of thiol-capped gold nanoparticles (NPs) with similar diameters between 2.0 and 2.5 nm and different organic molecules linked to the sulfur atom: dodecanethiol and tiopronin. In addition, Au NPs capped with tetraoctyl ammonium bromide have also been included in the investigation since such capping molecules weakly interact with the gold surface atoms and, therefore, this system can be used as a model for naked gold NPs; such particles presented a bimodal size distribution with diameters around 1.5 and 5 nm. The plasmon resonance is non-existent for tiopronin-capped NPs, whereas a trace of such a feature is observed for NPs covered with dodecanethiol molecules and a bulk-like feature is measured for NPs capped with tetralkyl ammonium salts. These differences would indicate that the modification of the surface electronic structure of the Au NPs depends on the geometry and self-assembling capabilities of the capping molecules and on the electric charge transferred between Au and S atoms. Regarding the magnetization, dodecanethiol-capped NPs have a ferromagnetic-like behaviour, while the NPs capped with tiopronin exhibit a paramagnetic behaviour and tetralkyl ammonium-protected NPs are diamagnetic across the studied temperature range; straight chains with a well-defined symmetry axis can induce orbital momentum on surface electrons close to the binding atoms. The orbital momentum not only contributes to the magnetization but also to the local anisotropy, giving rise to permanent magnetism. Due to the domain structure of the adsorbed molecules, orbital momentum is not induced for tiopronin-capped NPs and the charge transfer only induces a paramagnetic spin component.

DRB1*1613N: a novel DRB1 allele with a premature termination codon

DRB1 null alleles are extremely rare and always sporadic, suggesting their biological selective disadvantage.

[Amoxicillin-clavulanic acid induced hepatotoxicity with progression to cirrhosis]

Amoxicillin-clavulanic acid is a commonly used antibiotic in clinical practice. It is usually prescribed on an empirical basis and several cases of hepatotoxicity with cholestasis have been described. We report the case of a 42-year-old man who developed an acute hepatocellular lesion with progression to cirrhosis. The patient received amoxicillin-clavulanic acid twice with an interval of four months. Other causes of hepatic failure were excluded. Although amoxicillin-clavulanic acid-induced hepatotoxicity has been widely documented, there are no other reports describing its progression to cirrhosis in an adult.

Analysis of the Physician Variable in Pain Management

BACKGROUND

The role of physician variability in pain management is unknown.

OBJECTIVE

To assess the role of physician variability in the management of pain and provide quantitative data regarding the status of pain management in Michigan.

DESIGN

A multi-item mail survey was used to determine the physician's perceived knowledge of pain management modalities, goals, satisfaction, and confidence with pain treatment. Participants. The focus of this report was a group of 368 licensed Michigan physicians who provide clinical care.

RESULTS

Overall, 30% of the study group reported no formal education in pain management, although younger physicians reported more education (correlation coefficient = -0.252, P <.001). The physicians reported greater confidence in their knowledge of meperidine than other Schedule II opioids (P <.001 ). In regards to the opinion that prescribing strong opioids would attract a medical review, the physician responses ranged from 1 (strongly disagree) to 5 (strongly agree). The median score for this scale was 4, accounting for 46% of the responses. The study group expressed less satisfaction with their treatment of chronic pain as well as lower goals for relief (mean: 3.8; 95% confidence interval: 3.7-3.9).

CONCLUSIONS

Lower expectations for relief and less satisfaction in its management may contribute to the undertreatment of chronic pain. Perceptions of regulatory scrutiny may contribute to suboptimal pain management. These preliminary data highlight physician variability in pain decision making while providing insights into educational needs.

A multinational evaluation of the efficacy, safety and acceptability of the Protectaid contraceptive sponge

OBJECTIVE

The Protectaid sponge (Gefar Pharma, Switzerland) is a new feminine barrier contraceptive method containing three low-dose spermicidal agents. In order to evaluate its efficacy and safety profiles, an international, multicenter study has been conducted in four countries.

METHODS

Healthy, presumably fertile and sexually active women were enrolled in this study and were followed at 15 days, 3, 6, 9 and 12 months. Contraceptive efficacy was assessed by a pregnancy test, while safety was evaluated by performing gynecological examinations as well as reporting adverse events. The 'acceptability' of the sponge by the women was assessed through a standard questionnaire.

RESULTS

A total of 129 women were enrolled in the study, generating 1182 cycles of use of the sponge. The overall efficacy rate was 77%, with no significant influence of age or parity. Acceptability was high, with 85% of subjects being symptom- or problem-free while using the sponge. Finally, the safety profile was very good, with no clinically significant evidence of local or systemic adverse reactions.

