Promoting gender, equity, human rights and ethnic equality in neglected tropical disease programmes

Limited attention to tackling neglected tropical diseases (NTDs) through the lenses of gender, equity, ethnicity and human rights inadvertently undermines progress due to the exclusion of subgroups in populations living in conditions of vulnerability. Supporting national NTD programmes to make equity analysis part of their routine activities and revitalising intersectoral collaboration will be essential to achieve effective, sustainable service delivery with a person-centred approach. Gender, equity, human rights and ethnic equality for NTD programmes should therefore be incorporated in multisectoral engagements.

Predictors of extra-articular manifestations in axial spondyloarthritis and their influence on TNF-inhibitor prescribing patterns: results from the British Society for Rheumatology Biologics Register in Ankylosing Spondylitis

OBJECTIVES

Extra-articular manifestations (EAMs) are important systemic features of axial spondyloarthritis (axSpA), which may influence the choice of tumour necrosis factor-inhibitor (TNFi). We examined the cumulative incidence and predictors of EAMs and the influence of these on first TNFi choice in a 'real-world' cohort of patients with axSpA.

METHODS

Clinical and patient-reported outcomes of 2420 patients with axSpA from 83 centres were collected by the British Society for Rheumatology Biologics Register in Ankylosing Spondylitis. Lifestyle factors for EAMs (acute anterior uveitis (AAU), inflammatory bowel diseases (IBD), psoriasis) were compared with those without EAMs. Also, the association between pretreatment EAMs and choice of first TNFi (adalimumab, etanercept, certolizumab) was analysed.

RESULTS

AAU was directly associated with human leukocyte antigen (HLA)-B27 (incidence rate ratio (IRR) 1.95, 95% CI 1.40 to 2.73) and inversely associated with ever-smoking (IRR=0.71, 95% CI 0.55 to 0.92). For both psoriasis and IBD, there was an inverse relationship with HLA-B27 (IRR 0.54, 95% CI 0.36 to 0.79 and IRR 0.63, 95% CI 0.43 to 0.91, respectively). A diagnosis of either AAU (OR 3.79, 95% CI 2.11 to 6.80) or IBD (OR 5.50, 95% CI 2.09 to 14.46) was associated with preference for adalimumab versus others. In contrast, a diagnosis of either AAU (OR 0.14, 95% CI 0.06 to 0.33) or IBD (OR 0.17, 95% CI 0.05 to 0.57) was associated with less preference for etanercept over other TNFi.

CONCLUSION

The higher occurrence of AAU and lower occurrence of psoriasis and IBD in HLA-B27-positive patients with axSpA are consistent with current pathophysiology. Patients with previous AAU and IBD are more likely to be prescribed adalimumab and less likely to receive etanercept, consistent with the superior efficacy of monoclonal TNFi for these indications. Future work will determine whether EAMs influence TNFi survival, or effectiveness, and whether this varies between agents.

OP0085 THE CHANGING STATES OF FIBROMYALGIA IN A LONGITUDINAL COHORT OF PATIENTS WITH AXIAL SPONDYLOARTHRITIS

Background:

The identification of predictors for longitudinal fibromyalgia (FM) development has been identified as a research priority in a recent systematic review and meta-analyses (1). This paper examines the longitudinal development of, or recovery from, FM in patients with axial Spondyloarthritis(axSpA).

Objectives:

To identify predictors for FM development and recovery in patients with axSpA.

Methods:

The British Society of Rheumatology Biologics Register (BSRBR-AS) recruited patients with axSpA from 83 centres in a prospective study. Fibromyalgia was diagnosed using the self-reported Fibromyalgia Survey Diagnostic Criteria (FSDC). Measures of axSpA disease activity and clinical findings were recorded at regular intervals. We identified predictors for developing FM, and for recovering from FM, between yearly visits using uni- and multivariate logistical regression models.

Results:

Eight hundred and one patients had two or more visits and were eligible for inclusion. 686 patients did not have FM at baseline, of whom 45 had developed FM by follow-up. 115 patients had FM at baseline, of whom 77 had recovered by follow-up. The uni- and multivariate models are presented in table 1.

Table 1.Models of FM developmentModels of FM recoveryVariableAdjusted univariateOR (95% CI)Multivariate modelOR (95% CI)Adjusted univariateOR (95% CI)Multivariate modelOR (95% CI)Age years1.01 (0.98-1.03)1.00 (0.98-1.03)1.00 (0.97-1.02)1.02 (0.99-1.06)Female gender1.89 (1.01-3.53)*2.04 (0.99-4.21)$0.90 (0.40-2.04)1.20 (0.48-3.03)BASDAI per unit1.39 (1.21-1.60)**1.27 (1.08-1.49) *0.79 (0.63-1.00)*BASFI per unit1.22 (1.08-1.38)*0.70 (0.56-0.88)*0.68 (0.53-0.86)*ASDAS-CRP per unit1.47 (1.11-1.95)*0.63 (0.39-1.01)$Started on TNF1.95 (0.92-4.15)$2.78 (1.21-6.38)*4.23 (1.63-11.00)*Symptomscale per unit1.28 (1.13-1.45)**0.76 (0.61-0.96)*WPI index per unit1.24 (1.13-1.36)**1.14 (1.02-1.28) *0.84 (0.73-0.96)*0.84 (0.72-0.97)*HADS Anxiety per unit1.12 (1.05-1.20)*0.96 (0.88-1.04)Chalder per unit1.14 (1.05-1.24)*0.91(0.81-1.02)Jenkins baseline1.07 (1.01-1.13)*0.90 (0.83-0.98)*ROC/sensitivity/specificity0.75/55.6/75.60.78/62.3/73.7

