An assessment of myocardial ischemia in women with the exercise test validated by coronary angiography]

Ischemic heart disease has been studied in men and women only as a group. We studied the sensitivity and specificity of the exercise stress testing in women. The exercise stress testing (EST) was validated with the coronary arteriography. We studied 72 women and 129 men, the mean age was 55 years for women and 51 years for men. We found in women 83.2% of estimated maximal heart rate; the rate pressure product was 2.4, no different from the values recorded in men (p greater than 0.06). The blood pressure response to exercise was higher in women, and the maximal work capacity was more elevated in men (p less than 0.006). We found normal coronary arteries in 41 women, 70.7% with a positive (EST) compared with a 87.07% in men. The sensitivity and specificity of the exercise stress testing for the diagnosis of ischemic heart disease is smaller in women.     

Pituitary glycoprotein hormone alpha-subunit secretion after thyrotropin-releasing hormone stimulation in normal men and men with idiopathic hypogonadotropic hypogonadism.

Although TRH stimulates the release of uncombined alpha-subunit into the circulation in patients with primary hypothyroidism, it is not clear whether alpha-subunit is released from the thyrotrophs in euthyroid subjects. We hypothesized that spontaneous fluctuations in circulating alpha-subunit released from gonadotrophs by GnRH in normal adults could obscure the detection of small changes in alpha-subunit after TRH administration. We, therefore, examined alpha-subunit responses to TRH in five euthyroid men with idiopathic hypogonadotropic hypogonadism (IHH), who produce little or no GnRH, five normal men, and four postmenopausal women. Mean (+/- SEM) basal serum alpha-subunit levels were significantly (P less than 0.05) less in men with IHH (0.26 +/- 0.07 microgram/L) than in the normal men (0.80 +/- 0.20 microgram/L) or postmenopausal women (3.54 +/- 0.60 microgram/L). alpha-Subunit levels rose after TRH administration in all men with IHH to a peak level of 0.86 +/- 0.25 ng/ml; TSH levels also increased from 1.9 +/- 0.4 to 13.0 +/- 5.6 mU/L. The increment in TSH and alpha-subunit levels was highly positively correlated (r = 0.96). alpha-Subunit levels also increased 2-fold in normal men given TRH, whereas alpha-subunit levels in postmenopausal women were unchanged. We conclude that thyrotrophs release alpha-subunit into the circulation in normal men and euthyroid men with IHH. Thus, both thyrotrophs and gonadotrophs appear to contribute to circulating alpha-subunit in men with IHH; however, most of the uncombined alpha-subunit in normal men appears to be from gonadotrophs.     

Treatment of primary hypogonadism in men by the transdermal administration of testosterone

We tested the efficacy of a thin flexible testosterone-impregnated membrane applied to the scrotum for the long term treatment of male hypogonadism. Ten men with primary hypogonadism were treated for 3 months (2 men) or 13 months (8 men). Serum testosterone concentrations increased in all 10 men, to within the normal range in 8. Serum dihydrotestosterone concentrations increased to supranormal values in all of the men, decreased to the normal range in 6, indicating the biological effectiveness of the testosterone in those subjects. Two men whose serum LH concentrations did not fall to normal had small or distorted scrotal surfaces. Seven of the 8 men whose serum testosterone concentrations became normal said that their hypogonadal symptoms were corrected by this treatment. We conclude that the transdermal administration of testosterone is an effective means of treating the majority of hypogonadal men who have a normal scrotum.     

Is asymptomatic non-chlamydial non-gonococcal urethritis associated with significant clinical consequences in men and their sexual partners: a systematic review

Opinions are divided on whether to screen asymptomatic men for non-chlamydial non-gonococcal urethritis (NCNGU). We systematically reviewed the literature to determine whether male asymptomatic NCNGU is associated with significant clinical outcomes for men and/or their sexual partners. We searched electronic databases and reference lists from retrieved articles and reviews. No studies reporting clinical outcomes in men with asymptomatic NCNGU were identified. Two eligible studies report rates of sexually transmitted infections (STIs) in female partners of men with asymptomatic NCNGU; Chlamydia trachomatis was detected in 2.4% and 8.3% of these women. The evidence available is insufficient in quality and breadth to enable us to conclude whether asymptomatic NCNGU is associated with significant health consequences for men or their sexual partners; however, clinical consequences of asymptomatic NCNGU are poorly investigated. Clinicians should be aware of the limitations of the evidence on which current screening guidelines for asymptomatic men are based.     