CONCLUSION

The new Protectaid sponge is a safe and effective non-hormonal contraceptive method for women.

Occupational and environmental medicine in Colombia

Colombia is a country rich in natural resources, with a steadily developing economy. Occupational and environmental medicine (OEM) education and practice have developed relatively recently in Colombia, mainly in response to a series of long overdue (and still partially implemented) reforms to the health care, social benefits, and education systems. Expansion in general and occupational health coverage of the Colombian population and development of OEM education and training were to be achieved through a clear stimulus to private sector initiatives. Despite some measurable overall progress, the goals remain elusive. This article discusses several aspects and the perspectives for further development of the specialty in this country, in the context of the socioeconomic factors involved in that process.

Number of roots and canals in maxillary first premolars: study of an Andalusian population

A study of 150 extracted maxillary first premolars from citizens of Seville, Andalusía, southern Spain, revealed 60 teeth with one root (40.0%), 85 teeth with two roots (56.7%) and five teeth with three roots (3.3%). The distribution of root canal shapes in the sample showed that all teeth with two or three roots had type I root canals (each canal had one apical foramen). Conversely, most of the single-rooted maxillary first premolars had root canal shape type II (two canals converging in the same apical foramen). Only 1.3% of the teeth had a unique orifice in the pulp chamber and only one root canal. These results emphasized the importance of good knowledge of the root canal morphology and the need for a careful radiographic examination as part of competent root canal therapy of maxillary first premolars.

Measuring condom use among sex workers in the Dominican Republic

The purpose of this paper is to assess the internal consistency of self-reported condom use among sex workers in Puerto Plata and Santo Domingo, Dominican Republic. We examined the responses to questions about condom use among 4 cross-sectional samples of sex workers. We compared measures based on: (1) questions using always-to-never scales; (2) questions about use with the past 5 clients; and (3) questions about use in the past week obtained from a retrospective coital log. In each sample, more women reported 'always' using condoms with clients than with each of the past 5 clients. In 3 of the 4 samples, only about half of the women who reported 'always' using condoms used condoms with the most recent 5 clients and with all clients in the past week. Internal consistency was significantly higher when the comparison was limited to use with the most recent 5 clients and use in the past week. Self-reported measures of condom use can be difficult to interpret. Assessing the internal consistency of several measures of use provides insight into the strengths and weaknesses of each measure.

Human papillomavirus DNA and antibodies to human papillomaviruses 16 E2, L2, and E7 peptides as predictors of survival in patients with squamous cell cervical cancer

PURPOSE

To assess whether human papillomavirus (HPV) DNA detection in cervical cancer specimens, or antibodies to selected HPV 16 peptides are predictors of tumor recurrence and long-term survival in patients with squamous cell invasive cervical cancer.

SUBJECTS AND METHODS

Four hundred seventy-one cases included in two population-based case-control studies underwent follow-up evaluation. The survival and cause of death were ascertained for 410 cases (87%), with a median follow-up time of 4.6 years after diagnosis. HPV DNA was assessed using an L1 polymerase chain reaction (PCR)-based system and Southern hybridization (SH) on scraped cytologic specimens or biopsies. HPV 16 antibodies to E2, L2, and E7 peptides were detected with enzyme-linked immunosorbent assay (ELISA).

RESULTS

Clinical stage was the only independent prognostic factor for recurrence or survival. Although seropositivity to HPV 16 E7/3 peptide predicted a twofold excess risk of mortality (adjusted hazards ratio [HRa] = 2.0; 95% confidence interval [CI], 1.2 to 3.3), the association was restricted to stage I (HRa = 6.6; 95% CI, 1.2 to 37.6) and II (HRa = 5.9; 95% CI, 2.1 to 16.5) patients. The presence of HPV DNA (HRa = 0.9; 95% CI, 0.5 to 1.5), different estimates of the HPV viral load and the HPV type identified were not predictors of tumor recurrence or survival.

CONCLUSION

The presence of antibodies to HPV 16 E7 proteins is of prognostic value in early-stage cervical cancer. Our results provide strong evidence that detection and typing of HPV DNA in cervical cells or tissues is not a prognostic factor for recurrence or survival.

Male sexual behavior and human papillomavirus DNA: key risk factors for cervical cancer in Spain

BACKGROUND

It is now established that certain types of human papillomaviruses (HPVs) are the sexually transmitted agents etiologically linked to cervical cancer. Studies assessing the contribution of the male's sexual behavior and genital HPV DNA status to the risk of development of cervical neoplasia in sexual partners have yielded inconsistent results.