Logistic regression models. OR; Odds ratio, BASDAI; Bath Ankylosing Spondyilits Disease Activity IndexBASFI; Bath Ankylosing Spondylitis Functional Index, TNF; Tumour Necrosis Factor inhibitor, HADS; Hospital Anxiety Scale, WPI; widespread pain index, Chalder; Chalder fatigue index, Jenkins; Jenkins sleep evaluation, ROC; receiver operator curve.

Conclusion:

The development of FM in patients with axSpA can be predicted by high levels of axSpA activity and presence of widespread pain, while low levels of the same variables, and starting a TNF-inhibitor predict recovery from FM. The presence of co-morbid FM should be considered in patients with a history of high axSpA disease activity and wide spread pain.

References:

[1]Zhao SS, Duffield SJ, Goodson NJ. The prevalence and impact of comorbid fibromyalgia in inflammatory arthritis. Best Pract Res Clin Rheumatol. 2019;33(3):101423.

Disclosure of Interests:

Sella Aarrestad Provan Consultant of: Novartis, Linda Dean: None declared, Gareth T. Jones Grant/research support from: Pfizer, AbbVie, UCB, Celgene and GSK., Gary Macfarlane: None declared

FRI0287 BIOLOGIC DRUG RESPONSE DOES NOT APPEAR RELATED TO RADIOGRAPHIC STATUS IN AXIAL SPONDYLOARTHRITIS: DATA FROM THE BSRBR-AS REGISTRY

Background:

The concept of axial spondyloarthritis (axSpA) incorporates the full range of inflammatory spinal disease. In the absence of specific immuno-genetic biomarkers, classification criteria differentiate two groups (non-radiographic [nr-axSpA] and radiographic axSpA [r-axSpA]) based on the presence of structural damage of the sacroiliac joints. Controversy remains as to whether nr-axSpA represents a milder form with biologic DMARD (bDMARD) treatment restrictions still in place in many countries.

Table 1.

Baseline characteristics of nr-axSpA and r-axSpA patients starting biologics.

VariablesLevelnr-axSpAn=418r-axSpAn=727p-valueAge, mean (SD), years39.7 (12.4)46.1 (13.4)<0.001Sex, n (%)Male239 (57%)529 (73%)<0.001Symptom duration, mean (SD), years11.2 (10.9)16.7 (12.9)<0.001Diagnostic delay, median (IQR), years3.0 (1.0, 10.0)3.0 (0.0, 11.0)0.83HLA-B27(missing=325)227 (73%)387 (76%)0.40Inflammatory back pain, n (%)384 (92%)619 (92%)0.95Uveitis, n (%)92 (22%)205 (30%)0.003Crohn’s / Colitis, n (%)55 (13%)113 (17%)0.11Psoriasis, n (%)79 (19%)115 (17%)0.43Smoking status, n (%)Never smoked148 (43%)218 (38%)0.040Ex-smoker95 (28%)207 (36%)Current smoker100 (29%)154 (27%)NSAID use, n (%)311 (75%)560 (77%)0.43CRP, median (IQR), mg/dL0.5 (0.1, 1.3)0.9 (0.3, 2.5)<0.001BMI, mean (SD)27.5 (5.6)28.2 (5.8)0.10BASDAI, median (IQR)6.7 (5.4, 7.8)6.5 (5.0, 7.7)0.12BASFI, median (IQR)5.9 (4.2, 7.8)6.5 (4.4, 8.3)0.043VAS-G, mean (SD)7.0 (2.0)6.8 (2.0)0.056ASDAS-CRP, mean (SD)2.8 (0.8)2.8 (0.9)0.32ASQOL, median (IQR)13.0 (9.0, 16.0)13.0 (9.0, 15.5)0.29Biologic (to start), n (%)Adalimumab238 (57%)436 (60%)0.20Etanercept131 (31%)220 (30%)Certolizumab35 (8%)47 (6%)Golimumab5 (1%)12 (2%)Secukinumab7 (2%)10 (1%)Infliximab2 (<1%)2 (<1%)

Objectives:

To describe the baseline characteristics and bDMARD response at one year in axSpA patients in the British Society for Rheumatology Biologics Register in Ankylosing Spondylitis (BSRBR-AS) according to radiographic status.

Methods:

BSRBR-AS is a national prospective cohort including participants who fulfil the ASAS classification criteria for axSpA. In this analysis, cross-sectional baseline data of patients starting bDMARDs including clinical, demographic and patient-reported outcomes (PROs) were compared. Follow-up data at one year was identified if 12±4 months from baseline and PROs completed within 2 months of visit date. Ankylosing Spondylitis Disease Activity Scores (ASDAS) for low disease status, clinically important improvement (CII) and major improvement (MI) were used to assess treatment response.