High Grade Anal Dysplasia in Visually Normal Mucosa in Homosexual Men: Seven Cases

Background: Anal cancer and anal human Papillomavirus (HPV) infection are increased in homosexual men.
Methods: We screened high risk homosexual men as part of a longitudinal study examining the effect of HIV infection on the risk of development of high grade anal intraepithelial neoplasia (AIN II, III).
Results: We found seven men who had histological evidence of AIN II-III with visually normal findings by anoscopy. Two men were HIV-seronegative, five were HIV-seropositive, and only one of the HIV-seropositive men had a low CD₄ count < 200. Abnormal cytological results seen over follow-up periods of 3 months to 2.5 yr suggest the persistence of visually inapparent anal abnormalities. Two of the men had had small internal warts at earlier examinations, and three of the seven men subsequently developed visually abnormal anal findings. All men had HPV 16 DNA detected at some point.
Conclusions: We hypothesize that high grade anal neoplasia may develop deep in the glands and can be detected by cytology before visible lesions are detected even with the aid of a colposcope. However, the implications of finding high grade anal cytology are not known at this time. Natural history studies are ongoing.     

Social Discrimination,Concurrent Sexual Partnerships,and HIV Risk Among Men Who have Sex with Men in Shanghai,China

We examined the potential mediating role of sex partner concurrency in explaining associations between experiences of homophobia and financial hardship and HIV risk behavior among a sample of 477 men who have sex with men (MSM) recruited in Shanghai, China from 2004 to 2005. We found significant positive direct associations of experiences of homophobia and financial hardship with having unprotected anal sex with men. These associations were not mediated by male partner concurrency. However, male partner concurrency had a direct effect on having unprotected anal sex with men. Male and female partner concurrency did not mediate the significant association between experiences of homophobia and having unprotected anal/vaginal sex with both men and women, but was positively associated with having unprotected anal/vaginal sex with both men and women. These results suggest that homophobia, financial hardship, and sex partner concurrency should be addressed to help reduce sexual risk for HIV among MSM in China.     

Community-based electronic data collections for HIV prevention research with black/African-American men in the rural,Southern USA

In Florida, the HIV case rate among black men is five times that of white men; tailored HIV prevention interventions are lacking. Historical concerns regarding trust with public health venues and sharing sensitive information make face-to-face data collection with some rural, southern black men challenging. We evaluated the feasibility and acceptability of using audio computer-assisted self-interviews (ACASIs) by local community-based organization members to collect HIV-related information from black men in rural settings. We used logistic regression to estimate associations between using ACASI and participants' sociodemographic characteristics. Of 636 men approached, 586 (92.0%) participated, 479 (81.7%) never completed a computer survey, and 287 (71%) of those reporting a preference preferred ACASI for future data collections. Increased age, past computer use, and sharing a household with someone were significantly associated with ACASI feasibility and acceptability. Using ACASI with black men in rural settings is feasible for HIV intervention research and disparity-reducing goals.     

'Face up to the truth': helping gay men in Vietnam protect themselves from AIDS

Appropriate AIDS prevention information is not available in Vietnam for men who have sex with men. Current AIDS prevention messages can be misunderstood with potentially dangerous results. We outline some features of gay culture in a provincial city in Vietnam. We describe the activities of a peer educator who made contact with a small group of young gay men during 1996 and 1997. All the young men were ill-informed about AIDS. Their attitudes and sexual practices made them vulnerable to AIDS. The peer educator provided clear information and emotional support. The peer education was done without government endorsement and on a very low budget.     