PURPOSE

This study evaluates the role of men's sexual behavior and the presence of HPV DNA in the penis on the development of cervical cancer in their sexual partners in Spain, a low-risk area for cervical neoplasia.

METHODS

Husbands (n = 633) of women participating in two case-control studies of cervical neoplasia were interviewed to obtain information on lifestyle habits, including sexual practices. Cytologic samples were taken from the distal urethra and the surface of the glans penis of 183 husbands of case women and of 171 husbands of control women. These samples were analyzed by a polymerase chain reaction-based system using a generic probe and 25 type-specific probes for the detection and typing of HPV DNA. Serologic specimens were also obtained and analyzed for antibodies to Chlamydia trachomatis, Treponema pallidum, herpes simplex virus type II, and Neisseria gonorrhoeae.

RESULTS

The presence of HPV DNA in the husbands' penis conveyed a fivefold risk of cervical cancer to their wives (adjusted odds ratio [OR] for HPV DNA positivity = 4.9; 95% confidence interval [CI] = 1.9-12.6). The risk of cervical cancer was strongly related to HPV type (adjusted OR for HPV type 16 = 9.0; 95% CI = 1.1-77.5), to the husbands' number of extramarital partners (adjusted OR = 11.0; 95% CI = 3.0-40.0; for > or = 21 women versus one), and to the number of prostitutes as extramarital sexual partners (adjusted OR = 8.0; 95% CI = 2.9-22.2; for > or = 10 women versus none). Presence of antibodies to C. trachomatis (adjusted OR = 2.6; 95% CI = 1.4-4.6) and an early age at first sexual intercourse of the husband (adjusted OR = 3.2; 95% CI = 1.7-5.9; for < or = 15 years versus > or = 21 years) were also associated with cervical neoplasia in the wife. After adjustment for these variables and for the wife's pack-years of smoking, the husband's smoking was moderately associated with cervical cancer in his wife (adjusted OR = 2.5; 95% CI = 1.4-4.4; for > or = 26.2 pack-years versus none).

CONCLUSIONS

The study supports the role of men as vectors of the HPV types that are related to cervical cancer. Life-time number of female sexual partners, number of female prostitutes as sexual partners, and detection of HPV DNA in the penis of husbands are all surrogate markers of exposure to HPV during marriage.

IMPLICATIONS

Men who report multiple sexual partners or who are carriers of HPV DNA may be vectors of high-risk HPV types and may place their wives at high risk of developing cervical cancer. Prostitutes are an important reservoir of high-risk HPVs.

Vulvar vestibulitis is rarely associated with human papillomavirus infection types 6, 11, 16, or 18

Vulvar vestibular biopsy specimens from 31 women with clinical and pathologic findings of vulvar vestibulitis were studied using polymerase chain reaction (PCR) for the identification of human papilloma virus (HPV). The PCR technique specifically probed for HPV types 6, 11, 16, and 18. Of the 31 subjects, three were found to have HPV within the biopsy specimens; two had HPV type 11 and one had HPV 16. Five of the 31 cases had histopathologic features of koilocytosis consistent with HPV effect; three of these five were found to have HPV. The findings support the hypothesis that HPV types 6, 11, 16, and 18 are rarely associated with vulvar vestibulitis. The frequencies identified were similar to those seen with control patients. True koilocytosis is the most useful pathologic feature distinguishing HPV-related cases; it is rarely identified in typical vulvar vestibulitis. Nonspecific changes in the vestibular epithelium associated with glycogen effect should not be interpreted as koilocytosis.

HIV-1 and HTLV-I in sexually transmitted disease clinics in the Dominican Republic

A cross-sectional seroprevalence study of human immunodeficiency virus type 1 (HIV-1) and human T-cell lymphotropic virus type I (HTLV-I) was undertaken among 494 attendees in two Santo Domingo sexually transmitted disease clinics in 1989. All participants were evaluated for Neisseria gonorrhoeae, Chlamydia trachomatis, syphilis, and genital ulcers. Of the 494 participants, 15 (3.0%) were positive for HIV-1 and 14 (2.8%) were positive for HTLV-I. Twelve of 371 (3.2%) men were HIV-1 seropositive: 0 of 68 homosexual/bisexual and 12 (4.0%) of 302 heterosexual men (one seronegative male could not be classified). Three (2.4%) of 123 women were HIV-1 seropositive. One (1.5%) homosexual/bisexual man, five (1.7%) heterosexual men, and eight (6.5%) women were HTLV-I seropositive. Among heterosexual men, HIV-1 was associated with multiple lifetime sex partners (O.R. = 5.9; 95% C.I. = 1.4, 23; p = 0.007). HIV-1 was associated with genital ulcer disease among women (p = 0.004). Among women, HTLV-I was associated with professional sex work (O.R. = 18; 95% C.I. = 2.1, > 100; p = 0.001). These findings suggest the need for control of sexually transmitted diseases and targeted educational programs for prevention of HIV-1 and HTLV-I among individuals with high-risk behaviors in the Dominican Republic.

