A longitudinal study of seroreactivity against Mycoplasma penetrans in HIV-infected homosexual men: association with disease progression

The soluble form of the vascular cell adhesion molecule-1 (VCAM-1) is detectable in human sera and is elevated in diabetic patients, with unknown clinical significance. In the present study, the relationship between serum soluble VCAM-1 and diabetic microvascular complications (retinopathy, nephropathy, and neuropathy) was evaluated in 95 Japanese patients with Type 2 diabetes mellitus (DM). Serum soluble VCAM-1 concentration was higher in patients with more advanced stages of retinopathy as well as nephropathy. There was a significant correlation between soluble VCAM-1 and log10 (urinary albumin excretion) in 69 patients with normal serum creatinine levels (r = 0.51, p < 0.0001) and a significant correlation between soluble VCAM-1 and log10 (serum creatinine) in all the patients (r = 0.83, p < 0.0001). Soluble VCAM-1 concentration was also elevated in patients with neuropathy. There was a significant correlation between soluble VCAM-1 concentration and the number of microvascular complications (r = 0.59, p < 0.0001). However, multivariate regression analysis revealed that only diabetic nephropathy, was associated with the soluble VCAM-1 concentration. The elevation of circulating VCAM-1 level in diabetic nephropathy may result from underlying systemic endothelial dysfunction, increased VCAM-1 production in damaged renal tubular or glomerular epithelial cells and/or decreased renal clearance of this molecule, depending on the stage of nephropathy.     

HIV protease inhibitors influence the prevalence of oral candidosis in HIV-infected patients: a 2-year study

The introduction of HIV protease inhibitors was accompanied by reduction in HIV-associated opportunistic infections. Therefore, we performed a retrospective study of HIV-infected patients to evaluate the effects of therapy with an HIV protease inhibitor (PI) on oral candidosis. This was of special interest, because an important virulence factor of Candida albicans is the secreted aspartic protease (SAP), which is assigned to the same class of aspartic proteases as HIV protease. Sixty-two patients were examined five times over a period of 2 years. There was a hint at a difference in the frequencies of C. albicans carrier state and manifest oral candidosis in favour of treatment with a PI. In addition, loss of Candida colonization and manifest oral candidosis was observed only in patients with elevation of CD4 cells upon PI. This might explain the effect, which also might go back to a direct inhibition of yeast SAP.     

Circadian rhythm of lymphocytes and their glucocorticoid receptors in HIV-infected homosexual men

Glucocorticoids (Gc) are known to modulate protein synthesis by immune cells through binding to a specific receptor (GcR). We outlined the circadian rhythm of plasma cortisol, ACTH, of the peripheral blood mononuclear cells (PBMC isolated by Ficoll-Hypaque technique), and of their subsets CD4, CD8 in 14 asymptomatic HIV+ homosexual men and in nine controls. We also estimated the GcR of the PBMC at 0700 and at 2300 hours, near the peak and nadir of the cortisol rhythm. In the HIV+ subjects, the PBMC circadian rhythm is abolished, an observation that confirms previous reports; in more than half of these patients, the GcR dissociation constant is larger than that of the controls. The circadian rhythms of plasma cortisol and ACTH levels do not differ from those of the controls. These changes may impair the function of the hypothalamic pituitary-adrenal axis in the HIV-infected subject.     

Prevalence, density, and manifestations of oral Candida albicans in patients with Sj?gren''s syndrome

Current studies verify the safety of surgery in the elderly. Delirium is a costly complication, but its incidence and severity can be reduced by pre- and postoperative interventions. Avoidance of even mild hypothermia has now been shown to reduce cardiovascular morbidity. New information available on the cardiovascular response of elderly patients to laparoscopic surgery highlights the importance of avoiding preoperative dehydration. Proper pain management minimizes complications and promotes recovery.     

Bone loss in Great Britain and Japan: a comparative longitudinal study

Benzenediazonium sulfate (BD) was given to Swiss mice by 26 subcutaneous injections of 10 micrograms/g body weight at weekly intervals. The treatment gave rise to tumors of the subcutis. The tumor incidences in the treated groups were 42% in females and 26% in males. The corresponding tumor incidences in the untreated controls were 0% in females and 2% in males. Histopathologically, the neoplasms were classified as fibrosarcomas, rhabdomyosarcomas, and osteosarcomas of the subcutaneous tissue. BD is formed during the cytochrome P-450 catalyzed metabolism of the carcinogenic 1-(phenylazo)-2-hydroxynaphthalene (Sudan I, Solvent Yellow 14), which was used as a coloring agent for food and other materials in several countries. Further, BD is a metabolic breakdown product of different classes of nitrogen-nitrogen bond- containing chemicals. BD is the fourth benzenediazonium salt found to be carcinogenic in this laboratory.     