Results:

Baseline characteristics were available for 1,145 patients. Those with r-axSpA were more likely to be male, were older, and had longer disease duration (Table 1). Follow-up ASDAS was available in 290 patients. Two thirds of the patients achieved ASDAS low disease state at one year regardless of radiographic status (nr-axSpA: 64.2% vs r-axSpA: 66.1, Diff: -1.9%, 95% CI -13.7 to 9.8). Further, no significant differences were seen between the groups in attaining ASDAS CII (nr-axSpA: 50.7% vs r-axSpA: 44.7%, Diff: 6.0%, 95% CI -7.8 to 19.8%) or MI (nr-axSpA: 20% vs r-axSpA: 18.7%, Diff: 1.3%, 95% CI -9.7 to 12.3%).

Conclusion:

Although there appeared to be some differences in the baseline characteristics when exploring this cohort, according to radiographic status, which are likely related to the natural history of the disease; the level of biologic response was comparable between the groups supporting the concept of axSpA as a single disease entity.

Acknowledgments:

This project is supported by a FOREUM fellowship.

Disclosure of Interests:

Xabier Michelena: None declared, Sizheng Steven Zhao: None declared, Sayam Dubash: None declared, Gareth T. Jones Grant/research support from: Pfizer, AbbVie, UCB, Celgene and GSK., Linda Dean: None declared, Helena Marzo-Ortega Grant/research support from: Janssen, Novartis, Consultant of: Abbvie, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, UCB, Speakers bureau: Abbvie, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, Takeda, UCB

DOI:10.1136/±annrheumdis-2020-eular.3147

O25 Quantifying and predicting the effect of anti-TNF therapy on axSpA-related fatigue: results from the BSRBR-AS registry and meta-analysis

Background

Fatigue represents a critical priority among patients with axial spondyloarthritis (axSpA). Its effective management is a major unmet clinical need. Existing studies indicate that anti-TNF therapy may reduce fatigue levels, although any effect has yet to be definitively quantified. Moreover, predictors of any such improvements have not been studied.

Methods

The British Society for Rheumatology Register in Axial Spondyloarthritis (BSRBR-AS) prospectively recruited axSpA patients across 83 centres in the UK. Changes in fatigue levels (measured using the Chalder Fatigue Scale (0-33)) over 1 year were compared between those starting anti-TNF therapy at the time of recruitment and those not. Differences between treatment groups were adjusted using propensity score matching. Results were combined with other studies in a meta-analysis to calculate pooled estimates. Then, among those BSRBR-AS anti-TNF commencers with clinically relevant fatigue, baseline predictors of response were investigated.

Results

Of the 998 BSRBR-AS recruits with complete fatigue outcome data, 310 were anti-TNF commencers and 688 were not. At 1 year follow-up, the former group reported a mean change in fatigue of -2.6 (95% CI -4.1, -1.9) points while the latter reported a mean worsening of fatigue by 0.2 points. Following propensity score adjustment, those commencing anti-TNF therapy reduced fatigue by 3.0 points compared to those not 95% CI (-4.1-1.9). In the meta-analysis, including 1109 subjects across 5 observational studies and trials, treatment with anti-TNF therapy resulted in a significant improvement in fatigue (SMD 0.36, 95% CI 0.15-1.56). Of those BSRBR-AS recruits commencing anti-TNF, n = 205 (66%) reported clinically significant fatigue at baseline of whom n = 139 (68%) experienced a clinically relevant improvement in their fatigue at 1 year. Poor sleep quality at baseline was predictive of fatigue improvement.

Conclusion

Anti TNF therapy results in a significant but modest reduction in fatigue amongst axSpA patients, with those reporting poor sleep quality most likely to report improvement. Effective management will likely require additional, possibly non-pharmacological, approaches.

Disclosures

J. Shim None. L. Dean None. M. Karabayas None. G. Jones None. G. Macfarlane None. N. Basu None.

A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk

OBJECTIVE

We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals.

RESEARCH DESIGN AND METHODS

We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables.

RESULTS

Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002).

CONCLUSIONS

The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.

Randomized, double-blind, phase 2, study evaluating same-day vs next-day administration of pegfilgrastim with R-CHOP in non-Hodgkin’s lymphoma patients