Refining the treatment of women with unstable angina—A randomized,double-blind,comparative safety and efficacy evaluation of integrelin™ versus aspirin in the management of unstable angina

Background: Although women typically develop coronary artery disease several years after men, once they have symptomatic disease their thromboembolic complications are worse than in men. The mechanism mediating this gender difference in outcome after thromboembolic events is unknown. We previously studied platelet functions in siblings from patients with premature coronary artery disease. We observed that platelets from women are more responsive than their male counterparts. In particular, platelets from women stimulated ex vivo with various agonists bind more fibrinogen molecules than platelets from men. Hypothesis: We hypothesized that in patients with acute coronary events, the control of platelet activity might require stronger antagonists in women than in men. Methods: To test this hypothesis, we investigated retrospectively the results of a trial on Integrelin? in unstable angina. Results: We report that platelet aggregation and Holter-de-tected ischemic episodes are significantly reduced in women with unstable angina treated with the specific GPIIb-IIIa inhibitor, Integrelin, compared with the standard platelet inhibitor aspirin. In contrast, both platelet aggregation and Holter-detected ischemic events are well controlled in men with unstable angina treated with standard therapy including aspirin. Conclusion: Integrelin does provide protection in men, but, in contrast with women, not beyond what can be achieved with aspirin. Our data are consistent with the concept that the platelets from women require stronger and more specific inhibitors to limit their activity, and that platelets may play a more important role in women with acute coronary syndromes than in men. Most important, specific GPIIb-IIIa inhibitors may represent a therapeutic option which provides as much suppression of ischemic events in women as they do in men with coronary artery disease.     

Mortality rates by gender and sexual orientation reveal a disproportionally high mortality among cisgender men of unknown sexual orientation and men who have sex with women in a cohort of people living with HIV in Rio de Janeiro,Brazil

BackgroundAntiretroviral therapy use has led to a decline in HIV-related mortality yet disparities by gender and/or sexual orientation may exist. In this study, we estimated hazards of death in people living with HIV (PLWH) according to gender and sexual orientation.MethodsWe included PLWH ≥ 18 years enrolled between 2000 and 2018 at INI/Fiocruz, Rio de Janeiro, Brazil. Participants were grouped as cisgender or transgender women, cisgender men who have sex with men (MSM) or men who have sex with women, or cisgender men with unknown sexual orientation. We assessed disparities in the hazard of death using Cox proportional hazards models.ResultsAmong 5,576 PLWH, median age at enrollment was 35 years, 39% were MSM, 28% cisgender women, 23% men who have sex with women, 5% transgender women, and 5% men with unknown sexual orientation. A total of 795 deaths occurred in 39,141 person-years of follow-up. Mortality rates per 1,000 person-years were: 82.4 for men with unknown sexual orientation, 24.5 for men who have sex with women, 18.3 for cisgender, 16.6 for transgender women, and 15.1 for MSM. Compared to MSM, men with unknown sexual orientation had the highest death hazard ratio (adjusted hazard ratio [aHR] 2.93, 95% confidence interval [CI] 2.35–3.81), followed by men who have sex with women (aHR 1.17, 95%CI 0.96, 1.43); death hazard ratios for cisgender and transgender women were not statistically different.ConclusionWe observed disparities in the hazard of death for men with unknown sexual orientation and men who have sex with women despite universal access to antiretroviral therapy in Brazil. Future work should characterize and assist men with unknown sexual orientation with tailored policies and interventions. Increased hazard of death was not observed for transgender women, which probably results from interventions implemented in our service to reach, engage, retain, and support this population.     

肾脏病患者血浆内皮素测定的临床意义

本文应用放免法测定了58例肾脏病患者的血浆内皮素(ET)水平,结果显示肾脏病患者ET较正常人明量增高.其增高程度与BUN,Gr,K~+,MAP呈正相关关系.肾性高血压患者较原发性高血压患者明显增高,血液透析组较尿毒症非透析组差异非常显著.血透后ET水平下降.本文还探讨了肾脏病患者ET升高的原因及血液透析对ET的影响,提出ET作为内源性致损伤因子对肾脏病的发生、发展有重要作用.     