Comparison of ViraPap, Southern hybridization, and polymerase chain reaction methods for human papillomavirus identification in an epidemiological investigation of cervical cancer

In order to provide a reliable diagnosis for the presence and type of human papillomavirus (HPV) DNA in a case-control study of cervical cancer in Colombia and Spain, 926 cervical scrapes from female subjects were examined by ViraPap (VP) and Southern hybridization (SH), and 510 of these (263 cases and 247 controls) were also tested by polymerase chain reaction (PCR) using the HPV L1 consensus primers. HPV DNA prevalence was much higher in cases than in controls by each of the three tests. There was complete agreement between the results of the three tests for 64.9% of the 510 specimens; 53.5% were negative and 11.4% were positive (regardless of type) by all tests. An additional 29.0% of the specimens were positive by PCR: 19.4% by PCR alone, 6.7% by PCR and VP, and 2.9% by PCR and SH. SH and/or VP gave positive results for 6.0% of the specimens for which the PCR finding was negative: 2.7% by SH alone, 2.5% by VP alone, and 0.8% by both VP and SH. When specimens which were positive by VP alone or only by SH at low-stringency conditions were excluded, PCR confirmed all but four specimens which were positive by other tests. The concordance between type-specific diagnosis by SH and PCR was 86% when HPVs were typed in both tests. HPV-16 accounted for over 80% of the typed HPVs in each test. The presence of blood in case specimens did not appear to inhibit HPV positivity by VP or by PCR at the dilution tested. Low amounts of cellular DNA of specimens resulted in some underestimation of HPV positivity by VP and SH but not by PCR. Compared with that of PCR, the sensitivities for case specimens were 38% by SH and 50% by VP; the sensitivity for control specimens, although it could not be measured precisely because there were few positive specimens, appeared to be lower than for case specimens. It was concluded that PCR-based tests are best suited for epidemiological investigation of HPVs.

Antibodies to HPV-16 E6 and E7 proteins as markers for HPV-16-associated invasive cervical cancer

Transforming proteins E6 and E7 of human papillomaviruses (HPVs) are consistently expressed in HPV-associated cervical cancers. In ELISA with four HPV-16 E6-E7 peptides, patients with HPV-16-associated invasive cervical cancer (group 1) had a greater seroreactivity than all other groups, which included patients with HPV-16-associated cervical intraepithelial neoplasia, invasive cervical cancer patients without HPVs, and unaffected controls. A larger proportion of group 1 sera, as compared to sera of all other groups, was reactive with at least one peptide (49% vs 17-27%), and with two or more peptides (22% vs 0-6%). A clear difference between group 1 and all other groups was also found for high ELISA absorbance values to at least one peptide (22% vs 0-8%). This high seroreactivity of group 1 sera was confirmed by a radioimmunoprecipitation assay with in vitro transcribed and translated HPV-16 E7 protein. Sera from 50% of group 1 but only 3% of controls were reactive in this test. Antibodies to HPV-16 E6 and E7 proteins appear to be virus-specific and disease state-specific markers of HPV-associated cervical cancer.

[Pulmonary involvement in familial amyloid polyneuropathy type I]

Familial amyloid polyneuropathy type 1 or Corino Andrade's disease (FAP 1) is classified amongst the hereditary systemic amyloidosis, being autosomically dominant and preferably affecting the peripheral nervous system. Our country is the fourth world focus with regard to incidence, preceded only by Portugal, Japan, and Sweden. Amyloid involvement is rare, generally following primary forms. There are only three cases described of these hereditary forms, none of which is of the FAP type 1. Our goal is to present a patient diagnosed of FAP type 1 who developed hemoptysis during the course of her disease, observing an amyloid bronchial infiltrate in the samples obtained by bronchoscopy. This is the first case described of pulmonary involvement in this type of amyloidosis according to the literature reviewed.

