A Global Review of HIV Self-testing: Themes and Implications

HIV self-test kits may have the potential to increase testing rates around the globe, and thereby lead to reductions in HIV-related incidence and mortality. However, the effectiveness of these self-test kits and the issues surrounding self-testing have been greatly debated in recent years. We conducted a literature review on the acceptability, feasibility, and effectiveness of HIV self-testing (HST) around the world. Of the 28 articles abstracted, several themes of HST were explored, including behavioral risk compensation, presence of counseling, uses of HST, ability to perform the self-test, sensitivity and specificity, concordance with confirmatory testing, perceptions surrounding HST, instruction and supervision, and cost. Overall, this literature review found that this diverse group of participants generally performed HST correctly with a few exceptions, were accepting of the test if available at a relatively low cost, and preferred the oral-based HST over the blood-based test.     

Report of the Task Force on Residency Training Information (2004-2005), American Board of Emergency Medicine

The American Board of Emergency Medicine gathers extensive background information on emergency medicine residency training programs and the residents training in those programs. We present the eighth annual report on the status of US emergency medicine residency programs.     

The NLRP3 inflammasome inhibitor OLT1177 rescues cognitive impairment in a mouse model of Alzheimer’s disease

Numerous studies demonstrate that neuroinflammation is a key player in the progression of Alzheimer’s disease (AD). Interleukin (IL)-1β is a main inducer of inflammation and therefore a prime target for therapeutic options. The inactive IL-1β precursor requires processing by the the nucleotide-binding oligomerization domain-like receptor family, pyrin domain containing 3 (NLRP3) inflammasome into a mature and active form. Studies have shown that IL-1β is up-regulated in brains of patients with AD, and that genetic inactivation of the NLRP3 inflammasome improves behavioral tests and synaptic plasticity phenotypes in a murine model of the disease. In the present study, we analyzed the effect of pharmacological inhibition of the NLRP3 inflammasome using dapansutrile (OLT1177), an oral NLRP3-specific inhibitor that is safe in humans. Six-month-old WT and APP/PS1 mice were fed with standard mouse chow or OLT1177-enriched chow for 3 mo. The Morris water maze test revealed an impaired learning and memory ability of 9-mo-old APP/PS1 mice (P = 0.001), which was completely rescued by OLT1177 fed to mice (P = 0.008 to untreated APP/PS1). Furthermore, our findings revealed that 3 mo of OLT1177 diet can rescue synaptic plasticity in this mouse model of AD (P = 0.007 to untreated APP/PS1). In addition, microglia were less activated (P = 0.07) and the number of plaques was reduced in the cortex (P = 0.03) following NLRP3 inhibition with OLT1177 administration. We also observed an OLT1177 dose-dependent normalization of plasma metabolic markers of AD to those of WT mice. This study suggests the therapeutic potential of treating neuroinflammation with an oral inhibitor of the NLRP3 inflammasome.

