Epidemiology of Escherichia coli O157:H7 outbreaks, United States, 1982-2002

Escherichia coli O157:H7 causes 73,000 illnesses in the United States annually. We reviewed E. coli O157 outbreaks reported to Centers for Disease Control and Prevention (CDC) to better understand the epidemiology of E. coli O157. E. coli O157 outbreaks (>or=2 cases of E. coli O157 infection with a common epidemiologic exposure) reported to CDC from 1982 to 2002 were reviewed. In that period, 49 states reported 350 outbreaks, representing 8,598 cases, 1,493 (17%) hospitalizations, 354 (4%) hemolytic uremic syndrome cases, and 40 (0.5%) deaths. Transmission route for 183 (52%) was foodborne, 74 (21%) unknown, 50 (14%) person-to-person, 31 (9%) waterborne, 11 (3%) animal contact, and 1 (0.3%) laboratory-related. The food vehicle for 75 (41%) foodborne outbreaks was ground beef, and for 38 (21%) outbreaks, produce.     

One year postoperative hard and soft tissue volumetric changes after a BSSO mandibular advancement

In this study, cone beam computed tomography (CBCT) and three dimensional (3D) stereophotogrammetry are used to compare the 3D skeletal and soft tissue changes caused by a bilateral sagittal split osteotomy (BSSO) 1 year after a mandibular advancement. Eighteen consecutive patients with a hypoplastic mandible were treated with a BSSO according to the Hunsuck modification. Preoperatively and 1 year postoperatively, a CBCT scan was acquired and a 3D photograph. The pre- and postoperative CBCT scans were matched using voxel based registration. After registration, the mandible could be segmented in the pre- and postoperative scans. The preoperative scan was subtracted from the postoperative scan, resulting in the hard tissue difference. To investigate the soft tissue changes, the pre- and postoperative 3D photographs were registered using surface based registration. After registration the preoperative surface could be subtracted from the postoperative surface, resulting in the overall volumetric difference. As expected, a correlation between mandibular advancent and volumetric changes of the hard tissues was found. The correlation between advancement and soft tissues was weak. The labial mental fold stretched after surgery. This study proved that using 3D imaging techniques it is possible to document volumetric surgical changes accurately and objectively.     

Love,Trust, and HIV Risk Among Female Sex Workers and Their Intimate Male Partners