7570

Background: R-CHOP is associated with a high risk of febrile neutropenia (FN). Pegfilgrastim is indicated to lower infection incidence, manifested by FN, when administered once-per-cycle 24 hrs after chemotherapy (CT). However, eliminating an office visit the day after CT is desirable. Methods: Pts ≥ 18 years with previously untreated non-Hodgkin’s lymphoma (NHL) who received R-CHOP (rituximab 375 mg/m2, C 750 mg/m2, H 50 mg/m2, O 1.4 mg/m2, prednisone 100 mg; for 6 cycles Q21D) were randomized 1:1 to pegfilgrastim 6mg within 4 hours or ∼24hrs after CT. The primary endpoint was the duration of severe (grade 4) neutropenia (DSN) in cycle 1. Same-day administration was considered noninferior to next-day if the upper limit of the 2-sided 95% CI for the difference in mean cycle 1 DSN (same day - next day) was <2 days. Results: 77 pts (8 mantle-cell, 69 diffuse large B-cell) were enrolled of 90 planned (due to slow accrual). 75 pts (36 same-day, 39 next-day) received CT and pegfilgrastim. Most pts had stage 3/4 disease (69% same-day, 74% next-day), no bone marrow involvement (75% same-day, 69% next-day) and ECOG status 0 or 1 (94% same-day, 97% next-day). Difference in mean cycle 1 DSN was 0.9 days (95% CI: 0.3–1.4) longer in the same-day than the next-day group (mean [SD]: 2.1 [1.22] vs 1.2 [1.20] days; grade 4 neutropenia incidence: 86% vs 64%). In cycle 1, more pts had a DSN ≥ 3 days in the same-day (36%) than the next-day group (15%). In cycle 4, mean DSN was longer in the same-day than the next-day group (mean [SD] 1.4 [1.40] vs 0.7 [0.94] days; grade 4 neutropenia incidence: 57% vs 42%). Pts in the 2 groups had similar occurrence of FN (17% vs 15%) and serious adverse events (33% vs 36%) across the study. Full dose on schedule, and the incidence of IV anti-infective use or hospitalization due to FN were also similar between groups. Conclusions: In cycles 1 and 4, the mean DSN was nearly 1 day longer for pts in the same-day group compared with the next-day group. Although the protocol-specified 2-day non-inferiority margin for DSN was met, for pts with NHL receiving R-CHOP, we recommend administering pegfilgrastim 24 hours after CT per labeling guidelines.

[Table: see text]

Percutaneous transmyocardial laser revascularisation for severe angina: the PACIFIC randomised trial. Potential Class Improvement From Intramyocardial Channels

BACKGROUND

Percutaneous transmyocardial laser revascularisation (PTMR) is a proposed catheter-based therapy for refractory angina pectoris when bypass surgery or angioplasty is not possible. We undertook a randomised trial to assess the safety and efficacy of this technique.

METHODS

221 patients with reversible ischaemia of Canadian Cardiovascular Society angina class III (61%) or IV (39%) and incomplete response to other therapies were recruited from 13 centres. Patients were randomly assigned PTMR with a holmium:YAG laser plus continued medical treatment (n=110) or continued medical treatment only (n=111). The primary endpoint was the exercise tolerance at 12 months. Analyses were by intention to treat.

FINDINGS

11 patients died and 19 withdrew; 92 PTMR-group and 99 medical-treatment-group patients completed the study. Exercise tolerance at 12 months had increased by a median of 89.0 s (IQR -15 to 183) with PTMR compared with 12.5 s (-67 to 125) with medical treatment only (p=0.008). On masked assessment, angina class was II or lower in 34.1% of PTMR patients compared with 13.0% of those medically treated. All indices of the Seattle angina questionnaire improved more with PTMR than with medical care only. By 12 months there had been eight deaths in the PTMR group and three in the medical treatment group, with similar survival in the two groups.

INTERPRETATION

PTMR was associated with increased exercise tolerance time, low morbidity, lower angina scores assessed by masked reviewers, and improved quality of life. Although there is controversy about the mechanism of action, and the contribution of the placebo effect cannot be quantified, this unmasked study suggests that this palliative procedure provides some clinical benefits in the defined population of patients.

Symptom interpretation: implications for delay in HIV testing and care among HIV-infected late middle-aged and older adults

Physical symptoms and the attributions assigned to them are fundamental aspects of individuals' illness representations and influence health behaviours. The effects of the presence or absence of symptoms and the interpretation of these symptoms on the initiation of HIV testing and medical care are explored using data from a psychosocial study of HIV illness in late middle-aged and older men and women. The absence of symptoms negatively influenced willingness both to seek testing and to seek medical care. While the presence of symptoms would be expected to lead to testing and the initiation of medical care, the effect of symptoms was dependent on causal interpretations of the symptoms. Symptoms attributed (or misattributed) to other illnesses or to normal aging did not lead to initiation of testing or care. These results appear to be due to people's lay belief that illness must include symptoms and due to a resistance against accepting an illness identity. This research suggests that HIV education and counselling should emphasize the need for individuals at risk for HIV to seek testing and medical care even if symptoms of the disease are absent.

Maintaining health: proactive client-oriented community day treatment centres for the chronic mentally ill

This grounded theory study compared the definition of health by clients of two rural mental health day treatment centres, Big Sky Centre and Montana Centre. Based on an original grounded theory study of seven chronic mentally ill/disabled clients in Big Sky Centre (Yurkovich et al. 1997), the core variable, 'preventing loss of control' and related properties, were validated with nine residents of Montana Centre. While establishing a 'fit' with previous research findings, differences emerged between these two centres. These differences related to the staffs' philosophical approaches in providing treatment to the chronic mentally ill. Big Sky Centre care providers empowered their clients to learn new behaviours from their peers and assume new roles such as newcomer, member and leader. They also encouraged a prosocial attitude, and created a sense of belonging through valued involvement in their treatment. Montana Centre clients were not empowered to try out new behaviours in the treatment environment, or seek social support networks among their peers at the centre, which would foster a sense of belonging. The result was that clients from Montana Centre relied on the formal healthcare system more often than clients from the Big Sky Centre. The competing forces in healthcare today--family members, mental health providers, and insurance or managed care providers--make it easy to lose sight of or fail to gain the client's perspective about their health status and maintenance, particularly as it concerns day treatment centres. The importance of the day treatment centre as a therapeutic community which requires educational processes, innovative nursing practice, and client-centred interventions will be discussed.