Research note: ability of fenthion to increase gizzard erosion in broiler chicks

Fenthion, an irreversible cholinesterase inhibitor, was used to study the role of the cholinergic system on the development of gizzard erosion. Fenthion increases the gizzard erosion score in a dose-dependent manner and this effect became significant at levels higher than .1 ppm (p less than .05). An inverse relationship between plasma cholinesterase activity and pesticide concentration was also observed at doses higher than 1 ppm (P less than .05). These results show the necessity to evaluate organophosphate pesticide levels during the selection of fish meals in poultry.

Investigation of ovarian neoplasia of low malignant potential for human papillomavirus

Recent in situ hybridization studies have suggested the presence of human papillomavirus type 6 (HPV-6) DNA in ovarian cancer cells. An association between HPV and ovarian neoplasia of low malignant potential (LMP) has not been previously identified. Paraffin-embedded tissue blocks from 24 patients with LMP ovarian tumors were screened for human papillomavirus DNA. The patients ranged in age from 18 to 73 years. Corresponding microscopic slides from each tissue block were reviewed to confirm the histopathologic diagnosis. For identification of HPV genome, deparaffinized sections were subjected to the polymerase chain reaction to achieve amplification of DNAs of HPV types 6, 11, 16, and 18. For each HPV type, a 120-base-pair region of the E6 gene was targeted for amplification. Human papillomaviral DNA was not detected in the tissue specimens subjected to polymerase chain reaction. These results suggest that HPV types 6, 11, 16, and 18 are not likely to play a role in LMP ovarian tumors. These results do not totally exclude possible contributions of other HPV types.

The antigenic structure of HBsAg: study of the d/y subtype determinant by chemical modification and site directed mutagenesis

Lysine residue 122 of the major protein of HBsAg/adw has been shown previously to be involved in the d subtype determinant. We demonstrate here that the corresponding residue of the HBsAg/ayw, arginine 122, does not play such a critical role the y site of this antigen subtype. Thus, conversion by site directed mutagenesis of arginine 122 to lysine 122 in HBsAg/ayw does not result in the loss of y activity nor gain of d activity. Moreover, chemical modification studies of both the adw and ayw antigens with the reagents o-methylisourea and cyclohexanedione, demonstrate that arginine 122 plays at most only a minor role in this subtype antigenic site.

Hepatitis B surface antigen. Role of lipids in maintaining the structural and antigenic properties of protein components

Most of the lipid components of hepatitis B surface antigen (HBsAg) can be removed by treatment with the non-ionic non-denaturing detergent beta-D-octyl glucoside (OG) followed by centrifugation through caesium chloride linear density gradients (density 1.15-1.32 g/ml). The conformational changes induced by the elimination of lipids decreased the helical content of HBsAg proteins from 52 to 28% as indicated by c.d. techniques. Measurements of the extent of quenching of protein fluorescence by iodide showed that half of the tryptophan residues which are buried in the native structure of HBsAg particles are brought close to the surface of the molecule by such conformational changes. The antigenic activity, as measured by binding to polyclonal antibodies, was decreased upon removal of lipids. Moreover, the six different antigenic sites recognized by our panel of monoclonal antibodies decreased their capacity to bind to the corresponding antibody when lipids were removed. However, the extent of this decrease differed for the different antibodies. Thus the apparent dependence of antibody binding on the lipid content seemed to indicate a greater involvement of the lipid-protein interaction for some of the epitopes than for others.

Changes in the protein fractions of human milk during lactation

The changes in the absolute and relative contents of alpha- and kappa-caseins, lactoferrin, alpha-lactalbumin, serum albumin and lysozyme in human milk have been studied through the period of lactation. Protein fractions of 209 samples were analyzed by a discontinuous polyacrylamide gel electrophoresis method. beta- and kappa-caseins decreased from colostrum to mature milk although their relative percentages remained constant. They accounted for 12-15 and 9-13% of the total protein in human milk, respectively. Lactoferrin decreased in absolute and relative amounts with advancing lactation. This protein represented 32-19% of the human milk proteins. alpha-Lactalbumin slightly decreased from colostrum to transitional milk but there was an increase in mature milk by 16-30 days. The percentages of this protein in colostrum and mature milk were approximately 23 and 30%, respectively. Serum albumin also decreased with advancing lactation, but the differences between transitional and mature milk were not statistically significant. Lysozyme increased from colostrum to mature milk both in relative and absolute amounts. Colostrum contained about 262 micrograms/ml, and mature milk 1,246 micrograms/ml, representing 1.5 and 12.1% of total milk proteins.