African-American Adolescents’ Weight Loss Skills Utilization: Effects on Weight Change in a Sequential Multiple Assignment Randomized Trial

Objective

Successful weight loss interventions for African-Americans adolescents are lacking. Cognitive-behavioral interventions seek to develop weight loss skills (e.g., counting calories, goal setting, managing one's environment). Little is known about how well adolescents implement such skills in their daily lives. Study aims were to (1) examine weight loss skills utilization at midpoint and end of a 6-month cognitive-behavioral/motivational interviewing weight loss sequential multiple assignment randomized trial (SMART), and (2) determine if greater skill utilization predicted weight loss at treatment end and 3 months post-treatment.

Multiple Cranial Nerve Palsies in a Patient 15 Years after Curative Therapy for a Pituitary Adenoma

Over a 3-year period, a 31-year-old man developed multiple cranial nerve palsies consisting of diplopia, left-sided facial numbness and weakness, and loss of the left corneal reflex. Fifteen years prior to presentation, he had undergone curative therapy for a prolactin-secreting pituitary macroadenoma. The imaging studies were helpful in localizing the disease process, which correlated well with the clinical examination, and for focusing the differential diagnosis.     

Magnetic resonance imaging and clinical correlates of intellectual impairment in myotonic dystrophy

Although intellectual impairment is common in patients with myotonic dystrophy, this aspect of the disease has received relatively little research attention. We examined 41 patients with myotonic dystrophy using objective neuropsychological procedures and magnetic resonance imaging. Ten patients (24%) had severe and generalized intellectual dysfunction, while lesser or no cognitive impairment characterized the remaining patients. Degree of intellectual impairment was not related to neuromuscular status or sex. Patients with severe intellectual disturbance had significantly earlier onset of both myotonia and weakness and were more likely to inherit the disease from their mother. Magnetic resonance imaging findings indicated that while degree of cerebral atrophy was not related to severity of intellectual impairment, skull thickness, focal white matter lesions, and anterior temporal lobe abnormalities were significantly more common in patients with severely disturbed intellect. This study reports a number of previously unreported cerebral magnetic resonance imaging findings associated with intellectual impairment in myotonic dystrophy, but the etiology of these changes awaits neuropathologic examination.     

Voluntary HIV counseling and testing: experience among the sexually active population in Bangui,Central African Republic

OBJECTIVES: In July 1997, the National Reference Center for Sexually Transmitted Diseases of Bangui, Central African Republic (CAR), was expanded by the creation of an anonymous and voluntary counseling and testing (VCT) unit for HIV infection, the Anonymous Surveillance Unit (Unité de Dépistage Anonyme [UDA]). The goal of the UDA was to initiate and promote voluntary HIV testing in the general adult population of Bangui. We carried out an observational and comprehensive survey over a 4-year period to document and analyze the experience of VCT in the UDA, with special attention to risk factors associated with HIV infection. METHODS: All clients for VCT were given adequate pretest counseling by trained counselors focused on knowledge about HIV infection and sexually transmitted infections, individual risks of acquiring HIV, and anticipation of the client's attitude about test results. After consent was obtained, a blood sample was drawn and tested for HIV by two ELISAs in parallel. The client paid a standard cost of $1.20 at the initial visit. After a week, test results were given to the client during the posttest visit, at which time HIV-seropositive individuals received emotional support and were referred to specific social or medical structures. Seronegative clients received reinforcement of prevention messages and were asked to come back for serologic follow-up free of charge after 3 (M3) and 12 (M12) months. RESULTS: From July 1997 to March 2001, 5686 individuals aged 14 to 65 years (mean age, 27 years) had an initial visit for VCT (V1). Peaks of UDA visitation (250-450 clients) were observed on the annual AIDS Day in the CAR, at which time HIV serologic testing was offered free of charge. A total of 5060 (89%) clients came back for a second visit (V2) to receive test results. Among those, 18.3% were infected with HIV type 1. Multivariate analysis of risk factors demonstrated marked association of HIV seropositivity with age, female gender, widowed/divorced women, poor or low education level, occupations such as civil servants or merchants, presence of symptoms of sexually transmitted infections, and lack of systematic condom use. Single young women were at higher risk for HIV infection compared with men of the same age (OR = 7.7 for women aged 15-24 years, 95% CI: 4.0-14.0; OR = 2.8 for women aged 25-34 years, 95% CI: 1.7-4.5). Widowed women older than 44 years of age were more likely to be HIV-seropositive than men (OR = 10.0; 95% CI: 1.7-83.6). A total of 885 (21%) HIV-seronegative individuals returned for follow-up at 3 months (M3; 0.45% rate of seroconversion). Seventy-nine (9%) individuals returned at 12 months (M12), without any new cases of HIV infection. HIV-negative clients consulting at M3 and M12 showed a significant reduction in unprotected intercourse with occasional sexual partners. CONCLUSION: This experience demonstrates that VCT for HIV infection is feasible in Central Africa.     