Better outcome for women compared with men undergoing coronary revascularization: a report from the bypass angioplasty revascularization investigation (BARI)

BACKGROUND

Numerous studies have shown that women undergoing coronary revascularization procedures do so at a higher risk for an adverse outcome compared with men. However, the impact of advances in technology and improvements in techniques on in-hospital and long-term outcome after revascularization in women is unclear.

METHODS AND RESULTS

We evaluated 1829 patients with symptomatic multivessel coronary disease randomized to CABG or PTCA in the Bypass Angioplasty Revascularization Investigation (BARI), of whom 27% were women. As expected, women were older (64.0 versus 60.5 years), with more congestive heart failure (14% versus 7%), hypertension (68% versus 42%), treated diabetes mellitus (31% versus 15%), and unstable angina (67% versus 61%) than men but had similar preservation of left ventricular function and extent of multivessel disease. Women assigned to surgery received the same number of total grafts but fewer internal mammary artery grafts (72% versus 85%, P<0. 01), and those assigned to angioplasty had more intended lesions (76% versus 71%, P<0.01) successfully dilated than men. At an average of 5.4 years' follow-up, crude mortality rates were similar in women (12.8%) and men (12.0%). The Cox regression model adjusting for baseline differences revealed that women had a significantly lower risk of death (relative risk, 0.60; 95% CI, 0.43 to 0.84; P=0. 003) but not a significantly lower risk of death plus myocardial infarction (relative risk, 0.84; 95% CI, 0.66 to 1.07; P=0.16) than men.

CONCLUSIONS

Although the unadjusted mortality rate suggests that women and men undergoing CABG and PTCA have a similar 5-year mortality, women have higher risk profiles; consequently, contrary to previous reports, female sex is an independent predictor of improved 5-year survival after we control for multiple risk factors.

Bacillaene, a novel inhibitor of procaryotic protein synthesis produced by Bacillus subtilis: production, taxonomy, isolation, physico-chemical characterization and biological activity

Bacillaene, a novel polyene antibiotic, was discovered and isolated from fermentation broths of a strain of Bacillus subtilis. The novel antibiotic has a nominal molecular weight of 580 and an empirical formula of C35H48O7. Bacillaene is active against a broad spectrum of bacteria in agar-plate diffusion assays. Studies in vitro indicate that the antibiotic inhibits prokaryotic protein synthesis but not eukaryotic protein synthesis. Cell survival studies performed with strains of Escherichia coli indicate that the antibiotic is a bacteriostatic agent.

HIV prevalence and sexual behavior in a cohort of New York City gay men (aged 18-24)

An ethnically diverse cohort (n = 174) of New York City gay men (aged 18-24) was studied to determine human immunodeficiency virus (HIV) prevalence and to document sexual behavior patterns. Blood tests of 87 men showed an HIV prevalence of 9%, but only 3% of the previously tested men (n = 77) reported knowledge of a positive test result at baseline interview. An annual HIV seroconversion rate of 2% was observed. Ethnic minority men were more likely to test HIV positive. In addition, the median number of both sexual episodes and sex partners, and the proportion of men who engaged in anal intercourse, increased significantly from 1990 to 1991. During this 2-year period, 91% of the men engaged in unprotected receptive oral intercourse, and 37% engaged in unprotected receptive anal intercourse.

Social and sexual networks: their role in the spread of HIV/AIDS among young gay men

This article examines how networks of social and sexual relations affect risky sexual behavior and HIV seroprevalence among young gay men. Social networks can transmit information and cultural norms regarding safer sex, while networks of sexual partners channel the risk of exposure to HIV infection. These two network effects may help to explain some of the behavior and seroconversion differentials in the gay community. A number of recent studies have shown higher rates of unsafe sex among younger gay men. In the Longitudinal AIDS Impact Project, for example, younger gay men (18-24) report unsafe receptive anal sex at rates double that for any other age group (30% vs. 14-16%). One possible explanation is that younger men have watched fewer friends and colleagues contract HIV or AIDS, and are correspondingly less cautious. We test this hypothesis by comparing the personal networks of younger and older gay men to see whether those who practice safer sex have more exposure to persons with HIV or AIDS. The results give only weak support for the hypothesis that personal exposure to the effects of HIV and AIDS increases adherence to safer sex practices. Seroprevalence patterns among young men may be the result of their sexual networks, with those choosing older partners more likely to be exposed to HIV infection. We examine this hypothesis by comparing the age composition of the unsafe sexual partner network for seropositive and seronegative young men. The results strongly support the hypothesis that younger gay men with older partners are the leading edge of the epidemic in their cohort.

