Low vaccination coverage for human papillomavirus disease among young men who have sex with men,France, 2019

BackgroundIn France, human papillomavirus (HPV) vaccination has been recommended in 2016 for men who have sex with men (MSM) up to age 26 years.AimWe aimed to estimate HPV vaccine coverage in 18–28 year-old MSM and identify uptake determinants.MethodsWe collected data on socio-demographic characteristics, sexual behaviour, sexually transmitted diseases (STI) screening and vaccination uptake using a voluntary cross-sectional online survey conducted in 2019 targeting MSM. We calculated coverage of at least one dose of HPV vaccine and prevalence ratios (PR) of determinants with 95% confidence intervals (CI) using Poisson regression.ResultsOf 9,469 respondents (age range: 18–28 years), 15% (95% CI: 14–16) reported being vaccinated for HPV. Coverage was significantly higher among MSM < 24 years (PR: 1.25; 95% CI: 1.13–1.39), with education level below university degree (PR: 1.12; 95% CI: 1.08–1.32), living in rural areas (PR: 1.21; 95% CI: 1.08–1.36), attending sex parties (PR: 1.12; 95% CI: 1.03–1.33), using HIV-related biomedical prevention methods (PR: 1.31; 95% CI: 1.12–1.54), with STI diagnosis (PR: 1.22; 95% CI: 1.08–1.38) and with hepatitis A or B vaccination (PR: 4.56; 95% CI: 3.63–5.81 vs PR: 3.35; 95% CI: 2.53–4.44).ConclusionsThe HPV vaccination uptake among MSM in France was not satisfactory. It was higher among MSM benefitting from other vaccinations and biomedical preventive methods against HIV, suggesting a synergistic effect of the national preventive sexual health recommendations for MSM. Further efforts to improve HPV vaccination coverage targeting MSM are warranted.     

Potential role of tocilizumab in severe gastrointestinal barrier damage after CAR T-cell therapy

We report a septicemia and disseminated candidiasis due to delayed gastrointestinal mucosae repair in a patient treated with tocilizumab after anti-CD19 CAR T-cell therapy. Tocilizumab could have inhibited intestinal tissue repair and furthered bacteria translocation leading to the invasion of intestinal mucosa by yeasts as IL-6 is known to be involved in mucosal wound healing.     

Structural and Functional Comparisons of Retroviral Envelope Protein C-Terminal Domains: Still Much to Learn

Retroviruses are a family of viruses that cause a broad range of pathologies in animals and humans, from the apparently harmless, long-term genomic insertion of endogenous retroviruses, to tumors induced by the oncogenic retroviruses and acquired immunodeficiency syndrome (AIDS) resulting from human immunodeficiency virus infection. Disease can be the result of diverse mechanisms, including tumorigenesis induced by viral oncogenes or immune destruction, leading to the gradual loss of CD4 T-cells. Of the virally encoded proteins common to all retroviruses, the envelope (Env) displays perhaps the most diverse functionality. Env is primarily responsible for binding the cellular receptor and for effecting the fusion process, with these functions mediated by protein domains localized to the exterior of the virus. The remaining C-terminal domain may have the most variable functionality of all retroviral proteins. The C-terminal domains from three prototypical retroviruses are discussed, focusing on the different structures and functions, which include fusion activation, tumorigenesis and viral assembly and lifecycle influences. Despite these genetic and functional differences, however, the C-terminal domains of these viruses share a common feature in the modulation of Env ectodomain conformation. Despite their differences, perhaps each system still has information to share with the others.     

CT scan-guided percutaneous osteosynthesis of a complex,multifocal fracture of the pelvic girdle in a 14-year-old adolescent

We report on a 14-year-old girl with minimally displaced pelvic girdle and acetabular roof fracture following motor vehicle trauma, treated percutaneously under CT and C-arm fluoroscopic guidance by an interventional radiologist. After informed consent from the patient’s parents, under surgical aseptic conditions and under general anesthesia, three screws were positioned adequately under dual guidance by a radiologist and without immediate or long-term complication. The patient was mobilized 48 h after the procedure and resumed normal activities after 1 month. Even though the technique has been described before on adults, to our knowledge this is the first time it has been described on a pediatric patient.     

Contribution of the sentinel node procedure to tailoring the radicality of hysterectomy for cervical cancer

OBJECTIVE: The required radicality of hysterectomy for women with early-stage cervical cancer is controversial owing to the risk of severe complications. The aim of this study was to determine the contribution of the sentinel node (SN) procedure to tailoring the radicality of hysterectomy in women with cervical cancer. METHODS: Between April 2001 and December 2005, 54 patients with early-stage or locally advanced cervical cancer underwent laparoscopic sentinel node (SN) biopsy based on combined patent blue and radiocolloid detection. Thirty-nine patients with early-stage cervical cancer underwent a laparoscopic SN procedure with complete pelvic lymphadenectomy and radical hysterectomy. Moreover, 15 women with locally advanced cervical cancer underwent an SN procedure with pelvic and para-aortic lymphadenectomy before concurrent neoadjuvant chemoradiotherapy. RESULTS: The SN detection rate was 83.3%. The detection rate was higher in women with early-stage disease (90%) than in women with more advanced disease (66.6%) (p=0.03). At final histology, 14 metastatic SN were found in 11 (21.3%) of the 54 patients. They comprised macrometastases in 6 SN, micrometastases in 5 SN, and isolated tumour cells in 3 SN. Parametrial involvement with negative sentinel nodes was found in 15.1% of cases. The overall sensitivity, specificity, positive and negative predictive values and accuracy of intraoperative imprint cytology were 20%, 100%, 100%, 79.5% and 80.5%, respectively. Among the 39 women with early cervical cancer, five (12.8%) had parametrial involvement. In univariate analysis, parametrial involvement was significantly associated with large tumour size, advanced-stage disease, positive pelvic lymph nodes and lymphovascular space involvement. Parametrial involvement tended to be associated with positive sentinel nodes. CONCLUSION: These results underline the contribution of the SN procedure to evaluating lymph node status. However, intraoperative imprint cytology appeared poorly accurate, and further histological or biological tools are needed to evaluate SN status and, hence, to tailor the radicality of hysterectomy.