Demand patterns for HIV-tests in general practice: Information collected by sentinel networks in 5 European countries

This study describes a p. year international data collection on the demand pattern for HIV-antibody tests in general practice recorded by 6 sentinel networks in 5 European countries. The purpose of the recording was to evaluate the use of HIV-antibody testing by general practitioners and the demand for testing among the general population. Sentinel networks of general practitioners are a possible and available instrument for monitoring the perception of the HIV-test, and indirectly of the threat of the HIV-epidemic by the public and by the general practitioners (GPs). Differences were found between the countries in the frequency of testing, the person asking the test and the reason for testing. Possible explanatory factors, such as differences in the routine testing of specific groups, differences in the training and in the role of the GP, differences in the characteristics of prevention policy, are discussed. The European comparison also offers the opportunity to reflect on common medical practice in dealing with demands for HIV-tests.     

Interleukin-1 beta and beta-endorphin circadian rhythms are inversely related in normal and stress-altered sleep.

Normal sleep is associated to physiological nocturnal rises in Interleukin 1 beta (IL 1 beta) secretion. The 24 h pattern of IL 1 beta, beta-Endorphin (beta-EPH), ACTH and cortisol (F) production was evaluated in four male healthy volunteers. Two subjects were unable to sleep, due to the stress of the experiment; in these cases, no detectable plasma IL 1 beta secretion, both diurnal and nocturnal, was present, beta-EPH plasma levels were significantly higher (p < 0.01) than in the subjects who slept regularly and, in one case, increased F plasma levels were also reported. A strong negative correlation between IL 1 beta and beta-EPH plasma levels was present in all the cases. In conclusion, stress-induced sleep alterations might deeply affect both diurnal and nocturnal IL 1 beta plasma secretion, probably due to the hypothalamus-pituitary-adrenal axis (HPAA) activation, and beta-EPH might be the reliable marker of the stress-induced HPAA activation level.     

Helicobacter pylori cytotoxin: importance of native conformation for induction of neutralizing antibodies.

We have attempted to express the Helicobacter pylori vacuolating cytotoxin in Escherichia coli. Although the 95-kDa VacA polypeptide was expressed abundantly, it completely lacked any biological activity. In addition, this material failed to induce neutralizing antibodies after immunization of rabbits. In contrast, highly purified high-molecular-mass cytotoxin from the supernatant of H. pylori cultures was active in a HeLa cell assay and effectively induced a neutralizing response in rabbits. Neutralizing sera were shown to contain a high proportion of antibodies which recognized conformational epitopes found only on the native toxin. The data indicate that toxin-neutralizing epitopes are conformational and that potential vaccines based on the cytotoxin may benefit from the use of the intact molecule.     

Persistent increase in the incidence of acute male urethritis diagnosed in general practices in France

BACKGROUND: At-risk sexual behaviour seems to have increased in Europe, possibly due to the reassuring efficacy of highly active antiretroviral treatments. AIM: To follow, from 1990 to 2003, in France, the trends in the incidence of acute male urethritis diagnosed in general practice, a marker of at-risk sexual behaviour. DESIGN OF STUDY: Electronic disease surveillance. SETTING: General practices located all over mainland France. METHOD: The GPs of the French Sentinelles network reported, via online computer systems, the acute urethritis cases they diagnosed, and for each case the characteristics of the patients. RESULTS: After a striking decrease between 1990 and 1995 from 460 per 100 000 men aged 15-64 years (95% confidence interval [CI] = 390 to 520) to 180 (95% CI = 150 to 200), when antiretroviral drugs became available on the French market, the incidence of acute male urethritis stopped decreasing. Between 1996 and 2003, it may have risen again from 190 per 100 000 men (95% CI = 160 to 210) to 325 per 100 000 men (95% CI = 280 to 370) aged 15-64 years. The percentage of homosexual/bisexual men among the cases reported was higher than in the general population (10% versus 4%, P<0.001). Homosexual/bisexual patients were younger than heterosexual patients (34 versus 37 years, P = 0.04), more of them had a discharge (88% versus 59%, P<0.001), a history of sexually transmitted disease (65% versus 32%, P<0.001), and at least two sexual partners (74% versus 38%, P<0.001). The most frequent pathogens were Chlamydia trachomatis (25%), Neisseria gonorrhoea (21%), Mycoplasma genitalium (8%), Ureaplasma urealyticum (5%), Trichomonas vaginalis (3%) and other bacteria (32%). Presence of co-infections was observed in 8.3% of patients. CONCLUSIONS: This increase in the incidence of urethritis, shows that the sexual health of men has worsened in France, and calls for urgent new preventive measures.     