Patterns of sexual behavior and risk taking among young New York City gay men

One-hundred and seventy-four young New York City gay men (aged 18-24) were studied over a two-year period. We describe patterns of HIV risk taking behavior and factors that predict risk taking. Among men who engaged in receptive anal intercourse we discerned different patterns of behaviors. We defined risk takers as men who engaged in receptive anal intercourse. About two-thirds of the men fall into this category in each year, and about half of those (one third of the total) engaged in unprotected anal intercourse. Most of these men seem to make implicit decisions in managing their risk for HIV. Men who engaged in receptive anal intercourse were more likely to be in a coupled relationship and to know their partners' HIV status. Alcohol and/or drug use during sex, earlier sexual experiences, and greater integration into the gay community were also related to receptive anal intercourse. By contrast, a significant minority of the men, about 6% of the sample, engaged in very high risk behavior in each year of the study-defined as unprotected receptive anal intercourse with multiple partners. It appears that very high risk takers are qualitatively different from other risk takers: They reported more mental health problems, including more drug use, and higher levels of internalized homophobia and AIDS-related traumatic stress response. Implications for AIDS education and prevention are discussed.

Effects of AIDS-related bereavement on HIV progression among New York City gay men

This study investigates the relationship between early AIDS-related bereavement and subsequent changes in CD4 T-cell levels and health over a three- to four-year follow-up period in 85 HIV positive gay men. In addition, two psychological responses to loss, grief, and depression were distinguished and used as predictors of changes in health following loss. Interview data collected each year was used to assess psychological, behavioral and health factors. Blood samples drawn yearly were used to assess CD4 T-cell levels. Results indicate that those who had experienced an AIDS-related bereavement event prior to entry into the study showed a more rapid loss of CD4 T-cells over time, controlling for age, initial health status, use of antiretrovirals, sedatives, recreational drugs, cigarettes, and alcohol as well as other potential confounding factors. CD4 loss-rate differences were observable by two years post-bereavement. In addition, grief reactions were distinguishable from depressive reactions. Grief reactions were unrelated to CD4 decline and symptom onset while aspects of depression, specifically self-reproach, were predictive of CD4 loss. These data suggest that bereavement may impact biological systems relevant to HIV progression and that distinguishing specific responses to loss may improve our understanding of these relationships.

Effect of sexual behavior change on long-term human immunodeficiency virus prevalence among homosexual men

Substantial changes in human immunodeficiency virus (HIV)-related sexual behavior have been reported by virtually every survey of homosexual/bisexual men in the last decade. This paper uses a behavior-based simulation to examine how such changes are likely to affect the long-term future of the acquired immunodeficiency syndrome (AIDS) epidemic among homosexual men. Data from the Longitudinal AIDS Impact Project in New York City are used to estimate age-specific patterns of unprotected anogenital contact and behavioral change from 1980 to 1991. Model projections are validated using New York City surveillance data on AIDS incidence from 1981 to 1991. The current levels of unsafe sex reported in the Longitudinal AIDS Impact Project are shown to be almost exactly on the epidemic threshold. If this behavior were maintained, HIV prevalence would slowly decline in the population, but with just one additional unsafe sexual partner per year HIV would instead become endemic, with seroprevalence of about 65% in the oldest group and about 25% in the youngest. Transmission dynamics in the youngest group are analyzed in detail. For this group, the assortative age-matching bias in partner selection patterns raises the unsafe behavior threshold slightly in the long run.

Effects of AIDS-related bereavement and HIV-related illness on psychological distress among gay men: a 7-year longitudinal study, 1985-1991

In this study we examined the influence of acquired immunodeficiency syndrome (AIDS)-related bereavement on psychological distress from 1985 through 1991. We predicted that this relation would be influenced by personal knowledge of human immunodeficiency virus (HIV) infection and symptoms consistent with HIV-related illness. Interview data collected each year on a cohort of 746 gay men included information on the deaths and illnesses of network members caused by AIDS, as well as on psychological distress, sedative use, HIV-related symptoms, and HIV infection status. Significant main effects of bereavement were found in each year after controlling for both losses occurring from 1 to 2 years previously and for AIDS and HIV health status. The intensity and duration of these bereavement effects diminished over time. Groups of men who were both bereaved and classified as having AIDS or were HIV positive reported the highest level of distress in every year compared with the 3 other groups.

Effects of AIDS-related bereavement and HIV-related illness on psychological distress among gay men: a 7-year longitudinal study, 1985-1991

In this study we examined the influence of acquired immunodeficiency syndrome (AIDS)-related bereavement on psychological distress from 1985 through 1991. We predicted that this relation would be influenced by personal knowledge of human immunodeficiency virus (HIV) infection and symptoms consistent with HIV-related illness. Interview data collected each year on a cohort of 746 gay men included information on the deaths and illnesses of network members caused by AIDS, as well as on psychological distress, sedative use, HIV-related symptoms, and HIV infection status. Significant main effects of bereavement were found in each year after controlling for both losses occurring from 1 to 2 years previously and for AIDS and HIV health status. The intensity and duration of these bereavement effects diminished over time. Groups of men who were both bereaved and classified as having AIDS or were HIV positive reported the highest level of distress in every year compared with the 3 other groups.

