Online and Offline Sexual Health-Seeking Patterns of HIV-Negative Men Who Have Sex with Men

To inform health information targeting, we used cross-sectional data from 2577 HIV-negative MSM to identify groups of men who access similar sources. Offline, more men reported talking to a physician about HIV than about having sex with men; fewer than half attended a safer sex workshop. Online, men sought information primarily through Internet search engines, GLBT websites, or health websites. A latent class analysis identified four groups of health seekers: minimal health seekers, those who accessed online sources only, those who sought information mostly from health professionals, and those who sought information from diverse sources. Minimal health seekers, 9% of the sample, were the group of greatest concern. They engaged in unprotected anal sex with multiple partners but infrequently testing for HIV or sought sexual health information. By encouraging health seeking from diverse sources, opportunities exist to increase men’s knowledge of HIV/STI prevention and, when necessary, access to medical care.     

Increasing the pool of educational leaders for UCLA.

The dual goals of the faculty Fellowship in Medical Education (MEF) program at the David Geffen School of Medicine at UCLA, established in 1992, are to prepare excellent teachers to serve as clerkship chairs, course chairs, or residency program directors while strengthening their dossiers for promotion based on a scholarly approach to curriculum development, implementation, and evaluation. Fellows are nominated from their departments and must demonstrate a strong interest in assuming educational leadership in their respective specialties. A total of eight fellows are accommodated each year based on interviews with the MEF faculty. The two-year program consists of two seminars and two projects focused on four objectives: to critique teaching and testing practices in medical education in light of current theories of learning; to develop and implement curricula that reflect these theories; to improve personal teaching skills through reflection and feedback; and to design and conduct an educational research or program evaluation study. An analysis of the curricula vitae of faculty members who have completed the fellowship suggest that this program continues to provide educational leaders for the school as originally intended. Of the 71 medical school faculty members who completed the MEF between 1993 and 2004 and have remained at the university, 43 (61%) have assumed new leadership roles in medical education. The evaluation data strongly suggest that the MEF has had a major role since its inception in creating a pool of faculty members with the confidence to manage the tasks of educational planning and implementation.     

Pentoxifylline and Cyclosporine in the Treatment of Febrile Ulceronecrotic Mucha‐Habermann Disease

Abstract: We describe two pediatric cases of febrile ulceronecrotic Mucha‐Habermann disease (FUMHD) with response to pentoxifylline and cyclosporine therapies. Based on our review of the literature, we are presenting the first case of FUMHD treated with pentoxifylline and the third case of FUMHD successfully treated with cyclosporine. These agents may be of therapeutic benefit in the treatment of FUMHD, in part by suppressing tumor necrosis factor‐alpha, which we believe may mediate the disease process.     

Comparison of ropivacaine 0.2% and lidocaine 0.5% for intravenous regional anesthesia in volunteers.

A longer acting local anesthetic such as ropivacaine may offer advantages over lidocaine for IV regional anesthesia (IVRA). The objective of this investigation was to determine whether the use of ropivacaine improves the quality and duration of IVRA. In a randomized, double cross-over design, 10 volunteers received lidocaine 0.5% or ropivacaine 0.2% for IVRA of the upper extremity on two separate days with a standard double-cuff technique. Sensation to pinprick, response to tetanic stimuli, and tourniquet pain were assessed on a 0-10 verbal numeric score scale at 5-min intervals throughout the period of tourniquet inflation. Motor function was evaluated by grip strength. After release of the second (distal) cuff, pinprick sensation, motor strength, and systemic side effects were evaluated at 3, 10, and 30 min. No significant differences were observed for onset times of anesthesia and times to proximal (38 +/- 3 and 36 +/- 3 min) or distal (34 +/- 13 and 36 +/- 13 min) tourniquet release after the administration of ropivacaine and lidocaine, respectively. However, postdeflation hypoalgesia and motor blockade were prolonged with ropivacaine, and postdeflation light-headedness, tinnitus, and drowsiness were more prominent with lidocaine. We conclude that ropivacaine may be an alternative to lidocaine for IVRA. It may result in prolonged analgesia and fewer side effects after tourniquet release. IMPLICATIONS: In this study, volunteers received lidocaine 0.5% or ropivacaine 0.2% for IV regional anesthesia on two study days. Ropivacaine and lidocaine provided similar surgical conditions. However, after release of the distal tourniquet, prolonged sensory blockade and fewer central nervous system side effects were observed with ropivacaine.     