Objectives. We examined correlates of love and trust among female sex workers and their noncommercial male partners along the Mexico–US border.Methods. From 2011 to 2012, 322 partners in Tijuana and Ciudad Juárez, Mexico, completed assessments of love and trust. Cross-sectional dyadic regression analyses identified associations of relationship characteristics and HIV risk behaviors with love and trust.Results. Within 161 couples, love and trust scores were moderately high (median 70/95 and 29/40 points, respectively) and correlated with relationship satisfaction. In regression analyses of HIV risk factors, men and women who used methamphetamine reported lower love scores, whereas women who used heroin reported slightly higher love. In an alternate model, men with concurrent sexual partners had lower love scores. For both partners, relationship conflict was associated with lower trust.Conclusions. Love and trust are associated with relationship quality, sexual risk, and drug use patterns that shape intimate partners’ HIV risk. HIV interventions should consider the emotional quality of sex workers’ intimate relationships.While public health interventions continue to be grounded in tenets of risk and disease, there is growing recognition of the importance of emotions such as love and trust in shaping the health behaviors of diverse populations. Unprotected sex allows for transmission of HIV and other sexually transmitted infections (STIs) but often carries emotional meanings of trust and commitment that impede condom negotiation even among individuals with high knowledge and self-efficacy.1–4 Research has consistently found female sex workers’ condom use to be less frequent with their noncommercial male partners than with clients, which has been linked to intimacy, love, and trust.5–7 Similarly, drug-using couples may share syringes and engage in additional known HIV risk behaviors to convey support and emotional closeness.8,9 Although much of this research is qualitative, some quantitative work has confirmed associations between perceptions of intimacy and condom use among sex workers and clients10 and men who have sex with men.11Quantitative researchers have attempted to operationalize emotions into theoretical constructs for empirical research.12 Sternberg’s “triangular” theory posits that love comprises 3 components: intimacy (feelings of emotional closeness between partners), passion (physical attraction and sexual consummation), and commitment (decisions that partners make about maintaining relationships).13,14 Taken together, these components combine to generate different kinds of love.13,15,16Another important aspect of intimate relationships, trust is conceptualized as a belief in the integrity of a partner. Trust may be based on individuals’ assessments of their partners’ benevolence and honesty17 and subjective feelings of security within relationships.18,19 To measure trust quantitatively, Larzelere and Huston developed a dyadic trust scale that correlated with love and relationship quality.17A rich body of ethnographic scholarship has highlighted the importance of companionate relationships and love in diverse global contexts,20–22 but quantification of emotional constructs are largely absent from settings outside the Western middle-class experience. Most quantitative studies of love and trust have focused on privileged populations who do not experience the burden of disease that disproportionately affects socially marginalized couples. Existing studies among US populations have also suggested that women and men value components of these emotions differently,23–25 yet the implications of these potential gender differences for HIV prevention among vulnerable couples remains underexplored.Our study of love and trust among sex workers and their noncommercial partners is situated in 2 Mexican border cities: Tijuana, Baja California, south of San Diego, California (population 1.6 million), and Ciudad Juárez, Chihuahua, adjacent to El Paso, Texas (population 1.3 million). Both cities have areas where sex work and drug use are concentrated,26 lending to the conceptualization of the border as an HIV risk environment27 characterized by poverty, unemployment, violence, and availability of illicit drugs.28 Research has documented substantial overlap in risky sexual and injection drug use behaviors among marginalized female sex workers29 who often turn to sex work as a last option for supporting themselves and their dependents.30Drawing on Connell’s conceptualization of gender as a relational process influenced by structural and sociocultural factors,31 our previous qualitative and ethnographic inquiry into sex workers’ intimate partnerships in these cities proposed that emotions are shaped by the HIV risk environment of the border. Structural conditions bring partners together into relationships that provide critical material and emotional support. In light of limited economic opportunities, couples form tacit agreements regarding women’s engagement in sex work. In the process, women emerge as primary wage earners, alienating men from traditional gender roles as providers and shifting gender dynamics. To cope, partners mostly avoid communicating about sex work or disclosing HIV risk to protect the emotional integrity of the relationship.32We also found that these couples’ relationships range in emotional intensity from friendship and care to transformative experiences of love. Regardless, most couples demarcate their primary relationships from sex work by engaging in unprotected sex. Among couples who inject drugs, sharing syringes together (but not with others) often reinforces trust and care.33 Concerns of mistrust and infidelity also reduced couples’ interest in alternative HIV-prevention technologies such as pre-exposure prophylaxis.34In light of the central role of emotions in our qualitative research with these couples, we attempted to quantify constructs of love and trust and identify associated relationship traits and HIV risk behaviors in our larger cohort. We hypothesized that markers of relationship quality (e.g., higher satisfaction, lower conflict) and unprotected sex within primary relationships would be associated with higher love and trust, whereas extradyadic HIV risk behaviors (e.g., concurrent sexual partners, syringe sharing with others) would be associated with lower love and trust.     

Immunobiologic factors predictive of clinical outcome in diffuse large-cell lymphoma

The prognostic importance of immunobiologic factors in diffuse large-cell lymphoma (DLCL) is studied in 105 consecutive DLCL patients. Multivariate results using the Cox proportional hazards model clearly indicate that the Ki-67 index (P = .002), a marker of cell proliferation activity, and the presence or absence of human leukocyte antigen-DR (HLA-DR) (P = .007) are strong predictors of survival even in the presence of established clinical factors of stage (P = .015) and symptoms (P = .050). Using these four variables, prognostic groups were formed identifying patient groups with varying degrees of risk. The group of patients with three or four risk factors present at the time of diagnosis had a median survival of 4 months compared with a median survival of 59 months for the group with no risk factors. Similarly, prognostic groups for disease-free survival (DFS) were constructed based on the proportional hazards model that involved B versus T phenotype (P = .035) and HLA-DR (P = .054). Median DFS for the patient group with one or two risk factors present was 11 months compared with 43 months with no risk factors present. This study suggests immunobiologic parameters are important predictors of clinical outcome in DLCL patients and are of value in identifying subgroups of patients who have not responded to currently available therapy. The practical significance of this study is to identify parameters that may suggest specific changes in therapy of patient subgroups.     

