Alcohol and Sexual HIV Risk Behavior Among Problem Drinking Men Who Have Sex With Men: An Event Level Analysis of Timeline Followback Data

While heavy drinking among men who have sex with men (MSM) has been shown to be associated with an increase in sexual risk taking, a temporal relationship between drinking and an increase in subsequent HIV risk behaviors among adult samples has been less obvious. This study used an event level analysis to examine this relationship among HIV negative problem drinking MSM. Within subjects analyses show a higher probability of unprotected anal intercourse after drinking. Post-hoc analyses of within subjects data indicate that drinking increases risk taking when engaging in receptive anal intercourse but not for insertive anal intercourse. Findings from this study support evidence that drinking is a factor that increases risk taking among HIV negative problem drinking MSM, particularly for receptive anal intercourse.     

Evolution of disease phenotype in adult and pediatric onset Crohn’s disease in a population-based cohort

AIM:To investigate the evolution of disease phenotypein adult and pediatric onset Crohn’s disease(CD) populations,diagnosed between 1977 and 2008.METHODS:Data of 506 incident CD patients were analyzed(age at diagnosis:28.5 years,interquartile range:22-38 years).Both in-and outpatient records were collected prospectively with a complete clinical follow-up and comprehensively reviewed in the population-based Veszprem province database,which included incident patients diagnosed between January 1,1977 and December 31,2008 in adult and pediatric onset CD populations.Disease phenotype according to the Montreal classification and long-term disease course was analysed according to the age at onset in time-dependent univariate and multivariate analysis.RESULTS:Among this population-based cohort,seventy-four(12.8%) pediatric-onset CD patients were identified(diagnosed ≤ 17 years of age).There was no significant difference in the distribution of disease behavior between pediatric(B1:62%,B2:15%,B3:23%) and adult-onset CD patients(B1:56%,B2:21%,B3:23%) at diagnosis,or during follow-up.Overall,the probability of developing complicated disease behaviour was 49.7% and 61.3% in the pediatric and 55.1% and 62.4% in the adult onset patients after 5-and 10-years of follow-up.Similarly,time to change in disease behaviour from non stricturing,non penetrating(B1) to complicated,stricturing or penetrating(B2/B3) disease was not significantly different between pediatric and adult onset CD in a Kaplan-Meier analysis.Calendar year of diagnosis(P = 0.04),ileal location(P < 0.001),perianal disease(P < 0.001),smoking(P = 0.038) and need for steroids(P < 0.001) were associated with presence of,or progression to,complicated disease behavior at diagnosis and during follow-up.A change in disease location was observed in 8.9% of patients and it was associated with smoking status(P = 0.01),but not with age at diagnosis.CONCLUSION:Long-term evolution of disease behavior was not different in pediatric-and adult-onset CD patients in this     

Demographic Characteristics and Sexual Behaviors Associated with Methamphetamine Use among MSM and Non-MSM diagnosed with AIDS in Los Angeles County

Demographic and behavioral factors associated with methamphetamine use are presented for 455 men who have sex with men (MSM) and 228 non-MSM diagnosed with AIDS in Los Angeles County (LAC) from 2000 to 2004, as there are limited population-based data for these subgroups. Lifetime methamphetamine use was 35% for MSM, 14% for non-MSM, 50% for white MSM, and 35% for black MSM. Methamphetamine use in the previous 12 months among MSM (11%) and non-MSM (0.4%) was less than lifetime use. Compared to MSM with no history of methamphetamine use in a multivariate analysis, MSM methamphetamine users were more likely to be non-Latino (white or black) (OR = 2.8, 95% CI: 1.6, 4.9) compared to Latino and reported >/=10 sexual partners in the previous 12 months (OR = 3.1, 95% CI: 1.7, 5.6). These data indicate that methamphetamine has been widely used by both MSM and non-MSM with AIDS in LAC and that lifetime use is associated with sexual risk behaviors among MSM.     