ASO Visual Abstract: Association Between Ageing and Short-Term Survival Outcomes in Patients Undergoing Surgery for Primary Retroperitoneal Sarcoma

Annals of Surgical Oncology -     

Ig VH gene mutational patterns indicate different tumor cell status in human myeloma and monoclonal gammopathy of undetermined significance

Plasma cell tumors display a wide spectrum of clinical progression, ranging from aggressive multiple myeloma to a benign form known as monoclonal gammopathy of undetermined significance (MGUS), which requires no treatment. Because both diseases involve mature Ig- secreting plasma cells, the reason for this variation in malignant behavior is unclear. However, assessment of malignant potential is desirable for choice of treatment protocols. Ig variable (VH) gene sequences analysis has previously shown the tumor cell of multiple myeloma to be postfollicular, with mutated homogeneous clonal sequences indicating no continuing exposure to the somatic hypermutation mechanism, and this was confirmed in 7 of 7 patients. Comparison of the VH gene sequences in the monoclonal cells in MGUS yielded a different result, with 3 of 7 patients demonstrating mutated heterogeneous sequences consistent with the tumor cells remaining under the influence of the mutator. In 1 of 3 of these patients, an IgM-positive precursor cell was identified that expressed heterogeneous VH sequences similar to those of the isotype-switched plasma cell. These results indicate that the clonal cells in MGUS differ from those in myeloma and suggest that the difference may reflect malignant potential.     

A Refined Prediction Model for Core and Lower Extremity Sprains and Strains Among Collegiate Football Players

Context

Researchers have identified high exposure to game conditions, low back dysfunction, and poor endurance of the core musculature as strong predictors for the occurrence of sprains and strains among collegiate football players.

Objective

To refine a previously developed injury-prediction model through analysis of 3 consecutive seasons of data.

Design

Cohort study.

Setting

National Collegiate Athletic Association Division I Football Championship Subdivision football program.

Patients or Other Participants

For 3 consecutive years, all 152 team members (age = 19.7 ± 1.5 years, height = 1.84 ± 0.08 m, mass = 101.08 ± 19.28 kg) presented for a mandatory physical examination on the day before initiation of preseason practice sessions.

Main Outcome Measure(s)

Associations between preseason measurements and the subsequent occurrence of a core or lower extremity sprain or strain were established for 256 player-seasons of data. We used receiver operating characteristic analysis to identify optimal cut points for dichotomous categorizations of cases as high risk or low risk. Both logistic regression and Cox regression analyses were used to identify a multivariable injury-prediction model with optimal discriminatory power.

Results

Exceptionally good discrimination between injured and uninjured cases was found for a 3-factor prediction model that included equal to or greater than 1 game as a starter, Oswestry Disability Index score equal to or greater than 4, and poor wall-sit–hold performance. The existence of at least 2 of the 3 risk factors demonstrated 56% sensitivity, 80% specificity, an odds ratio of 5.28 (90% confidence interval = 3.31, 8.44), and a hazard ratio of 2.97 (90% confidence interval = 2.14, 4.12).

Conclusions

High exposure to game conditions was the dominant injury risk factor for collegiate football players, but a surprisingly mild degree of low back dysfunction and poor core-muscle endurance appeared to be important modifiable risk factors that should be identified and addressed before participation.Key Words: clinical decision making, primary injury prevention, low back pain

Key Points

• A 3-factor prediction model that includes 2 modifiable injury risk factors can be used to identify collegiate football players who might benefit from targeted risk-reduction interventions.
• A mild degree of low back dysfunction and a suboptimal level of core-muscle endurance appeared to be important injury risk factors that should be identified and addressed.
• High exposure to game conditions was a dominant injury risk factor.
• The combination of high exposure to game conditions with a potentially modifiable risk factor was associated with a substantially increased risk of core or lower extremity sprain or strain.