A fluorescence histochemical and biochemical evaluation of the effect of p-chloroamphetamine on individual serotonergic nuclei in the rat brain.

The serotonin (5-hydroxytryptamine) content of eight raphe nuclei was measured 9 days after injection of p-chloroamphetamine. 5-Hydroxytryptamine levels were reduced in only the B-9 cell group.The histofluorescence of serotonergic neurons in the B-9 cell group was also studied at two time intervals after a single injection of p-chloroamphetamine. Nine days after the administration of p-chloroamphetamine there was a small decrease both in the intensity of fluorescence and in the number of yellow fluorescent serotonergic cells. After 2 months the drug caused a more marked decrease in the number of viable serotonergic cells. The results are discussed in relation to the mechanism of action of p-chloroamphetamine.It is suggested that following the administration of p-chloroamphetamine retrograde destruction may occur in the B-9 cell group, in contrast to those of the other raphe nuclei, whose cell bodies may possess a sufficient number of collateral processes to resist the slow neurotoxic destruction of their cell bodies.     

Narrative review of prostate cancer grading systems: will the Gleason scores be replaced by the Grade Groups?

The Gleason grading system, proposed by Dr. Donald F. Gleason in 1966, is one of the most important prognostic factors in men with prostate cancer (PCa). At consensus conferences held in 2005 and 2014, organized by the International Society of Urological Pathology (ISUP), the system was modified to reflect the current diagnostic and therapeutic approaches. In particular, in the 2014 Conference, it was recognized that there were weaknesses with the original and the 2005 ISUP modified Gleason systems. Based on the results of a research conducted by Prof. JI Epstein and his group, a new grading system was proposed by the ISUP in order to address some of such deficiencies: i.e., the five distinct Grade Groups (GGs). Since 2014, results of studies have been published by different groups and societies, including the Genitourinary Pathology Society (GUPS), giving additional support to the prognostic role of the architectural Gleason patterns and, in particular, of the GGs. A revised GG system, taking into account the percentage of Gleason pattern (GP) 4, cribriform and intraductal carcinoma, tertiary GP 5, and reactive stroma grade, has shown to have some advantages, however not ready for adoption in the current practice. The aim of this contribution was to review the major updates and recommendations regarding the GPs and GSs, as well as the GGs, trying to give an answer to the following questions: “How has the grade group system been used in the routine?” and “will the Gleason scoring system be replace by the grade groups?” We also discussed the potential implementation in the future of molecular pathology and artificial intelligence in grading to further define risk groups in patients with PCa.     

Towards a new WHO classification of renal cell tumor: what the clinician needs to know—a narrative review

In 1952, renal cell carcinomas had been divided into 2 categories—clear cell or granular cell—depending upon their cytoplasmic staining characteristics. In the following years, the inventory of renal epithelial tumors has expanded by the addition of tumors named by their architectural pattern (i.e., papillary RCC, tubulocystic RCC), anatomic location (i.e., collecting duct carcinoma, renal medullary carcinoma), associated diseases (i.e., acquired cystic disease-associated RCCs). With the extensive application of molecular diagnostic techniques, it becomes possible to detect genetic distinctions between various types of renal neoplasm and discover new entities, otherwise misdiagnosed or diagnosed as unclassified RCC. Some tumors such as ALK rearrangement-associated RCC, MiT family translocation renal carcinomas, SDH-deficient renal cancer or FH-deficient RCC, are defined by their molecular characteristics. The most recent World Health Organization (WHO) classification of renal neoplasms account for more than 50 entities and provisional entities. New entities might be included in the upcoming WHO classification. The aim of this review is to summarise and discuss the newly acquired data and evidence on the clinical, pathological, molecular features and on the prognosis of new RCC entities, which will hopefully increase the awareness and the acceptance of these entities among clinicians and improve prognostication for individual patients.     

Acute coronary syndromes

The first 150 words of the full text of this article appear below. Key points Coronary artery disease accounts for >30% ofdeaths in Western society. The diagnosis of myocardial infarctionshould be qualified by size, causation and time from occurrence. Mortalityis reduced by immediate or ‘primary’ percutaneouscoronary intervention or thrombolysis within the first 24 hof onset of ST-segment elevation myocardial infarction. Strategiesto reduce platelet activation (glycoprotein IIb/IIIa receptorantagonists, or clopidogrel) are now recommended in the treatmentof high-risk non-ST-segment myocardial infarction/unstable angina. Elevatedserum troponins may be the result of non-ischaemic myocardialdamage, especially in critical illness.