Screening for Neisseria gonorrhoeae and Chlamydia trachomatis in men who have sex with men at male-only saunas

BACKGROUND AND OBJECTIVES: In response to increases in sexually transmissible infections (STI) and HIV infection rates among men who have sex with men (MSM), the current study aimed to investigate the feasibility of a screening program at male-only saunas in Melbourne, Australia. GOAL: The goal was to determine (1) the participation rate, and the proportion whom obtain test results; (2) the prevalence of gonorrhea and chlamydia; and (3) to evaluate risk factors for STI acquisition. STUDY DESIGN: We used a cross-sectional design. Pharyngeal, rectal, and urethral specimens were collected from participants, and tested for Chlamydia trachomatis and Neisseria gonorrhoeae by polymerase chain reaction (PCR). RESULTS: There was a participation rate of 24% (n=521), and 70% obtained their test results. The infection rate in those who failed to collect their results was no different than those seeking theirs. The proportion of participants with PCR-detected gonorrhea and/or chlamydia infection was high, 10.7%. The presence of infection was associated with seeking sexual health care in the last year. CONCLUSION: The high prevalence rate of gonorrhea and chlamydia supports the concept of a screening program in Melbourne male-only saunas. The low participation rate has highlighted the need to consider alternative methods for making contact with men in the saunas or offering incentives to participate in future screening programs. Although anonymous participation encouraged participation for some men, future programs should attempt to obtain contact details for follow up of positive test results.     

Population-Level Effects of Human Papillomavirus Vaccination Programs on Infections with Nonvaccine Genotypes

We analyzed human papillomavirus (HPV) prevalences during prevaccination and postvaccination periods to consider possible changes in nonvaccine HPV genotypes after introduction of vaccines that confer protection against 2 high-risk types, HPV16 and HPV18. Our meta-analysis included 9 studies with data for 13,886 girls and women ≤19 years of age and 23,340 women 20–24 years of age. We found evidence of cross-protection for HPV31 among the younger age group after vaccine introduction but little evidence for reductions of HPV33 and HPV45. For the group this same age group, we also found slight increases in 2 nonvaccine high-risk HPV types (HPV39 and HPV52) and in 2 possible high-risk types (HPV53 and HPV73). However, results between age groups and vaccines used were inconsistent, and the increases had possible alternative explanations; consequently, these data provided no clear evidence for type replacement. Continued monitoring of these HPV genotypes is important.     

冠心病并发抑郁与血清白介素-6水平的关系

目的: 分析冠心病(CHD)患者的心理状况,探讨血清白介素-6（IL-6）与CHD并发抑郁的关系,为临床提供CHD并发抑郁干预治疗的依据。方法: 对90例CHD患者进行ZUNG抑郁自评量表 (SDS)评分,根据评分结果分为CHD伴有抑郁组(A组)与不伴抑郁组(B组)。用放射免疫法测定血清IL-6的水平,并记录年龄、性别、吸烟、文化程度、糖尿病、高血压病史及血脂水平等相关资料。结果: 入选的CHD患者57.58%伴有不同程度的抑郁,其中轻度抑郁者24例(26.67%),中、重度抑郁者28例(31.11%)。男性患者57.79%伴有抑郁,女性患者57.89%伴有抑郁;男、女性CHD患者抑郁并存率之间的差异无统计学意义。A组患者血清IL-6的水平［M(P25,P75］为［0.04(0.01,0.06)］ μg/L,B组患者为［0.02(0.01,0.05)］ μg/L,A组高于B组,差异有统计学意义(P<0.05)。A组中、重度抑郁患者血清IL-6水平为［0.05(0.02,0.08)］ μg/L高于轻度抑郁IL-6水平为［0.04(0.01,0.05)］ μg/L,差异有统计学意义(P<0.05)。结论: CHD患者有较高的抑郁并存率,CHD伴有抑郁患者血清IL-6的水平明显高于不伴有抑郁患者,中、重度抑郁患者血清IL-6的水平明显高于轻度抑郁。CHD伴有抑郁是体内具有炎性反应的一个标志,也即炎性反应在CHD并发抑郁中起着一定的作用。     

Do Social Support, Stress, Disclosure and Stigma Influence Retention in HIV Care for Latino and African American Men Who Have Sex with Men and Women?