Alzheimer’s disease (AD) and other related neurodegenerative diseases leading to dementia represent an enormous burden for the society and health economies. AD patients suffer progressive cognitive and functional deficits often for many years, which result in a heavy burden to patients, families, and the public health system. In fact, in 2015 an estimated 46.8 million people worldwide were living with dementia, which could extend to 131.5 million by 2050 (1). Rising prevalence and mortality rates in combination with a lack of effective treatments lead to enormous costs to society. Research on AD in the last decades has focused on the pathological hallmarks and cellular deposits of amyloid-β (Aβ) peptides and neurofibrils (2). Recently, there has been increased evidence supporting a central role of the immune system in the progression or even the origin of the disease (3–5). In this respect, it is noteworthy that it has been known since 1989 that levels of interleukin (IL)-1β, one of the main mediators of innate immune response, are elevated in brains of patients with AD and can be associated with the progression and onset of AD (6–11). Additionally, it was shown that the nucleotide-binding oligomerization domain-like receptor family, pyrin domain containing 3 (NLRP3) inflammasome (12, 13), a multisubunit complex important for the maturation of IL-1β, is activated by Aβ peptides, leading to an overproduction of IL-1β, neuroinflammation, and cognitive impairment (14, 15). Inhibition of the NLRP3 inflammasome and the subsequent reduced IL-1β production can be linked to a change in the phenotype of microglia, the innate immune cells in the brain. Heneka et al. (16) pointed out the important role of the NLRP3 inflammasome/caspase-1 axis in AD pathogenesis by demonstrating significant improvements (e.g., in cognition) in APP/PS1 mice (a mouse model for AD) when crossed with NLRP3^−/− animals. The APP/PS1 mice express a human amyloid precursor protein (APP) and human presenilin-1 (PS1), leading to the accumulation of Aβ peptides, neuroinflammation, and cognitive impairment (17).OLT1177 (rINN: dapansutrile) is a new chemical entity small molecule that specifically targets the NLRP3 inflammasome and prevents the activation of caspase-1 and the maturation and release of IL-1β (18). OLT1177 has been shown to be well tolerated in animals and humans (18) and is currently in phase 2 clinical studies for the treatment of inflammatory conditions, such as osteoarthritis (topical gel dosage form) and inflammatory diseases, such as acute gout flare (oral capsule dosage form), among other diseases (19).In this study, we used the APP/PS1 mouse model of AD to investigate the effects of OLT1177 as an acute, oral pharmacological intervention (17). Six-month-old WT and APP/PS1ΔE9 mice consumed ad libitum OLT1177 in feed pellets (∼0, 500, or 1,000 mg/kg/d based on feed concentrations of 0, 3.75 or 7.5 g of OLT1177 per kilogram of feed; hereafter referred to as 3.75 or 7.5 g/kg OLT1177) for the treatment duration of 3 mo. APP/PS1 mice treated with OLT1177 showed rescue effects in various assessments, ranging from improved cognitive function to overall reduction in proinflammatory cytokines in the brain, suggesting the potential benefits of pharmaceutically blocking NLRP3 signaling in AD.     

Surplus dietary tryptophan reduces plasma cortisol and noradrenaline concentrations and enhances recovery after social stress in pigs

Social stress occurs in intensive pig farming due to aggressive behavior. This stress may be reduced at elevated dietary levels of tryptophan (TRP). In this study, we compared the effects of high (13.2%) vs. normal (3.4%) dietary TRP to large neutral amino acid (LNAA) ratios on behavior and stress hormones in catheterized pigs ( approximately 50 kg BW), which were exposed to social stress by placing them twice into the territory of a dominant pig ( approximately 60 kg) for 15 min. Pre-stress plasma TRP concentrations were 156+/-15 vs. 53+/-6 micromol/l (p<0.01) in pigs on the high vs. normal TRP diets, respectively. Pre-stress plasma cortisol and noradrenaline concentrations were twofold (p<0.01) and 1.4-fold (p<0.05) lower but plasma adrenaline concentration was similar in pigs on the high vs. normal TRP diets, respectively. During the social confrontations, pigs on the high vs. normal TRP diets show a tendency towards reduced active avoidance behavior (3.2+/-1.1 vs. 6.7+/-1.2 min, p<0.1) but their physical activity (8.5+/-0.6 vs. 10.2+/-0.8 min) and aggressive attitude towards the dominant pig (11+/-3 vs. 7+/-2 times biting) were similar. Immediate (+5 min) post-stress plasma cortisol, noradrenaline and adrenaline responses were similar among dietary groups. After the social confrontations, the post-stress plasma cortisol, noradrenaline and adrenaline concentrations and/or curves (from +5 min to 2 h) were lower/steeper (p<0.05) in pigs on the high vs. normal TRP diets. In summary, surplus TRP in diets for pigs (1) does not significantly affect behavior when exposed to social stress, (2) reduces basal plasma cortisol and noradrenaline concentrations, (3) does not affect the immediate hormonal response to stress, and (4) reduces the long-term hormonal response to stress. In general, pigs receiving high dietary TRP were found to be less affected by stress.     