Comparison of frequency of coronary artery calcium in healthy Hispanic versus non-Hispanic white men by electron beam computed tomography

We recently demonstrated in subjects referred for the evaluation of cardiovascular disease that coronary atherosclerosis and coronary artery calcium (CAC) were reduced in Hispanics compared with non-Hispanic whites (NHWs). We now evaluate whether this ethnic disparity is present in a unselected healthy cohort of men. Despite the apparently worse risk factor profile, mean and median levels of CAC trended lower in Hispanic men, and the distribution of CAC scores differed from that of NHW (p <0.05), with fewer Hispanic subjects having CAC scores that are generally equated with extensive atherosclerotic burden (>400). These results demonstrate that healthy Hispanic men have reduced CAC compared with age-matched NHW men and this occurs despite evidence for a worse cardiovascular risk profile.     

Modeling the Impact of Post-Diagnosis Behavior Change on HIV Prevalence in Southern California Men Who Have Sex with Men (MSM)

Our objective here is to demonstrate the population-level effects of individual-level post-diagnosis behavior change (PDBC) in Southern Californian men who have sex with men (MSM), recently diagnosed with HIV. While PDBC has been empirically documented, the population-level effects of such behavior change are largely unknown. To examine these effects, we develop network models derived from the exponential random graph model family. We parameterize our models using behavioral data from the Southern California Acute Infection and Early Disease Research Program, and biological data from a number of published sources. Our models incorporate vital demographic processes, biology, treatment and behavior. We find that without PDBC, HIV prevalence among MSM would be significantly higher at any reasonable frequency of testing. We also demonstrate that higher levels of HIV risk behavior among HIV-positive men relative to HIV-negative men observed in some cross-sectional studies are consistent with individual-level PDBC.     

Risk of Erectile Dysfunction in Transfusion-naive Thalassemia Men: A Nationwide Population-based Retrospective Cohort Study

Based on the mechanism of pathophysiology, thalassemia major or transfusion-dependent thalassemia patients may have an increased risk of developing organic erectile dysfunction resulting from hypogonadism. However, there have been few studies investigating the association between erectile dysfunction and transfusion-naive thalassemia populations. We constructed a population-based cohort study to elucidate the association between transfusion-naive thalassemia populations and organic erectile dysfunctionThis nationwide population-based cohort study involved analyzing data from 1998 to 2010 obtained from the Taiwanese National Health Insurance Research Database, with a follow-up period extending to the end of 2011. We identified men with transfusion-naive thalassemia and selected a comparison cohort that was frequency-matched with these according to age, and year of diagnosis thalassemia at a ratio of 1 thalassemia man to 4 control men. We analyzed the risks for transfusion-naive thalassemia men and organic erectile dysfunction by using Cox proportional hazards regression models.In this study, 588 transfusion-naive thalassemia men and 2337 controls were included. Total 12 patients were identified within the thalassaemia group and 10 within the control group. The overall risks for developing organic erectile dysfunction were 4.56-fold in patients with transfusion-naive thalassemia men compared with the comparison cohort after we adjusted for age and comorbidities.Our long-term cohort study results showed that in transfusion-naive thalassemia men, there was a higher risk for the development of organic erectile dysfunction, particularly in those patients with comorbidities.     

High Risk Behaviors and Sexually Transmitted Infections Among Men in Tanzania

We assessed the association between risk behaviors and sexually transmitted infections (STIs) among men. We interviewed 794 men randomly selected from Moshi district of Tanzania. Blood and urine samples were tested for STIs. About 46% of the men tested positive for at least one STI including human immunodeficiency virus (HIV-1), herpes simplex virus (HSV-2), syphilis, chlamydia, trichomonas, and mycoplasma infection. Multiple sexual partners, casual sex, alcohol abuse, and older age were associated with higher odds of having an STI. Effective STI prevention programs in sub-Saharan Africa should have components aimed at addressing modifiable risk behaviors in men.     