Parent-child factors and their effect on communicating BRCA1/2 test results to children

The purpose of the present study was to evaluate the likelihood and the effect of parent-child factors on communicating about maternal genetic test results for breast/ovarian cancer risk. Subjects were 42 mothers enrolled in a hereditary breast cancer research program who reported on their interactions with 68 target children. Predictor variables (demographic, clinical, and psychological) were assessed at baseline after mothers participated in a comprehensive genetic counseling/education session and provided a blood sample for BRCA1/2 mutation analysis. Maternal communication of test results to children was assessed 1 month after mothers learned their mutation status. The rate of disclosure to pediatric-age children was 53%. Older children were more likely to be informed of their mothers' test results than were younger children. Maternal disclosure of genetic test results to children was also more likely to occur in the presence of more open parent-child communication styles, though the act of disclosing did not appear to impact communication style. These findings suggest that in addition to developmental phase, family behavioral interactions and communication styles are strongly predictive of whether or not mothers choose to share cancer genetic risk information with their children.     

Mechanisms of phagocytosis in human polymorphonuclear leucocytes

Human polymorphs have been found to ingest a wide variety of particles without the aid of serum, indicating that the cells possess a serum-independent mechanism of phagocytosis. Polymorphs have also been shown to possess a different and complementary mechanism of phagocytosis which depends on the presence of serum and serum components in the medium.

Ingestion of starch particles by human polymorphs in the absence of serum was unaffected by media at the extremes of physiological pH and at tonicities between 205 and 348 m-osmoles/l and by the presence in media of neutral and acid mucopolysaccharides.

Phagocytosis of starch particles was reversibly inhibited by media of high tonicity and irreversibly inhibited by low concentrations of bacterial lipopolysaccharide, which had a lethal effect on the cells. Serum was unable to promote phagocytosis by polymorphs in media of high tonicity but both untreated serum and inactivated serum promoted phagocytosis in media containing endotoxin, probably by neutralizing the action of the lipopolysaccharide.

Phagocytosis of starch particles by human polymorphs in the absence of serum was inhibited by prior treatment of the cells with iodoacetate, suggesting that serum-independent phagocytosis relies on glycolytic energy. Ingestion of starch particles by polymorphs, treated with iodoacetate, was largely contingent on the presence of serum in the suspending medium, but inactivated serum and individual plasma proteins also had a limited ability to promote phagocytosis. These results suggested that cell glycolysis is not the principal source of energy in the serum-dependent mechanism of phagocytosis.

Using hydrocarbon test particles, it was shown that combinations of either of the heat-labile components of complement (C′1 or C′2) with the C′4 component were active in promoting phagocytosis. Evidence was also presented that the C′3 component had some activity and another serum factor, which was only present in the heat-inactivated sera of some individuals, also had a limited ability to promote phagocytosis.

     

Specificity of the passive antibody-induced suppression of the humoral immune response of mice to surface antigens on human cells

The effect of passively administered antibody on the humoral immune response of BALB/c mice to antigenic determinants on human cells has been examined. Antiserum raised by immunizing mice with the human leukaemic cell line K562, which lacks HLA-A,B,C antigens, was administered to mice, together with the HLA-A,B,C-positive cell line, BALM-1. The antibody response to the unique antigen was assessed by measuring the ability of the resultant antiserum to inhibit the binding to BALM-1 cells of a labelled monoclonal antibody, 7B6, which is specific for a monomorphic HLA-A,B,C determinant. As an indication of the immune response to antigens common to K562 and BALM-1, the ability of the same antiserum to inhibit the binding of monoclonal antibody 6B1, which detects an epitope common to both cell lines, was measured. Passive antibody to K562 blocked the immune response of mice to the common antigen on BALM-1 cells. However, the response to the antigen not recognized by the passive antibody was unaffected, even though the two antigens were present on the same immunizing cell. Thus, the effect of passive antibody was 'determinant specific'. Similar results were obtained, irrespective of whether the i.v. or i.p. route of immunization was used, and whether the passive antibody was adsorbed onto the immunizing cells prior to injection, or administered separately. The blocking of the immune response did not depend on simple masking of the antigenic determinants by the passive antibody, since non-saturating amounts of antibody were effective. In addition, blocking activity was dependent on antibody class and on an intact Fc region. The latter considerations also imply that the outcome of passive antibody administration in this system was determined by factors other than the ability of the antigen-antibody complexes to interact directly with B cells, and indicate the importance of antigen processing and/or a mechanism such as antigen-reactive cell opsonization.