Effect of outpatient treatment of asthma with beta agonists on the response to sympathomimetics in an emergency room

It has been suggested that tolerance to the bronchodilating effects of sympathomimetics may develop in asthmatic patients after long-term use of these agents. In an emergency room setting, the effects of inhaled and injected sympathomimetic therapy in 58 patients who had pretreated themselves with beta agonists were compared with the results observed in 38 patients who had not used such drugs. The two groups had similar degrees of obstruction on presentation and were also well-matched with respect to the clinical features of their illness. Both populations showed equal responses to treatment; no significant differences were found in either the amount of bronchodilation or the incidence of adverse effects in those who had or had not taken sympathomimetics as outpatients. These findings indicate that drug resistance does not account for outpatient treatment failures with sympathomimetics and that beta agonists can be usefully employed in the treatment of acute asthma, irrespective of a patient's medication history.     

Glucocorticoids in acute asthma. A critical controlled trial

In order to determine objectively the efficacy of corticosteroids in relieving severe acute episodes of asthma, we administered infusions of hydrocortisone or placebo in a random, double-blind manner to 20 asthmatic subjects after they had been documented to be refractory to eight hours of conventional therapy. Eleven subjects received hydrocortisone (2 mg/kg bolus, then 0.5 mg/kg per hour for 24 hours) and nine received saline. All were given identical bronchodilator treatment during the study period, and all had multiple aspects of lung function serially recorded along with plasma cortisol levels. Although subjects in both groups had severe obstruction of similar magnitude at the beginning of treatment (one-second forced expiratory volume [FEV1] in placebo-treated group = 32 +/- 3 [SEM] percent of predicted, and 25 +/- 3 percent of predicted in steroid-treated group, p = NS), at the end of 24 hours, the subjects given corticosteroids had significantly greater resolution of airway obstruction (FEV1 in steroid-treated group increased 118 +/- 25 percent from control value, versus 35 +/- 22 percent with placebo). In five of nine subjects treated with placebo, pulmonary mechanics either were unchanged or deteriorated during the period of observation. There was no effect of the glucocorticoids on arterial blood gases, and no significant correlation could be found between plasma cortisol levels and the improvement in pulmonary mechanics and clinical status. These results provide objective documentation of the time course over which administration of parenteral corticosteroids speeds the recovery of asthmatic patients who are unresponsive to standard therapy.     

克罗恩病术后治疗和溃疡性结肠炎手术时机的抉择

炎症性肠病(IBD)包括克罗恩病(CD)和溃疡性结肠炎(UC),是一种肠道慢性非特异性炎症性疾病。尽管治疗IBD的药物层出不穷,但仍有部分患者需行手术治疗。CD的术后治疗和UC手术时机的选择对患者的生活质量的提高以及预后非常重要。本文就CD的术后治疗和UC手术时机的选择作一简单概述。     

20例糖原累积症Ⅸa型患者的临床和基因特点分析

目的总结糖原累积症Ⅸa型(GSDⅨa)患者的临床和基因特点,加强对该病的认识。方法回顾性分析2015年1月—2018年12月在复旦大学附属儿科医院住院并经基因确诊的20例GSDⅨa型患者的临床资料,总结其临床和基因特点。结果20例GSDⅨa型患者均为男性,确诊中位年龄为2.5岁。所有患者均有肝肿大,转氨酶水平升高;生长发育迟缓5例(25.0%),空腹低血糖19例(95.0%),高乳酸血症14例(70.0%),高甘油三酯血症9例(45.0%),高胆固醇血症5例(25.0%)。8例患者进行了空腹血酮检查,结果显示均升高;所有患者尿酸均正常,5例(25.0%)患者尿酮体阳性。18例患者进行了肝穿刺检查,其中15例存在轻至中度肝纤维化。共检测到16种PHKA2基因突变,5种为已知致病突变,11种为新突变,其中c.3614位点是高发突变位点。所有患者均使用生玉米淀粉治疗,大多数患者的临床表现均为好转。结论GSDⅨa型以男性为主。肝肿大,转氨酶升高,生长发育迟缓,空腹低血糖,空腹血酮升高,尿酸正常需考虑该病可能。可通过肝穿刺协助诊断,临床生化指标和基因检测可明确诊断及分型。该病多数临床表现较轻,但也可导致肝纤维化,使用生玉米淀粉治疗能够改善病情。     

Is early limited surgery associated with a more benign disease course in Crohn’s disease?