Fluconazole-resistant recurrent oral candidiasis in human immunodeficiency virus-positive patients: persistence of Candida albicans strains with the same genotype

Thirty human immunodeficiency virus-positive patients carrying Candida albicans in their oropharynx were treated with fluconazole and were monitored for 90 to 570 days. Fluconazole-resistant C. albicans (MIC, > 32 micrograms/ml) appeared only in seven patients and only after 90 days of treatment corresponding to a total dose of more than 10 g. Resistance was not associated with resistance to other azole derivatives. Susceptible and resistant strains from each patient had the same genotype (as defined by electrophoretic karyotype and restriction fragment length polymorphism). Thus, the resistant strains were selected by the antimycotic treatment from the susceptible strain present in each case.     

The prevalence of oral candidiasis in HIV-infected individuals and dental attenders in Edinburgh

This study prospectively assessed the prevalence of oral candidal carriage and oral candidiasis in known HIV-seropositive individuals (n = 121) and other dental attenders in Edinburgh (n = 614). Candida species were isolated from 57.4% of dental attenders and 93.4% of HIV-seropositive subjects. Clinical evidence of oral candidiasis was observed in 6% and 52% of these groups respectively, erythematous forms of candidiasis being the commonest in both groups.     

Nonperinatal nosocomial transmission of Candida albicans in a neonatal intensive care unit: prospective study

BACKGROUND: The adventitial inversion technique obliterates the false lumen and converts a dissected aorta into a conduit with tough adventitia on the inside and outside. Dacron grafts can be anastomosed to the aorta with fine sutures, which hold without tears. METHODS: From August 1995 to March 1997, we treated 6 patients with acute dissecting aneurysms. Three aneurysms were type I (A) involving the entire aorta, two type II (A) involving the ascending aorta, and one type III (B) involving the thoracoabdominal aorta. Circulatory arrest was used in 3 patients, 1 with type I aneurysm (A), 1 type II (A), and 1 type III (B). RESULTS: All Dacron-aorta anastomoses held sutures well and did not bleed intraoperatively or postoperatively. One patient (type II [A]) died of intraoperative low cardiac output. In patients with type I (A) aneurysms, the false lumen was obliterated, but 1 patient required resection of a 6-cm abdominal aortic aneurysm. CONCLUSIONS: The adventitial inversion technique is a safe technique for the treatment of acute dissecting aneurysms, which facilitates operation and solves the problem of intraoperative or postoperative bleeding due to tissue friability.     

Virologic, immunologic, and clinical parameters in the incidence and progression of anal squamous intraepithelial lesions in HIV-positive and HIV-negative homosexual men

Despite the development and widespread implementation of Basic Life Support and Advanced Cardiac Life Support, the percentage of patients who survive in-hospital cardiac arrest has remained stable at approximately 15%. Although survival rates may approach 90% in coronary care units, survival rates plummet outside of these units. The lower survival rates for cardiac arrest that occur outside of the coronary care unit may relate to the time elapsed between the onset of ventricular fibrillation and first defibrillation. The advent of automated external defibrillators has made it possible to decrease the time elapsed before first defibrillation in non-critical care areas of the hospital. First responders need only recognize that the patient is unresponsive, apneic, and pulseless before attaching and activating the automated external defibrillator. Our research shows that, as part of Basic Life Support training, non-critical care nurses can learn to use the device and can retain the knowledge and skill over time. Establishing an in-hospital automated external defibrillator program requires commitment from administration, physicians, and nursing personnel. Critical care practitioners should be aware of this technology and the literature that supports its safety and effectiveness when used by non-critical care first responders. Critical care nurses are in a unique position to effect changes that will decrease the time between the onset of cardiac arrest and first defibrillation.     

Calcium oxalate crystallization in urine of healthy men and women: a comparative study

This study aimed to compare calcium oxalate (CaOx) crystallization in undiluted urine from healthy men and women with the object of clarifying the difference in stone incidence between the two sexes. Twenty-four hour urine specimens were collected from 37 men and 28 women. Urinary pH, and concentrations of Ca, oxalate and urate were measured, and indices of crystallization determined by Coulter Counter particle analysis following induction of CaOx crystallization by addition of oxalate. The amount of oxalate required to induce crystallization was significantly (p < 0.01) higher in females than in males, as was the overall particle volume deposited after 90 minutes incubation (p < 0.006). Scanning electron microscopy revealed larger individual crystals in female urine, and a greater degree of crystal aggregation in male urine, although the average overall size of the precipitated crystal particles did not differ between the two sexes. There were no significant differences between men and women with regard to median pH, or Ca and oxalate concentrations, but the median urate concentrations were slightly, but significantly, higher (p < 0.05) in the women's urines than in the men's. It was concluded that the greater risk of CaOx stones in men is related to an increased propensity to nucleate CaOx crystals per se, rather than to a tendency to form larger crystalline particles.     