Injury prevention is mentioned in virtually every definition of sports medicine, but very little research evidence is available to support specific procedures for reduction of injury risk. A 4-step model to guide sports injury-prevention research and practice was introduced more than 20 years ago by van Mechelen et al.¹ The model subsequently was modified to incorporate additional concepts,^2,3 but very little progress has been made beyond the initial step of documenting injury incidences for various populations.^4,5 Risk factors for some specific types of injury have been identified, but little information in the literature has supported specific screening procedures to identify individual athletes who possess elevated injury risk.^6–8 The relative lack of evidence for the effectiveness of specific interventions for reducing injury incidence may be explained by the highly injury-specific and sport-specific nature of many risk factors⁹ and the cumulative effects, and possibly interactive effects, of multiple risk factors in creating injury susceptibility.^3,10–13Injury prevention is typically categorized as a clinical-practice domain that is distinct from injury rehabilitation, but some overlap exists. A previously sustained injury is a well-established risk factor for subsequent injury, which often may be attributable to suboptimal clinical management.^14,15 Furthermore, intrinsic injury risk factors may affect the rate at which an athlete''s functional capabilities are restored after an injury. An individual''s capacity to tolerate the external loads imposed by sport-related activities largely depends on tissue stiffness,¹¹ which is potentially modifiable through training-induced adaptations in neuromuscular function. Furthermore, injury-induced neural inhibition of muscle function can produce subtle and persistent performance deficiencies among highly active elite athletes.¹⁶ Most injuries do not completely remove athletes from participation,¹⁵ which may result in an unrecognized, persistent increase in injury susceptibility.A clinical prediction model can provide a quantitative estimate of the likelihood that an individual who possesses a particular combination of factors will ultimately develop a particular condition or experience an adverse event at some time.¹⁷ The combination of simple core-muscle–endurance test results, survey responses, anthropometric measurements, and recorded exposures to game conditions has been shown to differentiate the preseason profiles of collegiate football players who subsequently sustained core or lower extremity sprains or strains from players who did not, which was represented quantitatively by an odds ratio (OR).⁸ The maximum time that static body positions can be maintained against gravity has been reported to provide highly reliable measurements of core-muscle endurance.¹⁸ Wilkerson et al⁸ administered 4 tests in the same sequence: (1) back-extension hold, (2) 60° trunk-flexion hold, (3) side-bridge hold, and (4) bilateral wall-sit hold. Surveys that were originally designed to quantify joint function to document treatment outcome can be modified for use as discriminative instruments before injury occurrence.¹⁹ Researchers⁸ have suggested that well-validated outcome survey instruments can undergo minor modifications to obtain preparticipation joint function scores that have value for injury prediction. Self-perception of the preparticipation functional status of the lower back, knees, and ankles and feet has been quantified by 3 surveys with well-established psychometric properties: (1) the Oswestry Disability Index (ODI),^20,21 (2) the International Knee Documentation Committee Subjective Knee Form,²² and (3) the sports component of the Foot and Ankle Ability Measure.²³Wilkerson et al⁸ observed that the odds for occurrence of a core or lower extremity sprain or strain over 1 football season were 16 times greater for players who had at least 3 of the following characteristics: (1) trunk-flexion hold time equal to or less than 161 seconds, (2) bilateral wall-sit–hold time equal to or less than 88 seconds, (3) ODI score equal to or greater than 6, and (4) starting in 3 or more games or playing in all 11 games. With game exposure removed from the analysis, the odds for injury incidence among players with at least 2 of the 3 potentially modifiable risk factors was 4 times greater than the risk level for players with 0 or 1 factor. In subsequent years, the core-muscle–endurance tests were modified to increase their difficulty and thereby shorten the time required for their administration. Every modification of testing procedures resulted in improved efficiency of administration without loss of predictive power. Two subsequent single-season analyses confirmed the validity of the original multifactor model, but the results also demonstrated that the model could be simplified without substantial loss of predictive power (G.B.W., unpublished data, 2011, 2012). Therefore, the purpose of our study was to analyze 3 consecutive seasons of combined data for preseason status, game exposures, and injury occurrences to derive a refined model for prediction of core or lower extremity sprain or strain during participation in collegiate football.     

Mutations in the SBDS gene in acquired aplastic anemia

Shwachman-Diamond syndrome (SDS; OMIM 260400), an inherited bone marrow failure syndrome, is caused by mutations in both alleles of the SBDS gene, which encodes a protein of unknown function. Here we report heterozygosity for the 258 + 2 T>C SBDS gene mutation previously identified in SDS patients in 4 of 91 patients with apparently acquired aplastic anemia (AA) but not in 276 ethnically matched controls (Fisher exact test, P < .004). Affected patients were young and had a poor outcome; they had reduced SBDS expression but no evidence of the pancreatic exocrine failure or skeletal abnormalities typical of SDS. Length of telomeres in granulocytes of SBDS heterozygous patients was short for their age, and in SDS patients with both SBDS alleles affected further analyzed, granulocytes' telomeres were even shorter, correlating in length with SBDS expression. Higher heterogeneity in telomere length also was observed in SDS patients. Telomerase activity of SBDS-deficient patients' lymphocytes was comparable with controls, and no physical interaction between SBDS protein and telomerase complex components (TERT or TERC) was established. We propose that heterozygosity for the 258 + 2 T>C SBDS mutation predisposes to AA by accelerating telomere shortening of leukocytes via a telomerase-independent mechanism.