AIM:To analyze the difference in disease course and need for surgery in patients with Crohn’s disease(CD).METHODS:Data of 506 patients with incident CD were analyzed(age at diagnosis:31.5±13.8 years).Both hospital and outpatient records were collected prospectively with a complete clinical follow-up and comprehensively reviewed in the population-based Veszprem province database,which includes incident CD patients diagnosed between January 1,1977 and December 31,2008.Follow-up data were collected until December 31,2009.All patients included had at least 1year of follow-up available.Patients with indeterminate colitis at diagnosis were excluded from the analysis.RESULTS:Overall,73 patients(14.4%)required resective surgery within 1 year of diagnosis.Steroid exposure and need for biological therapy were lower in patients with early limited surgery(P<0.001 and P=0.09).In addition,surgery rates during follow-up in patients with and without early surgery differed significantly after matching on propensity scores(P<0.001,HR=0.23).The need for reoperation was also lower in patients with early limited resective surgery(P=0.038,HR=0.42)in a Kaplan-Meier and multivariate Cox regression(P=0.04)analysis.However,this advantage was not observed after matching on propensity scores(PLogrank=0.656,PBreslow=0.498).CONCLUSION:Long-term surgery rates and overall exposure to steroids and biological agents were lower in patients with early limited resective surgery,but reoperation rates did not differ.     

Are we on the precipice of a new epidemic? Risk for hepatitis C among HIV-negative men-, trans women-, and trans men- who have sex with men in the United States

ABSTRACT

Emerging data from Europe have documented increases in diagnoses of acute hepatitis C virus (HCV) infection among HIV-negative men who have sex with men. We investigated risk factors for HCV and their correlates in the Together 5000 study, a U.S. national cohort study of HIV-negative men (n?=?6089), transgender women (n?=?40), and transgender men (n?=?42) who have sex with men. We used bivariate and multivariable analyses to determine demographic and behavioral factors associated with high risk for acute HCV infection (using the HCV-MOSAIC risk indicator with a score?≥?2.0). Mean HCV risk score was 1.38 (SD?=?1.09) and 27.3% of participants had HCV risk scores?≥?2.0. In multivariable modeling, being cisgender male (vs. not) was associated with having a lower HCV-MOSAIC risk score. Meanwhile, being white, having been incarcerated, prior use of HIV pre- or post-exposure prophylaxis, having ever been tested for HIV, and recent methamphetamine use were associated with high risk for HCV. More than one-in-four participants exceeded the threshold score for HCV risk. Those with high HCV-MOSAIC risk scores were more likely to have been in settings where they could be tested for acute HCV (i.e., HIV testing, PrEP care, PEP care, incarceration), suggesting opportunities to engage them in HCV screening, prevention, and treatment.     

Intertwining Epidemics: A Review of Research on Substance Use Among Men Who Have Sex with Men and Its Connection to the AIDS Epidemic

This paper reviews the (1) literature on substance use among men who have sex with men (MSM), (2) data that test whether connections between substance use and abuse and high-risk sexual behavior exist among MSM, and (3) ways that HIV interventions might address the effects of substance use on high-risk sexual behavior. We conclude that while alcohol use patterns are not substantially different between gay and heterosexual men, gay men do use more kinds of other drugs. Although there is considerable evidence to support the view that substance use patterns have declined among gay men since the mid-1980s, substance use should still be regarded as a health risk in this population. Although the associations between substance use and sexual risk-taking for HIV are complex, the inclusion of interventions to disentangle substance use and high-risk sexual practices may increase the efficacy of AIDS prevention efforts among gay men.     