Responses of calves to acute stress: individual consistency and relations between behavioral and physiological measures

The present study examined the consistency over time of individual differences in behavioral and physiological responsiveness of calves to intuitively alarming test situations as well as the relationships between behavioral and physiological measures. Twenty Holstein Friesian heifer calves were individually subjected to the same series of two behavioral and two hypothalamo-pituitary-adrenocortical (HPA) axis reactivity tests at 3, 13 and 26 weeks of age. Novel environment (open field, OF) and novel object (NO) tests involved measurement of behavioral, plasma cortisol and heart rate responses. Plasma ACTH and/or cortisol response profiles were determined after administration of exogenous CRH and ACTH, respectively, in the HPA axis reactivity tests. Principal component analysis (PCA) was used to condense correlated measures within ages into principal components reflecting independent dimensions underlying the calves' reactivity. Cortisol responses to the OF and NO tests were positively associated with the latency to contact and negatively related to the time spent in contact with the NO. Individual differences in scores of a principal component summarizing this pattern of inter-correlations, as well as differences in separate measures of adrenocortical and behavioral reactivity in the OF and NO tests proved highly consistent over time. The cardiac response to confinement in a start box prior to the OF test was positively associated with the cortisol responses to the OF and NO tests at 26 weeks of age. HPA axis reactivity to ACTH or CRH was unrelated to adrenocortical and behavioral responses to novelty. These findings strongly suggest that the responsiveness of calves was mediated by stable individual characteristics. Correlated adrenocortical and behavioral responses to novelty may reflect underlying fearfulness, defining the individual's susceptibility to the elicitation of fear. Other independent characteristics mediating reactivity may include activity or coping style (related to locomotion) and underlying sociality (associated with vocalization).     

Chicks from a high and low feather pecking line of laying hens differ in apomorphine sensitivity

Proactive rodents show a larger behavioral response to apomorphine (APO) than reactive copers, suggesting a more sensitive DA system in proactive individuals. Previously, chicks from a high feather pecking (HFP) and low feather pecking line (LFP) have been suggested to display a proactive and reactive coping strategy, respectively. Therefore, at approximately 4 weeks of age, the behavior of 48 LFP and 48 HFP chicks in response to an APO injection was studied using an open field. Another objective of the present study was to determine whether behavioral variation (in an open field) between HFP and LFP birds, after APO injection, is also reflected by variation of D(1) and D(2) receptor densities in the brain. Receptor binding capacities were assessed by measuring specific binding of tritiated D(1) and D(2) receptor ligands in different regions of the brain of control HFP and LFP chicks. In the present study, it is shown that indeed HFP chicks display a more enhanced behavioral response to acute APO treatment (0.5 mg/kg BW) than LFP birds in an open field. This difference was not reflected by variation of D(1) and D(2) receptor densities in the brain between both lines.     

The benzodiazepine brotizolam reduces fear in calves exposed to a novel object test

The present study examined the effects of the intravenous administration of the anxiolytic drug brotizolam on the behavioral and physiological responsiveness of calves to novelty in a dose response fashion. Holstein Friesian heifer calves (39-41 weeks of age; body weight 200-300 kg) received an intravenous injection of either a vehicle control (12 calves) or one of four doses of brotizolam (8 calves per dose): 0.0125, 0.05, 0.2 and 0.8 mg/100 kg body weight. They were then individually subjected to a ‘combined’ test involving exposure to a novel environment (open field, OF) for 5 min followed by the sudden introduction of a novel object (NO) that remained in place for a further 10 min. Behavioral, heart rate and plasma cortisol responses were recorded in all animals. Compared to vehicle treatment, the highest dose of brotizolam dose-dependently and significantly increased the time spent in locomotion and the distance travelled near the NO, as well as the time spent in contact with the NO. In addition, post-test plasma cortisol concentrations changed in a dose-dependent manner over time: they decreased between 0 and 10 min after the test in calves that had received the two highest doses of brotizolam, whereas they increased in vehicle-treated and low-dosage calves. There were no effects of brotizolam on vocalization or locomotion during the OF phase of the test or on vocalization following introduction of the NO. These findings strongly support the notion that interaction with a novel object in a novel arena represents a behavioral index of fear and fearfulness in calves, and that vocalization and locomotion in an OF reflect other independent characteristics.     