Limited research has examined the role that social support, stress, stigma and HIV disclosure play in retention in HIV care for African Americans and Latinos. Among 398 Latino and African American men who have sex with men (MSM) and women, the major predictor of retention in HIV care was disclosure of HIV status to more social network members (OR?=?1.5; 95% CI: 1.1, 1.9). Among those who had disclosed (n?=?334), female gender (OR?=?1.8, 95% CI: 1.1, 3.1) and disclosure of HIV status to more network members (OR?=?1.5, 95% CI: 1.1, 1.9) was associated with retention in HIV care. General stress was associated with retention in care (OR?=?1.2; 95% CI: 1.1, 1.3) for African American MSM who had disclosed. More MSM-stigma was associated with poorer retention (OR?=?0.9; 95% CI: 0.8, 0.9) for Latino MSM. Interventions that help patients safely disclose their HIV status to more social network members may improve HIV care retention as would social network counseling for Latino MSM to reduce MSM-stigma.     

Recruitment of HIV/AIDS treatment‐naïve patients to clinical trials in the highly active antiretroviral therapy era: influence of gender,sexual orientation and race

Background

In the USA, women, racial/ethnic minorities and persons who acquire HIV infection through heterosexual intercourse represent an increasing proportion of HIV‐infected persons, and yet are frequently underrepresented in clinical trials. We assessed the demographic predictors of trial participation in antiretroviral‐naïve patients.

Methods

Patients were characterized as trial participants if highly active antiretroviral therapy (HAART) was initiated within a clinical trial. Prevalence ratios (PRs) were obtained using binomial regression.

Results

Between 1996 and 2006, 30% of 738 treatment‐naïve patients initiated HAART in a clinical trial. Trial participation rates for men who have sex with men (MSM), heterosexual men, and women were respectively 36.5, 29.6 and 24.3%. After adjustment for other factors, heterosexual men appeared less likely to participate in trials compared with MSM [PR 0.79, 95% confidence interval (CI) 0.57, 1.11], while women were as likely to participate as MSM (PR 0.97, 95% CI 0.68, 1.39). The participation rate in Black patients (25.9%) was lower compared with non‐Black patients (37.5%) (adjusted PR 0.80, 95% CI 0.60, 1.06).

Conclusions

In our clinical setting, gender did not appear to impact participation in HIV treatment trials, but Black patients were slightly less likely to participate in these trials. Considering the substantial proportion of HIV‐infected patients who are Black, future trials need to consider strategies to incorporate such underrepresented populations.     

Exercise Testing Identifies Patients at Increased Risk for Morbidity and Mortality Following Fontan Surgery

Objective. The objective of this study was to examine the relationship between exercise test data and mortality in patients who have had the Fontan procedure. Design. The study was designed as a retrospective cohort study. Setting. The study was set in a tertiary care center. Patients. All study participants were Fontan patients ≥16 years old who had cardiopulmonary exercise tests at our institution between November 2002 and March 2010. The first exercise test with adequate effort during the study period was retained for analysis. We enrolled 146 patients at a median age of 21.5 years (16.0–51.6); 15.8 years (1.2–29.9) after Fontan surgery. Outcome Measures. The outcome measures were exercise test data (peak oxygen consumption, peak heart rate, etc.); mortality. Results. Peak oxygen consumption averaged 21.2 ± 6.2 mL/kg/min, 57.1 ± 14.1% predicted. Follow‐up data were collected 4.0 ± 2.0 years (range 0.3–7.7) after the exercise test. Sixteen patients (11%) died during follow‐up; their peak oxygen consumption (16.3 ± 4.0 mL/kg/min) was significantly less than the survivors' (21.8 ± 6.2 mL/kg/min; P < .0001). Recursive partitioning and Cox proportional hazards modeling revealed that the hazard for death for patients with a peak oxygen consumption of <16.6 mL/kg/min was 7.5 (95% confidence interval: 2.6, 21.6; P < .0002) times that of patients with a higher peak oxygen consumption. Similarly, the hazard ratio for patients with peak‐exercise heart rates of <122.5 bpm was 10.6 (3.0, 37.1; 0 < 0.0002). Data from exercise tests could also identify patients at increased risk for a combined morbidity/mortality end point. Conclusions. In adults with Fontan surgery, exercise test data can identify patients at increased risk of midterm morbidity and mortality.     