不同缓解标准下类风湿关节炎临床缓解与持续临床缓解率:一项单中心观察性研究

目的分析本中心RA队列中不同缓解标准下的临床缓解率与持续临床缓解率。方法纳入2011年1月1日至2016年12月31日所有就诊于北京大学第一医院风湿免疫科门诊的RA患者,收集首次就诊至2018年6月或末次随访的所有门诊病历资料,分别以DAS28-ESR、简化疾病活动度指数(SDAI)、临床疾病活动度指数(CDAI)、Boolean标准评价疾病活动度值和/或临床缓解状态,持续缓解定义为维持临床缓解时间>6个月。采用Kaplan-Meier生存分析计算RA患者的累积缓解率与中位达临床缓解时间。采用Cox多因素回归分析持续缓解的相关因素。结果本研究共连续纳入648例患者,在中位24个月的随访过程中,分别有510例(78.7%)、459例(70.8%)、443例(68.4%)、445例(68.7%)患者至少1次达到过临床缓解。其中,第3、6、12个月的累积临床缓解率分别为10.6%~24.4%、25.3%~43.5%、51.8%~65.2%,患者达首次临床缓解的中位时间为7.2~11.4个月。在随访过程中,分别有338例(52.2%)、302例(46.6%)、292例(45.1%)、283例(43.7%)患者至少1次实现DAS28-ESR、SDAI、CDAI和Boolean标准定义下的持续缓解。在这些达持续缓解的患者中,维持缓解状态的中位时间分别为16.0个月(DAS28-ESR),15.4个月(CDAI),14.9个月(SDAI)和15.0个月(Boolean标准)。在达到持续缓解的患者中,DMARDs单药和联合用药的比例分别为18.7%(73/390)、81.3%(317/390),此外,22.3%(87/390)的患者接受小剂量激素治疗,超过半数患者(51/87)在持续临床缓解期间减停激素。结论在临床工作中,临床缓解是切实、可行的治疗目标,经过规范的临床治疗,超过半数的患者可在治疗1年内实现临床缓解。而在实现临床缓解的患者中,大部分可实现持续临床缓解,维持缓解状态的中位时间为15个月左右。     

外周血CD4~+CD25~+FOXP3~+调节性T细胞与炎症性肠病疾病活动度的关系

背景:炎症性肠病(IBD)的发病机制尚未完全阐明。调节性T细胞是一组具有免疫抑制作用的T细胞亚群,研究显示其改变与IBD的发病密切相关。目的:观察IBD患者外周血CD4~+CD25~+FOXP3~+调节性T细胞与疾病活动度的关系。方法:纳入克罗恩病(CD)和溃疡性结肠炎(UC)患者各31例,15例健康体检者作为正常对照。分别采用简化CD活动指数(CDAI)和临床活动度指数(CAI)评估CD和UC患者的疾病活动度,以流式细胞术检测外周血CD4~+CD25~+FOXP3~+调节性T细胞比例,同时检测ESR和血清CRP水平。结果:CD和UC患者外周血CD4~+CD25~+FOXP3~+调节性T细胞比例显著低于正常对照组(P0.05),并分别与简化CDAI评分和CAI评分呈负相关(P0.05),与ESR和血清CRP水平之间则无明显相关性。活动期CD和UC患者的ESR和血清CRP水平明显高于缓解期,但差异无统计学意义。ESR和CRP与疾病活动度评分之间亦无明显相关性。结论:CD4~+CD25~+FOXP3~+调节性T细胞在IBD的发生、发展中起重要作用,外周血调节性T细胞数量减少可能是IBD复发的重要因素。     

核周型抗中性粒细胞胞质抗体和抗酿酒酵母抗体在炎症性肠病中的临床意义

核周型抗中性粒细胞胞质抗体（pANCA）和抗酿酒酵母抗体（ASCA）是一组与炎症性肠病（IBD）密切相关的免疫球蛋白,但对溃疡性结肠炎（UC）、克罗恩病（CD）的诊断和鉴别诊断的价值仍有待进一步验证。目的：探讨pANCA和ASCA在UC与CD诊断和鉴别诊断中的意义。方法：以酶联免疫吸附测定（ELISA）检测64例UC、62例CD和56例健康对照者的血清pANCA、ASCA水平和阳性率,分析pANCA、ASCA及其组合的诊断敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。结果：UC组血清pANCA水平[（584．22±347．70）pg/ml对（304．99±211．10）pg／ml和（390．92±82．82）pg/ml,P〈0．01]和阳性率（50．0％对14．5％和14.3％,P〈0．01）显著高于CD组和健康对照组,三组间血清ASCA水平和阳性率无明显差异。pANCA^＋和pANCA^＋/ASCA-诊断UC的敏感性、特异性、PPV和NPV分别为50．0％、85．7％、80．0％、60．0％和42．2％、89.3％、81．8％、57．5％,ASCA^＋和ASCA^＋／pANCA^-诊断CD的敏感性、特异性、PPV和NPV分别为8．1％、87．5％、41．7％、46.2％和3.2％、91．1％、28．6％、45．9％。结论：pANCA阳性有利于UC的诊断。pANCA／ASCA联合检测有助于鉴别UC,但对CD诊断价值不高。