“Glass fairies” and “bone children”: Adolescents and young adults with anorexia nervosa show positive reactions towards extremely emaciated body pictures measured by the startle reflex paradigm

In this study, we investigated the emotional processing of extremely emaciated body cues in adolescents and young adults with (n = 36) and without (n = 36) anorexia nervosa (AN), introducing a new picture type, which was taken from websites that promote extreme thinness and is targeted specifically at adolescents interested in extreme thinness. A startle reflex paradigm was used for implicit reactions, while a self‐assessment instrument was used for subjective responses. We found a significant group difference with a startle inhibition (appetitive response) among the patients and a startle potentiation (aversive response) among the controls, whereas no such difference for subjective measures was found. The results are in contrast to previous studies, which proposed a general failure to activate the appetitive motivational system in AN, but in keeping with findings from other addictions, where the same response pattern has been found. Implications for prevention and therapy are discussed.     

Leg dominancy in relation to fast isometric torque production and squat jump height

We hypothesized that maximal unilateral isometric knee extensor torque, the rate of torque development during maximally fast isometric contractions and unilateral squat jump performance would be better with the dominant than non-dominant leg. Limb dominancy was established using the step up, balance recovery, and ball kick test. On two days, eight men (21.5 ± 2.2 years, means ± SD) performed unilateral maximal isometric contractions with their knee extensors (120° knee angle) with superimposed electrical stimulation to determine maximal torque and voluntary activation for both limbs. In addition, maximally fast isometric contractions without countermovement and unilateral squat jumps (SJ) starting from 120° knee angles were performed. Torque time integral (contractile impulse) over the first 40 ms after torque onset (TTI40) and maximal rates of torque development (MRTD) during voluntary and maximal electrical nerve stimulation were used to quantify initial torque rise. Limb dominancy tests were very consistent, but none of the parameters was (or tended to be) significantly different between limbs, neither during maximal electrical stimulation nor during voluntary attempts. Between limbs there were significant relationships for voluntary TTI40 (r ² = 0.94) and maximal SJ height (r ² = 0.88) and both parameters were significantly related in both limbs (r ² = 0.69 and 0.75). In conclusion, unilateral fast torque generating capacity, muscle activation and squat jump performance were similar in both limbs, but differed substantially among subjects, with strong correlations between fast voluntary isometric torque development and jump height. These findings further challenge the concept of lower limb dominancy in dynamometry testing in sports and rehabilitation.     

Prostaglandin E2 9-ketoreductase activity in human decidua vera tissue

Amnion is believed to be a tissue of central importance in the biochemical processes of parturition. In this tissue, prostaglandin E2 is the near exclusive prostaglandin produced. And although the production of prostaglandin E2 is increased during labor in women, the levels of the major metabolite of prostaglandin E2 in maternal plasma are not elevated; rather, the levels of 13,14-dihydro-15-ketoprostaglandin F2 alpha, the major circulating metabolite of prostaglandin F2 alpha, are increased strikingly. Because of this apparent paradox, we considered the possibility that prostaglandin E2, originating in amnion, chorion laeve, or decidua vera, is converted to prostaglandin F2 alpha in decidua vera by the action of prostaglandin E2-9-ketoreductase. We found that prostaglandin E2 9-ketoreductase, the enzyme that catalyzes the conversion of prostaglandin E2 to F2 alpha, is present in cytosolic fractions prepared from homogenates of uterine decidua vera tissue. The specific activity of 9-ketoreductase in cytosolic fractions of decidua of six women varied from 3.2 to 155 pmol X min-1 X mg-1 protein. We also evaluated the conversion of exogenous prostaglandin E2 to F2 alpha in intact human endometrial stromal cells in monolayer culture. We found that prostaglandin E2, added to the culture medium, was converted to prostaglandin F2 alpha by endometrial stromal cells that were maintained in the presence of inhibitors of prostaglandin synthase. The extent of conversion of exogenous prostaglandin E2 to F2 alpha, however, was low relative to the specific activity of prostaglandin E2 9-ketoreductase found in decidual cytosol. These findings are consistent with the possibility that prostaglandin E2 formed in decidua vera tissue may be converted in that tissue to prostaglandin F2 alpha by 9-ketoreductase; on the other hand, prostaglandin E2 formed in contiguous tissues probably is not converted significantly to prostaglandin F2 alpha by decidual 9-ketoreductase.