MRI of bilateral sensorimotor network activation in response to direct intracortical stimulation in rats after unilateral stroke

Reinstatement of perilesional activation and connectivity may underlie functional recovery after stroke. To measure activation responsiveness in perilesional cortex in relation to white matter integrity, we performed functional functional magnetic resonance imaging during stimulation of the contralesional cortex, together with diffusion tensor imaging, 3 and 28 days after stroke in rats. Despite disturbed sensorimotor function and abnormal callosal appearance at day 3, activation amplitudes were preserved in the perilesional sensorimotor cortex, although time-to-peak was significantly delayed. This indicates that in spite of dysfunction, perilesional cortical tissue can be activated subacutely after stroke, while delay of the hemodynamic activation response suggests impaired neurovascular coupling.     

Referral and comanagement of the patient with CKD

CKD is a common condition with well-documented associated morbidity and mortality. Given the substantial disease burden of CKD and the cost of ESRD, interventions to delay progression and decrease comorbidity remain an important part of CKD care. Early referral to nephrologists has been shown to delay progression of CKD. Conversely, late referral has been associated with increased hospitalizations, higher mortality, and worsened secondary outcomes. Late referral to nephrology has been consequent to numerous factors, including the health care system, provider issues, and patient related factors. In addition to timely referral to nephrologists, the optimal modality to provide care for CKD patients has also been evaluated. Multidisciplinary clinics have shown significant improvements in other disease states. Data for the use of these clinics have shown benefit in mortality, progression, and laboratory markers of disease severity. However, studies supporting the use of multidisciplinary clinics in CKD have been mixed. Evidence-based guidelines from groups, including Renal Physicians Association and NKF, provide tools for management of CKD patients by both generalists and nephrologists. Through the use of guidelines, timely referral, and a multidisciplinary approach to care, the ability to provide effective and efficient care for CKD patients can be improved. We present a model to guide a multidisciplinary comanagement approach to providing care to patients with CKD.     

Increased neutrophil adenosine a3 receptor expression is associated with hemorrhagic shock and injury severity in trauma patients

Hypertonic saline (HS) has been investigated as an immune modulator following hemorrhagic shock and sepsis. The polymorphonuclear neutrophil (PMN) response to HS is regulated by the release of ATP, which is converted to adenosine and activates adenosine receptors. Binding to A3 adenosine receptors promotes PMN activation, and inhibition of A3 receptors improves the efficacy of HS resuscitation. A3 receptor expression of PMNs has not been previously evaluated in injured patients. Whole blood was obtained from 10 healthy volunteers and 60 injured patients within 2 h of injury. Inclusion criteria were blunt or penetrating injury with evidence of hypovolemic shock (systolic blood pressure [SBP] ≤90 mmHg and base deficit ≥6 mEq/L or need for blood transfusion) or evidence of severe traumatic brain injury including initial Glasgow Coma Scale score of 8 or less or evidence of traumatic brain injury on head computed tomography scan (head Abbreviated Injury Score ≥3) or intubation in the field or emergency department. A3 receptor expression was assessed by flow cytometry. Polymorphonuclear neutrophils were also exposed to fMLP or HS (20-40 mM) in vitro. Clinical data were collected including admission physiology, injury severity (Injury Severity Score [ISS]), development of multiple organ failure, and survival. In normal volunteers, less than 1% of PMNs expressed A3 receptors on the cell surface. A3 receptor expression was significantly higher in injured patients, and the level of expression correlated with the severity of injury (ISS ≥25: A3 positive PMN 36.6% vs. ISS <25: 16.2%; P = 0.019) and degree of hypovolemic shock (SBP ≤90 mmHg: A3 positive PMN 43.8% vs. SBP>90 mmHg: 20.6%; P = 0.008). Stimulation with fMLP or HS increased A3 expression in normal volunteers, but only in patients with ISS of less than 25 or without hypovolemic shock. A3 receptor expression on the surface of PMNs is upregulated by injury, and increased expression levels are associated with greater injury severity and hypovolemic shock. Hypertonic saline increases A3 expression of PMNs from healthy volunteers and less severely injured patients.