Doxycycline Suppresses Microglial Activation by Inhibiting the p38 MAPK and NF-kB Signaling Pathways

In neurodegenerative diseases, the inflammatory response is mediated by activated glial cells, mainly microglia, which are the resident immune cells of the central nervous system. Activated microglial cells release proinflammatory mediators and neurotoxic factors that are suspected to cause or exacerbate these diseases. We recently demonstrated that doxycycline protects substantia nigra dopaminergic neurons in an animal model of Parkinson’s disease. This effect was associated with a reduction of microglial cell activation, which suggests that doxycycline may operate primarily as an anti-inflammatory drug. In the present study, we assessed the anti-inflammatory potential of doxycycline using lipopolysaccharide (LPS)-activated primary microglial cells in culture as a model of neuroinflammation. Doxycycline attenuated the expression of key activation markers in LPS-treated microglial cultures in a concentration-dependent manner. More specifically, doxycycline treatment lowered the expression of the microglial activation marker IBA-1 as well as the production of ROS, NO, and proinflammatory cytokines (TNF-α and IL-1β). In primary microglial cells, we also found that doxycycline inhibits LPS-induced p38 MAP kinase phosphorylation and NF-kB nuclear translocation. The present results indicate that the effect of doxycycline on LPS-induced microglial activation probably occurs via the modulation of p38 MAP kinase and NF-kB signaling pathways. These results support the idea that doxycycline may be useful in preventing or slowing the progression of PD and other neurodegenerative diseases that exhibit altered glia function.     

Radical prostatectomy for prostatic adenocarcinoma: a matched comparison of open retropubic and robot-assisted techniques

OBJECTIVE

To assess the perioperative complications and early oncological results in a comparative study matching open radical retropubic (RRP) and robot‐assisted radical prostatectomy (RARP) groups.

PATIENTS AND METHODS

From August 2002 to December 2005 we identified 294 patients undergoing RARP for clinically localized prostate cancer. A comparison RRP group of 588 patients from the same period was matched 2:1 for surgical year, age, preoperative prostate‐specific antigen level, clinical stage and biopsy Gleason grade. Perioperative complications were compared. Patients completed a standardized quality‐of‐life questionnaire. Pathological features were assessed and Kaplan‐Meier estimates of biochemical progression‐free survival (PFS) were compared.

RESULTS

There was no significant difference in overall perioperative complications between the RARP and RRP groups (8.0% vs 4.8%, P = 0.064). Wound herniation was more common after RARP (1.0% vs none, P = 0.038), and development of bladder neck contracture was more common after RRP (1.2% vs 4.6%; P < 0.018). The hospital stay was less after RARP (29.3% vs 19.4%, P = 0.004, for a stay of 1 day). At the 1‐year follow‐up there was no significant difference in continence (RARP 91.8%, RRP 93.7%, P = 0.344) or potency (RARP 70.0%, RRP 62.8%, P = 0.081) rates. The biochemical PFS was no different between treatments at 3 years (RARP 92.4%, RRP 92.2%; P = 0.69).

CONCLUSION

There was no significant difference in overall early complication, long‐term continence or potency rates between the RARP and RRP techniques. Furthermore, early oncological outcomes were similar, with equivalent margin positivity and PFS between the groups.     

Loxosceles gaucho spider venom and its sphingomyelinase fraction trigger the main functions of human and rabbit platelets

Loxosceles venoms can promote severe local and systemic damages. We have previously reported that Loxosceles gaucho spider venom causes a severe early thrombocytopenia in rabbits. Herein, we investigated the in vitro effects of this venom and its sphingomyelinase fraction on the main functions of platelets. Whole venom and its fraction induced aggregation of both human and rabbit platelets. Aggregation was dependent of plasma component(s) but independent of venom-induced lysophosphatidic acid generation. There was no increase in the levels of lactate dehydrogenase during platelet aggregation, ruling out the possibility of platelet lysis. The increased expression of ligand-induced binding site 1 (LIBS1) induced by L. gaucho venom and its sphingomyelinase fraction, as well as of P-selectin by the whole venom, evidenced the activation state of both human and rabbit platelets. Adhesion assays showed an irregular response when platelets were exposed to the whole venom, whereas the sphingomyelinase fraction induced a dose-dependent increase in the platelet adhesion to collagen. These findings evidence that L. gaucho venom and its sphingomyelinase fraction trigger adhesion, activation, and aggregation of both human and rabbit platelets. Thus, this work justifies the use of rabbits to investigate Loxosceles venom-induced platelet disturbances, and it also supports research on the role of platelets in the pathogenesis of loxoscelism.