Very young gay and bisexual men are at risk for HIV infection: the San Francisco Bay Area Young Men's Survey II

OBJECTIVES: To compare HIV seroprevalence and sexual risk behavior among very young gay and bisexual men (aged 15-17 years) and their older counterparts (aged 18-22 years). To examine drug-use patterns and correlates of sexual risk behavior in both of these age groups. DESIGN AND METHODS: An interviewer-administered cross-sectional survey of 719 gay and bisexual males between 15 and 22 years old was conducted through a venue-based sampling design. Blood specimens were collected and tested for HIV antibodies, hepatitis B, and syphilis. Interviews assessed sexual and drug-use behavior as well as psychosocial variables believed to be related to sexual risk-taking, including self-acceptance of gay or bisexual identity, perceptions of peer norms concerning safer sex, and perceptions of the ability to practice safer sex (safer sex self-efficacy). RESULTS: Of the 719 participants, 100 (16.2%) were aged between 15 and 17 years. HIV seroprevalence was somewhat lower among those aged 15 to 17 years (2.0%) compared with those aged 18 to 22 years (6.8%). Overall, the prevalence of hepatitis-B core antibody was significantly lower in the younger age group (5.0%) than in the older group (14.1%). The men aged 15 to 17 years used alcohol, ecstasy, and heroin less frequently than those aged 18 to 22 years. The age groups did not differ in the proportion of men who reported any unprotected anal intercourse in the previous 6 months (31.2%). In both age groups, use of amphetamines, ecstasy, and amyl nitrate was associated with unprotected anal intercourse. Self-acceptance of gay or bisexual identity was related to less sexual risk for those aged 15 to 17 years. In both age groups, greater safer sex self-efficacy was linked to less HIV sexual risk-taking. In the younger group, perceptions of peer norms that support safer sex were related to less risk behavior. CONCLUSIONS: Very young gay and bisexual men engage in unprotected anal sex at rates comparable with those for their somewhat older counterparts, raising serious concern over their risk of acquiring HIV infection. To prevent seroconversions, interventions must target those <18 years of age, and prevention programs should address the use of certain drugs in relation to sex and sexual risk-taking. To be most effective, programs should develop innovative communication strategies to take into account lack of self-acceptance of gay or bisexual identity and low self-efficacy for practicing safer sex.     

Atrial tachycardia as the presenting sign of a left atrial appendage aneurysm

A patient presented with atrial tachycardia. The work-up, guided by the tachycardia morphology, led to the diagnosis of left atrial appendage aneurysm. Surgical removal of the atrial appendage resulted in cure of the tachycardia and associated symptoms.     

Role of herbal compounds (PC-SPES) in hormone-refractory prostate cancer: two case reports

PURPOSE: Herbal therapies are unconventional treatments that have been used for several different diseases. PC-SPES is an herbal mixture, composed of eight different herbs (chrysanthemum, isatis, licorice, Ganoderma lucidum, Panax pseudo-ginseng, Rabdosia rubescens, saw palmetto, and scutellaria), which has been used as an alternative in the treatment of prostate cancer. We report two cases of hormone-refractory prostate cancer patients, who showed a favorable response to therapy with this herbal combination, controlling the progression of the disease. METHODS: We report two cases of biopsy proven prostate cancer patients with metastatic disease, treated with total androgen blockade, progressing to an androgen-independent status. These patients were offered traditional therapies for hormone-resistant prostate cancer, and they chose to take PC-SPES. The follow-up as well as their evolution are described. RESULTS: PC-SPES extract decreased the prostate-specific antigen (PSA) value for both patients from an initial value of 100 and 386 ng/mL to 24 and 114 ng/mL after 1 year and 4 months, respectively, remaining stable until now. No gynecomastia or hot flashes were observed in these patients and the treatment was well tolerated. CONCLUSION: PC-SPES has shown a strong estrogenic in vitro and in vivo activity as an alternative tool in the management of prostate cancer patients. These cases suggest that PC-SPES might have some potential activity against hormone-independent prostate cancers.     

