Cellular Targeting in Autoimmunity

Many biologic agents that were first approved for the treatment of malignancies are now being actively investigated and used in a variety of autoimmune diseases such as rheumatoid arthritis (RA), antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, systemic lupus erythematosus (SLE), and Sjogren??s syndrome. The relatively recent advance of selective immune targeting has significantly changed the management of autoimmune disorders and in part can be attributed to the progress made in understanding effector cell function and their signaling pathways. In this review, we will discuss the recent FDA-approved biologic therapies that directly target immune cells as well as the most promising investigational drugs affecting immune cell function and signaling for the treatment of autoimmune disease.     

A Peer-Educator Network HIV Prevention Intervention Among Injection Drug Users: Results of a Randomized Controlled Trial in St. Petersburg, Russia

We evaluated the efficacy of a peer-educator network intervention as a strategy to reduce HIV acquisition among injection drug users (IDUs) and their drug and/or sexual networks. A randomized controlled trial was conducted in St. Petersburg, Russia among IDU index participants and their risk network participants. Network units were randomized to the control or experimental intervention. Only the experimental index participants received training sessions to communicate risk reduction techniques to their network members. Analysis includes 76 index and 84 network participants who were HIV uninfected. The main outcome measure was HIV sero-conversion. The incidence rates in the control and experimental groups were 19.57 (95 % CI 10.74–35.65) and 7.76 (95 % CI 3.51–17.19) cases per 100 p/y, respectively. The IRR was 0.41 (95 % CI 0.15–1.08) without a statistically significant difference between the two groups (log rank test statistic X² = 2.73, permutation p value = 0.16). Retention rate was 67 % with a third of the loss due to incarceration or death. The results show a promising trend that this strategy would be successful in reducing the acquisition of HIV among IDUs.     

THE PROCESS OF RECOVERY: A TALE OF TWO MEN

Recovery has been identified as a focus for mental health care. Recovery requires learning to live again after a life-altering acute event or during a chronic illness, mental or physical. By analyzing within-person change over time, utilizing multiple sources of evidence, two cases illustrated particular dimensions that influenced the recovery process after stroke, within a biopsychosocial framework. Restoration of the self, through co-occurring, dual processes of grief and reconstruction, appeared to be an essential dimension in the recovery process. Suggestions for integrating this concept into current adult clinical practice are congruent with current models of disease management of several chronic conditions.     

Proceedings of the 2007 Annual Meeting of the Association of Directors of Medical Student Education in Psychiatry (ADMSEP)

The 33rd Annual Meeting of the Association of Directors of Medical Student Education in Psychiatry (ADMSEP) was held June 21 to 23, 2007, in Park City, Utah. Plenary sessions, workshops, and posters covered a wide range of educational topics, including Liaison Committee on Medical Education (LCME) issues, culture and stigma in medical education, and innovative media.

Dr. Robert Eaglen, the interim secretary for the LCME, gave the keynote address: “Modern Medical Education through the LCME Lens,” which highlighted clerkship directors' responsibilities in the accreditation process such as ensuring comparability and uniform criteria for student clinical experiences, equivalent cross-site evaluations, preparing residents for their instructional roles and providing timely mid- and final clerkship feedback. Dr. Ruth Lamdan, chair of the ADMSEP Task Force on LCME ED-2, presented “Results of ED-2 Adherence in 10 Medical Schools” and discussed the challenges of uniformity in data collection and remediation strategies for core topics. The group found that uniformity in collection efforts was limited because of different patient encounter documentation systems utilized and that remediation strategies vary greatly for students who had not encountered specified diagnoses, from case discussions and videos to team-based learning experiences to arranging an exposure at an additional clinical site. Hendry Ton, from University of California, Davis, presented a developmental approach to Cultural Competence, sharing strategies for addressing resistance to acknowledging bias and the impact of culture on health care in medical education.

The six abstracts in these proceedings include a range of topics, such as mindfulness training, application of virtual technologies, preparing for the National Board of Medical Examiners subject exam, palliative care, and how students judge their communication skills in Objective Structured Clinical Examinations. These abstracts, representative of ADMSEP educational research, were chosen for their general interest to medical student educators.     

An unusual interatrial septum

The images focus on a very rare atrial septal anatomy known as "double atrial septum with persistent interatrial space.” Only scarce reports of this anomaly are found in literature. Due to increasing use of catheter-based interventions requiring a transseptal puncture, the recognition of this anomaly is essential for performing safe and effective procedures.     

Only Hyperuricemia with Crystalluria,but not Asymptomatic Hyperuricemia,Drives Progression of Chronic Kidney Disease

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Suppression of serum lipid transfer proteins involved in high-density lipoprotein cholesterol metabolism by intensive insulin therapy in the first year of type 1 diabetes mellitus: Prospective InLipoDiab1 study

Background and aimsCholesteryl ester transfer protein (CETP) and phospholipid transfer protein (PLTP) are crucial proteins in reverse cholesterol transport. There are insufficient data on regulating these proteins by insulin therapy in type 1 diabetes mellitus (T1DM). We aimed to assess prospectively the impact of insulin therapy initiation on transfer proteins serum levels in adults with newly diagnosed T1DM.Methods and results57 adults with newly diagnosed T1DM were enrolled in the InLipoDiab1 Study. All participants were treated with subcutaneous insulin in the model of intensive insulin therapy since the diagnosis of diabetes. Serum PLTP and CETP concentrations were measured at diagnosis, after three weeks, six months, and after one year of insulin treatment, using the immunoenzymatic method ELISA.A significant decrease in PLTP and CETP concentrations were demonstrated during twelve months of insulin therapy in newly diagnosed T1DM. The dynamics of changes in the level of these proteins varied depending on the occurrence of remission after a year of the disease. In the group without remission, a significant decrease in PLTP and CETP levels appeared after six months of follow-up. The remission group was characterized by a decrease in proteins concentration only after one year of treatment. In the non-remission group, significant negative correlations were found between the daily dose of insulin and levels of PLTP and CETP.ConclusionExogenous insulin is an inhibitor of lipid transfer proteins involved in high-density lipoprotein cholesterol metabolism in the first year of treatment.