Changes in gay men's participation in gay community life: implications for HIV surveillance and research

Successful antiretroviral treatments, achievements in gay acceptance and human rights, and internet use have prompted changes in gay socialising which create potential challenges for engaging with gay men for HIV surveillance and research. We used data from the Australian behavioural surveillance and explored (i) the relationship between community engagement and HIV related practices, and (ii) time trends in gay men’s engagement with the gay community. Analyses were conducted using log-binomial regression and chi-square test for trend. The proportion of men who socialized mainly with gay men declined and the Internet use to connect with sex partners increased over time. Gay social engagement was associated with HIV positive serostatus, unprotected anal intercourse with regular partners and a high frequency of HIV/STI testing. Our findings indicate a shift in how gay men socialise and find partners. We discuss the challenges for ongoing engagement with gay men for behavioural surveillance and HIV research.     

HIV Prevention Among Cisgender Men Who have Sex with Transgender Women

AIDS and Behavior - Cisgender men who have sex with transgender women face elevated risk for HIV, yet are understudied in prevention research. We conducted in-depth interviews with 19 men who have...     

Antiprolactin autoantibodies are associated with hyperprolactinemic status in men infected with human immunodeficiency virus

High serum prolactin (PRL) levels and even hyperprolactinemia are a common finding in human immunodeficiency virus (HIV) infection. However, little is known regarding the mechanisms that may contribute to the rise of PRL. We measured serum PRL levels in 54 HIV-infected and 85 healthy age-matched men. The association between PRL levels among anti-PRL autoantibodies and other clinical variables in HIV-infected men was studied. We also evaluated the changes in serum PRL levels by chromatographic separation (affinity with protein G and gel filtration) after a 10-mg iv bolus of metoclopramide. HIV-infected men had higher serum PRL levels compared with healthy men. Sera from 9 of the 54 (16.7%) HIV-infected men were found to have hyperprolactinemia. Moreover, the anti-PRL autoantibody was present in four of nine (44.4%) HIV-infected men with hyperprolactinemia; it was also associated with hyperprolactinemic status. Serum total PRL levels were higher in HIV-infected men with anti-PRL autoantibodies than hyperprolactinemic HIV-infected men without anti-PRL autoantibodies; by contrast, free PRL levels were lower. In HIV-infected men with anti-PRL autoantibodies, gel filtration showed that big big PRL isoform was present as the predominant circulating form of PRL throughout each measurement after iv metoclopramide. By contrast, the predominant isoform of PRL in serum from healthy men and HIV-infected men who were anti-PRL autoantibody negative was little PRL. On the other hand, high serum total PRL levels were observed at each measurement throughout the metoclopramide test in HIV-infected men with anti-PRL autoantibodies; however, the serum free PRL levels were similar to those found in subjects without anti-PRL autoantibodies. These data demonstrated that anti-PRL autoantibodies are associated with hyperprolactinemic status in HIV-infected subjects, particularly in those with high serum PRL levels.     

Undetectable or Unknown? A Longitudinal Event-Level Analysis of Disclosure of HIV Serostatus and Undetectability Among Gay,Bisexual, and Other Men Who have Sex with Men (gbMSM) in Metro Vancouver

AIDS and Behavior - We examined temporal trends and factors associated with reporting partner’s serostatus and viral load among a sample of gay, bisexual and other men who have sex with men...     

Incidence and presentation of early syphilis diagnosed in HIV-positive gay men attending a central London outpatients' department

We examined the incidence, presentation and sexual behaviour of gay men diagnosed with early syphilis at the Royal Free Hospital HIV department in 2002. A total of 1086 gay men attended and 31 were diagnosed with early syphilis (2.9/100 person years). Twenty-six (84%) of the men were symptomatic and 15 (48%) had documented negative serology within the previous six months. All of the men reported anal intercourse with a new partner in the previous three months. The results support offering regular serological screening to sexually active gay men attending our HIV outpatients' department.