罗哌卡因、芬太尼用于硬膜外分娩镇痛的效果和结局

目的:评价0.125%的罗哌卡因与每毫升含5μg芬太尼的混合液硬膜外注射用于分娩镇痛的效果与结局。方法:180例初产妇人工破膜后行硬膜外镇痛,先注入1.5%的利多卡因4m l试验剂量后,注入0.125%的罗哌卡因与每毫升含5μg芬太尼的混合液15 m l。再根据病人的要求可给予补充剂量的上述混合液,每次8 m l。另160例初产妇作为对照组未接受镇痛。结果:两组间VAS疼痛分级差异有统计学意义,镇痛组第一产程活跃期明显比对照组,且催产素的使用率高于对照组,差异均有统计学意义。而两组间第二产程、器械助产率和剖宫产率、羊水胎粪污染率、Apgar评分、新生儿体重及产后出血量等差异均无统计学意义。结论:0.125%罗哌卡因与每毫升含5μg芬太尼的混合液硬膜外注射用于病人分娩镇痛具有极好的镇痛效果,不影响母婴结局,不增加器械助产率和剖宫产率。     

Sesame food allergy and sensitization in children: the natural history and long-term follow-up

Sesame food allergy (SFA) in children is an increasingly recognized one in many countries. Our objective was to describe the course and natural history of SFA. Seventy-four patients sensitized to sesame were evaluated using clinical records, questionnaires, skin prick tests (SPT), in vitro specific immunoglobulin (sIg) E, and oral challenges (OC) and categorized into three groups: group A: patients who experienced allergic reaction after ingestion of sesame-containing food (n = 45); group B: patients evaluated for atopic dermatitis and found to be sesame SPT-positive (n = 11); group C: patients with sensitization to sesame allergen (n = 18). Group A patients were followed for an average of 6.7 yr. Analysis of our results revealed that 76% of patients in group A developed the allergy by the age of 2. The median age at onset of allergy in these patients was 1 yr. Immediate reaction to a minimal amount of sesame was characteristic. Skin was the most common site of involvement, followed by respiratory and gastrointestinal systems. Tolerance developed in only 20% of the patients. High sIgE (>0.15 IU) was demonstrated only in 75% of those in which it was examined. Sixteen patients performed oral sesame food challenge which was found positive in 88%. No correlation was found between the size of SPT and the level of in vitro sesame IgE antibodies, the outcome of OC results, and the development of tolerance to sesame. In conclusion, SFA tends to appear early in life, but unlike cow's milk and egg allergy, persists in 80% of the cases. Typical reactions combined with positive sesame SPT are reliable for diagnosis.     

维持性血液透析患者血清胱抑素C浓度与左心室肥厚的相关分析

比较64例维持性血液透析(MHD)患者和20例健康对照者一般临床资料和临床常用血生化指标;采用乳胶颗粒增强免疫透射比浊法检测血清胱抑素C浓度,超声心动图测定心脏腔径及心功能参数.结果 示MHD患者随透析时间延长,血清胱抑素C浓度逐渐增加,且左心室肥厚发生率显著增高.左心室肥厚者收缩压、左心室重量指数和血胱抑素C浓度明显高于无左心室肥厚者.胱抑素C与左心室重量指数、收缩压相关(r=0.633,0.397,均P<0.01).提示MHD患者血清胱抑素C变化可能与左心室肥厚密切相关,并可能是透析患者远期心血管并发症的影响因素.     

雌激素受体β基因多态性与原因不明月经过少的关系

目的:探讨西南地区雌激素受体β(ER-β)基因多态性与原因不明月经过少的关系。方法:选择西南地区100名原因不明月经过少患者为实验组,100名正常月经者作为对照组。应用分子生物学的方法研究ER-β基因RsaI和AluI限制性片段长度多态性和5号内含子的高变区CA重复序列多态性在实验组与对照组中分布。结果:RsaI和AluI限制性片段长度多态性在两组中均呈多态性分布。分离出9种CA重复序列等位基因,正常组和实验组的等位基因的分布频率差异无显著性。以重复次数n≤20作为SS型,n>20为LL型,再比较两组病人SS型和LL型等位基因的分布频率,差异有显著性。结论:ER-β基因多态性与原因不明月经过少有关,R等位基因可能是其保护因素,SS型等位基因可能是原因不明月经过少的危险因素。