Acceptability of a hypothetical group B strep vaccine among pregnant and recently delivered women

Objective

Group B Streptococcus (GBS) causes significant infant morbidity and mortality. Promising GBS vaccines are currently in clinical trials. Because GBS vaccines would be the first to specifically target pregnant women, we sought to assess acceptability of a hypothetical GBS vaccine.

Study design

We performed an internet survey among currently pregnant or recently delivered women receiving care at one of 9 Ob/Gyn practices in Colorado. Vaccine acceptability was assessed using questions based on constructs from the Health Belief Model. Multivariable analyses assessed the characteristics associated with GBS vaccine acceptability during the current/recent pregnancy.

Results

The response rate was 50% (n = 231). While 78% agreed that a GBS vaccine would be a good way to protect newborns, 90% and 83% agreed, respectively, that they worried generally about the safety and effectiveness of new vaccines. Moreover, 39% believed it is generally dangerous for pregnant women to get vaccines. Seventy nine percent ‘definitely’ or ‘probably’ would have gotten a GBS vaccine in their most recent pregnancy if available. The most influential factors associated with this outcome were a strong belief in the vaccine's benefits (adjusted odds ratio [AOR] 6.37, 95% confidence interval [CI] 2.01–20.16), and low perceived barriers to vaccination (AOR 0.11, 95% CI (0.03–0.37)).

Conclusion

A GBS vaccine may be acceptable to pregnant women but would benefit from strong provider support and education about the risks and consequences of GBS infection and the benefits to vaccination.     

S-(−)equol producing status not associated with breast cancer risk among low isoflavone-consuming US postmenopausal women undergoing a physician-recommended breast biopsy

Soy foods are the richest sources of isoflavones, mainly daidzein and genistein. Soy isoflavones are structurally similar to the steroid hormone 17β-estradiol and may protect against breast cancer. S-(−)equol, a metabolite of the soy isoflavone daidzein, has a higher bioavailability and greater affinity for estrogen receptor β than daidzein. Approximately one-third of the Western population is able to produce S-(−)equol, and the ability is linked to certain gut microbes. We hypothesized that the prevalence of breast cancer, ductal hyperplasia, and overall breast pathology will be lower among S-(−)equol producing, as compared with nonproducing, postmenopausal women undergoing a breast biopsy. We tested our hypothesis using a cross-sectional study design. Usual diets of the participants were supplemented with 1 soy bar per day for 3 consecutive days. Liquid chromatography–multiple reaction ion monitoring mass spectrometry analysis of urine from 143 subjects revealed 25 (17.5%) as S-(−)equol producers. We found no statistically significant associations between S-(−)equol producing status and overall breast pathology (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.23-1.89), ductal hyperplasia (OR, 0.84; 95% CI, 0.20-3.41), or breast cancer (OR, 0.56; 95% CI, 0.16-1.87). However, the mean dietary isoflavone intake was much lower (0.3 mg/d) than in previous reports. Given that the amount of S-(−)equol produced in the gut depends on the amount of daidzein exposure, the low soy intake coupled with lower prevalence of S-(−)equol producing status in the study population favors toward null associations. Findings from our study could be used for further investigations on S-(−)equol producing status and disease risk.     

The link between genetic variation and variability in vaccine responses: Systematic review and meta-analyses

Although immune response to vaccines can be influenced by several parameters, human genetic variations are thought to strongly influence the variability in vaccine responsiveness. Systematic reviews and meta-analyses are needed to clarify the genetic contribution to this variability, which may affect the efficacy of existing vaccines. We performed a systematic literature search to identify all studies describing the associations of allelic variants or single nucleotide polymorphisms in immune response genes with vaccine responses until July 2013. The studies fulfilling inclusion criteria were meta-analyzed.     

Mapping mesoscale cortical connectivity in monkey sensorimotor cortex with optical imaging and microstimulation

To map in vivo cortical circuitry at the mesoscale, we applied a novel approach to map interareal functional connectivity. Electrical intracortical microstimulation (ICMS) in conjunction with optical imaging of intrinsic signals (OIS) was used map functional connections in somatosensory cortical areas in anesthetized squirrel monkeys. ICMS produced activations that were focal and that displayed responses which were stimulation intensity dependent. ICMS in supragranular layers of Brodmann Areas 3b, 1, 2, 3a, and M1 evoked interareal activation patterns that were topographically appropriate and appeared consistent with known anatomical connectivity. Specifically, ICMS revealed Area 3b connections with Area 1; Area 1 connections with Areas 2 and 3a; Area 2 connections with Areas 1, 3a, and M1; Area 3a connections with Areas M1, 1, and 2; and M1 connections with Areas 3a, 1, and 2. These somatosensory connectivity patterns were reminiscent of feedforward patterns observed anatomically, although feedback contributions are also likely present. Further consistent with anatomical connectivity, intra-areal and intra-areal patterns of activation were patchy with patch sizes of 200–300 μm. In summary, ICMS with OIS is a novel approach for mapping interareal and intra-areal connections in vivo. Comparisons with feedforward and feedback anatomical connectivity are discussed.     

Comprehensive Systematic Review Update Summary: Disorders of Consciousness: Report of the Guideline Development,Dissemination, and Implementation Subcommittee of the American Academy of Neurology; the American Congress of Rehabilitation Medicine; and the National Institute on Disability,Independent Living,and Rehabilitation Research

Objective

To update the 1995 American Academy of Neurology (AAN) practice parameter on persistent vegetative state and the 2002 case definition for the minimally conscious state (MCS) by reviewing the literature on the diagnosis, natural history, prognosis, and treatment of disorders of consciousness lasting at least 28 days.

Thoracic Aortic Calcification: Diagnostic,Prognostic, and Management Considerations

Thoracic aortic calcification (TAC) is associated with adverse cardiovascular outcomes, and for the cardiovascular imager, is predominantly encountered in 4 settings: 1) incidentally, for example, during a coronary artery calcium scan; 2) as part of dedicated screening; 3) in the evaluation of an embolic event; or 4) in procedural planning. This review focuses on TAC in these contexts. Within atherosclerosis, TAC is common, variable in extent, and begins in the intima with a patchy distribution. In metabolic disorders, aortitis, and radiation-associated cardiovascular disease, calcification preferentially involves the media and is often more concentric. As an incidental finding, atherosclerotic TAC provides limited incremental discriminative value, and current data do not support screening. After an embolic event, the demonstration of thoracic atheroma provides diagnostic clarity, but has limited treatment implications. Before any procedure, the plan often changes if the most severe form of TAC, a porcelain aorta, is discovered.