10'-Desmethoxystreptonigrin, a novel analog of streptonigrin

10'-Desmethoxystreptonigrin, a novel analog of streptonigrin produced by Streptomyces albus, was discovered in a screen for inhibitors of farnesylation of RAS p21 protein. The compound was isolated from the fermentation broth and its structure determined. It is markedly cytotoxic to several human tumor cell lines and also exhibits potent broad-spectrum antibacterial activity.

Janthinocins A, B and C, novel peptide lactone antibiotics produced by Janthinobacterium lividum. I. Taxonomy, fermentation, isolation, physico-chemical and biological characterization

Janthinocins A, B and C are novel antibacterial agents produced by Janthinobacterium lividum. They were isolated from fermentation broths and characterized by UV, IR, NMR and mass spectroscopy. They are cyclic decapeptide lactones with marked activity against aerobic and anaerobic Gram-positive bacteria and are 2 to 4 times more potent in vitro than vancomycin. Janthinocins A and B were also found to be effective in a Staphylococcus aureus systemic infection in mice.

Left ventricular volume measurement using cardiac axis nuclear magnetic resonance imaging. Validation by calibrated ventricular angiography

Proton nuclear magnetic resonance (NMR) imaging has the potential to serially assess left ventricular (LV) volumes with optimal accuracy because it is a high-resolution, three-dimensional, noninvasive modality. Previous NMR studies to assess LV volumes have been suboptimal, as they have used either planes aligned with the axes of the body, which are compromised by partial volume effects, or spin-echo techniques that have been time-consuming to acquire and analyze. Accordingly, for LV volume measurement, we developed a gradient-echo (cine) NMR strategy that uses two orthogonal planes intersecting along the intrinsic long axis of the heart (two-chamber and four-chamber). This approach was validated against calibrated contrast biplane LV cineangiography (CATH) and also compared with a previously reported short-axis spin-echo NMR method. Twenty-one patients underwent CATH and NMR (long-axis, n = 21; short-axis, n = 14) within a 3-day interval. Although both long- and short-axis NMR LV volumes and ejection fractions correlated well with CATH (r greater than 0.90, p less than 0.001 in all), end-diastolic volumes by both long-axis (161 +/- 85 ml) and short-axis (151 +/- 81 ml) NMR were systematically less than those by CATH (182 +/- 85 ml) (p less than 0.05). Consequently, ejection fractions by long-axis (48 +/- 17%) and short-axis (49 +/- 17%) NMR consistently underestimated those by CATH (54 +/- 16%, p less than 0.05). End-systolic volumes by long-axis (94 +/- 71 ml) and short-axis (87 +/- 72 ml) NMR were not significantly different from those by CATH (92 +/- 69 ml). Both NMR techniques had low intraobserver and interobserver variation (less than 11%); however, short-axis spin-echo NMR involved longer acquisition/reconstruction (35 versus 18 minutes) and analysis (25 versus 10 minutes) times. We conclude that both short-axis spin-echo and long-axis gradient-echo NMR approaches reliably estimate LV volumes. Currently, the long-axis strategy appears more practical for clinical use because the scan and analysis times are relatively short.

The influence of social support on AIDS-related grief reaction among gay men

This paper examines the relationships between instrumental and emotional social support and the experience of grief reaction in a sample of 180 gay men who had lost a lover or close friend to AIDS during the first 5 years of the epidemic. Structured, face-to-face interviews were conducted in mid-1985. Grief reaction was assessed through a newly developed 12-item scale (alpha = 0.85). Availability and adequacy of instrumental and emotional support were assessed with reference to the tasks of caretaking and emotional pain experienced during the lover's or close friend's illness with AIDS. The findings indicate that gay men who lost a lover or close friend to AIDS experienced symptoms of grief similar to those reported in studies of bereaved spouses and parents. The intensity of these grief reactions appears to be influenced by a number of factors. First, more intense grief reactions were observed among those who had taken care of their lover or close friend during his illness compared with those who did not act as caretakers. Second, while the simple availability of instrumental and emotional support was unrelated to grief reactions, the perceived adequacy of both types of support was strongly related to the level of grief. Respondents who had received inadequate help with caretaking responsibilities experienced more intense symptoms of grief subsequent to the death compared with those who reported receiving adequate caretaking support. Similarly, respondents who did not obtain adequate emotional support for the pain they experienced during the course of the illness reported more intense symptoms of grief compared with those who felt they had received adequate support.(ABSTRACT TRUNCATED AT 250 WORDS)

A comparative evaluation of a restrictive smoking policy in a general hospital

The impact of a restrictive smoking policy on the behavior and attitudes of smokers and non-smokers was assessed by surveying random cross-sectional samples of hospital employees before, six months after and 12 months after the policy was implemented, and comparing responses with those of employees of a hospital with no restrictive policy. Effectiveness of policy implementation was also evaluated. Results indicated that the policy was well-publicized and was approved by virtually all the non-smokers and the majority of the smokers. Following implementation, employees in the smoking policy hospital were less likely to report being bothered by smoke at their work stations than were employees of the comparison hospital. Six months and one year after the policy change, smokers reported lower smoking rates while at work, although quit smoking rates and home smoking rates were similar in both hospitals.

