Examining Mediators of the Relationship Between Community Mobilization and HIV Incidence Among Young South African Women Participating in the HPTN 068 Study Cohort

AIDS and Behavior - We previously demonstrated that village community mobilization (CM) was associated with reduced HIV incidence among adolescent girls and young women (AGYW) in South Africa....     

The assessment of prognosis of surgically resected oesophageal cancer is dependent on the number of lymph nodes examined pathologically

Aims:  The prognosis in surgically resected oesophageal carcinoma (OC) is dependent on the number of regional lymph nodes (LN) involved, but no guidance exists on how many LNs should be examined histopathologically to give a reliable pN status. The aim of this study was to determine whether the number of LNs examined after OC resection has a significant effect on the assessment of prognosis.
Methods and results:  Routinely generated pathology reports from 237 consecutive patients undergoing oesophagectomy for OC were examined and analysed in relation to survival. The main outcome measure was survival from date of diagnosis. Lymph node count (LNC) correlated strongly with survival; a plateau was reached after a count of 10. Median and 2-year survival was 30 months and 42%, respectively, if <10 nodes were examined ( n  = 88), compared with 51 months and 61% if >10 nodes were examined ( P  = 0.005). This effect was greatest in pN0 cases. The prognostic value of the absolute number of LN metastases (<4) and LN ratio (<0.4) was strongly dependent on a LNC of >10.
Conclusions:  These results demonstrate the importance of careful pathological examination and lymph node retrieval after OC resection. At least 10 nodes should be examined to designate an OC as pN0.     

HPTN 068: A Randomized Control Trial of a Conditional Cash Transfer to Reduce HIV Infection in Young Women in South Africa—Study Design and Baseline Results

Young women in South Africa are at high risk for HIV infection. Cash transfers offer promise to reduce HIV risk. We present the design and baseline results from HPTN 068, a phase III, individually randomized trial to assess the effect of a conditional cash transfer on HIV acquisition among South African young women. A total of 2533 young women were randomized to receive a monthly cash transfer conditional on school attendance or to a control group. A number of individual-, partner-, household- and school-level factors were associated with HIV and HSV-2 infection. After adjusting for age, all levels were associated with an increased odds of HIV infection with partner-level factors conveying the strongest association (aOR 3.05 95 % CI 1.84–5.06). Interventions like cash transfers that address structural factors such as schooling and poverty have the potential to reduce HIV risk in young women in South Africa.     

Norethynodrel metabolites in human plasma and urine

Norethynodrel metabolites in human plasma and urine were analyzed. Samples were collected from healthy young women over 1 24-hour period after the oral administration of 11.1 mg (50 mcCi) of 6, 7-tritiated norethynodrel. The 3 alpha-hydroxy compound from the reduction of the 3-ketone of norethynodrel was the major free metabolite in plasma, with lesser amounts of its 3 beta-isomer and norethindrone. These compounds were identified by carrier addition analysis and their concentrations were estimated by thin-layer radiochromatography. The bulk of plasma metabolites consisted of conjugates and greater than 95% of urinary metabolites (20% of total dose) were conjugated; 2 of which were beta-glucuronides. Enzymatic hydrolysis enabled the urinary compounds to be identified by gas-lizuid chromatography-mass spectrometry. 70-80% (10% of the dose) of the enzymatically hydrolyzed urinary metabolites were hydroxylated compounds. Triols were the principal hydroxylated compounds isolated. The metabolism of norethynodrel was rapid and extensive.     

Prevalence and outcome of esophagogastric anastomotic leak after esophagectomy in a UK regional cancer network

The aim of this study was to determine the contemporary prevalence, outcome, and survival after esophagogastric anastomotic leakage (EGAL) following esophagectomy by a regional upper gastrointestinal cancer network and to investigate etiological factors. Two hundred forty consecutive patients underwent esophagectomy over a 10‐year period (median age 61 [31–79] years, 147 transthoracic and 93 transhiatal esophagectomy, 105 neoadjuvant chemotherapy, 49 chemoradiotherapy). The primary outcome measures were the development of EGAL and survival. Twenty patients developed EGAL (8.3%, 15 managed conservatively, 5 reoperation). Overall operative mortality was 2% (5 patients in total, 1 after EGAL). Median, 1 and 2‐year survival was 22 months, 73% and 50%, in patients after EGAL, compared with 31 months, 80% and 56%, in patients who did not suffer EGAL (P= 0.314). On multivariate analysis, low body mass indices (hazard ratio [HR] 0.29, 95% confidence interval [CI] 0.11–0.79, P= 0.016), individual surgeon (HR 1.21, 95% CI 1.02–1.43, P= 0.02), and neoadjuvant chemotherapy (HR 3.28, 95% CI 1.16–9.22, P= 0.024) were significantly associated with the development of EGAL. EGAL following esophagectomy remained common, but associated mortality was less common than reported in earlier Western series and long‐term survival was unaffected.