Xylocandin: a new complex of antifungal peptides. I. Taxonomy, isolation and biological activity

Xylocandin is a complex of novel peptides with potent antifungal activity that is produced by Pseudomonas cepacia ATCC 39277. The complex was isolated from the fermentation broth by extraction with butanol-methanol, 9:1, followed by collection of the precipitate formed upon concentration of the solvent extract. Purification was effected by chromatography on reversed phase and size exclusion gels followed by TLC on silica gel. These techniques afforded eight components: A1, A2, B1, B2, C1, C2, D1 and D2. A mixture of the two closely related components, xylocandins A1 and A2, displayed potent anticandidal and antidermatophytic activities in vitro. The activity was diminished by the presence of serum or vaginal washings. No antibacterial activity was demonstrable.

Rete testis fluid (RTF) proteins: purification and characterization of RTF albumin

A major 68-kDa protein in ram rete testis fluid (RTF) is shown to be chemically and immunologically indistinguishable from albumin in ovine serum. Data obtained with two-dimensional gel electrophoresis of RTF demonstrate the presence of additional proteins with a molecular mass of 68 kDa that do not react with antisera against sheep serum albumin. Biochemical characteristics of albumin preparations isolated by immunoaffinity chromatography from ovine serum and from RTF were compared. Albumin from both sources had the same apparent molecular mass of 68 kDa, the same isoelectric point of approximately 4.2, and neither bound specifically to Concanavalin A. Analysis of tryptic peptide maps, obtained with reverse-phase high-pressure liquid chromatography, indicated no significant differences between digests of the two purified albumin preparations. Results indicate that RTF albumin and serum albumin are the same protein, which implies that RTF albumin may originate from serum. Albumin levels in RTF, collected from different rams and measured by radioimmunoassay, varied between 46 and 164 micrograms/ml, constituting between 11 and 17% of total RTF protein, while albumin levels in sheep plasma were 40,000 micrograms/ml. The protein composition of RTF is discussed in relation to the relative amounts of various components contributed by testis cells and the amounts derived from serum.

Disparate histologic responses in simultaneously resected primary and metastatic osteosarcoma following intravenous neoadjuvant chemotherapy

Seven patients with newly diagnosed metastatic osteosarcoma underwent simultaneous resection of the primary tumor and metastases following intravenous (IV) neoadjuvant chemotherapy. Histologic response was assessed in all tumor specimens. Disparate responses were noted between primary tumor and metastases and, in some cases, between two or more metastatic tumor deposits. The diverse histologic response to neoadjuvant chemotherapy suggests tumor cell heterogeneity. Changing postoperative therapy on the basis of the histologic response induced in the primary tumor may not be appropriate.

Catacandins, novel anticandidal antibiotics of bacterial origin

Two novel antibiotics, catacandin A and catacandin B, were isolated from the fermentation broth of the bacterium, Lysobacter gummosus, by extraction and adsorption, reverse-phase and gel filtration chromatography. On the basis of their physico-chemical properties, they are acyltetramic acids that are easily distinguishable from others in this class. Catacandin A and catacandin B possess good anticandidal activity.

Simultaneous evaluation for terminal deoxynucleotidyl transferase and myeloperoxidase in leukemia

A technique for dual staining of cells using terminal deoxynucleotidyl transferase (TdT) and myeloperoxidase (MPO) is described. The technique has been applied to cells of two patients. One patient had chronic myelomonocytic leukemia evolving into acute myelomonocytic leukemia. The other patient had chronic myelogenous leukemia in blast crisis. Our findings indicate that TdT and MPO are exclusive markers except for a rare precursor cell with dual staining in one patient. This study supports the concept of acute mixed leukemia.

Determination of terminal deoxynucleotidyl transferase on bone marrow smears by immunoperoxidase

Terminal deoxynucleotidyl transferase (TdT) is a marker of lymphoblastic disorders. Previously, the technique for determining TdT on smears was by indirect immunofluorescence. An immunoperoxidase procedure for detecting TdT on smears is reported. Results are in a comparable range with the indirect immunofluorescent technique. As discussed in this paper, TdT by immunoperoxidase may offer certain advantages over the indirect immunofluorescent procedure.

Quantitation of tobramycin by solid-phase immunofluorescence

Tobramycin usage, as for most aminoglycoside antibiotic usage, may require careful monitoring to avoid irreversible toxicity. Several methods for tobramycin quantitation are available. The purpose of this study was to evaluate the performance of solid-phase immunofluorescence as an alternative. Tobramycin was quantitated in the sera of 81 patients by radioimmunoassay and solid-phase immunofluorescence. No statistically significant or medically important difference was demonstrated (bias, 0.006 micrograms/ml, t = 0.09, s = 1.02, r = 0.97). Within-run and run-to-run precision for the two methods were comparable. Interference by gentamicin could not be demonstrated. Solid-phase immunofluorescence may be an acceptable alternative method for tobramycin quantitation in some laboratories.

Experience with the CAM vision stimulator: preliminary report

Eighty-four children with at least 2 lines of amblyopia were treated with the CAM vision stimulator. 91% of the children who had received no previous amblyopia therapy showed improvement, 73% achieving 6/12 vision or better. Of children in whom previous occlusion therapy had failed 73.8% improved. The treatment appears to be effective, rapid, and well tolerated. Our initial impressions have been sufficiently favourable to stimulate further clinical evaluation.