Calciphylaxis in patients on hemodialysis: a prevalence study

BACKGROUND: Calciphylaxis is characterized by painful, violaceous, mottled skin lesions (livedo reticularis) that may progress to tissue necrosis, nonhealing ulcers, gangrene, and potentially amputation, sepsis, or death. The prevalence and characteristics of patients who have calciphylaxis need further identification to predict which patients on dialysis may benefit from close monitoring or early surgical intervention. METHODS: All 242 patients undergoing hemodialysis in an outpatient unit were reviewed retrospectively during a 15-month cross-sectional study of the prevalence and characteristics of calciphylaxis. RESULTS: Ten patients (prevalence, 4.1%) had calciphylaxis. Patients with calciphylaxis were significantly younger (49 versus 60 years; p = 0.01), had undergone hemodialysis longer (80 versus 20 months; p < 0.0001), and had higher median serum calcium (9.7 versus 9.2 mg/dl; p = 0.03), phosphate (8.2 versus 5.7 mg/dl; p = 0.001), calcium phosphate product (81.5 versus 52.9; p = 0.0004), parathyroid hormone (1496 versus 138 pg/ml; p < 0.0001), and alkaline phosphatase levels (188 versus 89 IU/L; p = 0.0001). Bone surveys were positive in all 10 patients with calciphylaxis compared with 49 (21%) of the 232 patients without calciphylaxis (p < 0.0001). All patients who underwent parathyroidectomy for calciphylaxis had dramatic healing of the ulcers. CONCLUSIONS: The presence of calciphylaxis is higher among younger patients who had undergone longer periods of hemodialysis. Therefore this group of patients should be monitored aggressively and treated expeditiously for complications of secondary hyperparathyroidism.     

Cloning and disruption of caPLB1, a phospholipase B gene involved in the pathogenicity of Candida albicans

The Candida albicans PLB1 gene was cloned using a polymerase chain reaction-based approach relying on degenerate oligonucleotide primers designed according to the amino acid sequences of two peptide fragments obtained from a purified candidal enzyme displaying phospholipase activity (Mirbod, F., Banno, Y., Ghannoum, M. A., Ibrahim, A. S., Nakashima, S., Yasuo, K., Cole, G. T., and Nozawa, Y. (1995) Biochim. Biophys. Acta 1257, 181-188). Sequence analysis of a 6.7-kilobase pair EcoRI-ClaI genomic clone revealed a single open reading frame of 1818 base pairs that predicts for a pre-protein of 605 residues. Comparison of the putative candidal phospholipase with those of other proteins in data base revealed significant homology to known fungal phospholipase Bs from Saccharomyces cerevisiae (45%), Penicillium notatum (42%), Torulaspora delbrueckii (48%), and Schizosaccharomyces pombe (38%). Thus, we have cloned the gene encoding a C. albicans phospholipase B homolog. This gene, designated caPLB1, was mapped to chromosome 6. Disruption experiments revealed that the caplb1 null mutant is viable and displays no obvious phenotype. However, the virulence of strains deleted for caPLB1, as assessed in a murine model for hematogenously disseminated candidiasis, was significantly attenuated compared with the isogenic wild-type parental strain. Although deletion of caPLB1 did not produce any detectable effects on candidal adherence to human endothelial or epithelial cells, the ability of the caplb1 null mutant to penetrate host cells was dramatically reduced. Thus, phospholipase B may well contribute to the pathogenicity of C. albicans by abetting the fungus in damaging and traversing host cell membranes, processes which likely increase the rapidity of disseminated infection.     

Body mass index course in asymptomatic HIV-infected homosexual men and the predictive value of a decrease of body mass index for progression to AIDS

The King syndrome is characterized by a Noonan-like phenotype, the presence of a nonspecific myopathy and a predisposition to malignant hyperthermia. In some families, mild physical manifestations of the phenotype and/or elevated serum creatine phosphokinase (CPK) in relatives suggest the presence of an autosomal dominant myopathy with variable expressivity. We summarize the cases of 14 previously reported patients and describe a new patient, a 7-year-old girl, with the King syndrome and the unique findings of diaphragmatic eventration, tethered spinal cord, and severe paucity of type 2 skeletal muscle fibers. It has been proposed that the King syndrome represents a common phenotype that may result from several different slowly progressive congenital myopathies. This hypothesis, and the phenotypic overlap between the King and Noonan syndromes are discussed in light of the findings in this new patient.     

Accidents to patients in hospital: a comparative study

A comparative study of 50 reported accident patients (cases) and 50 non-accident patients (controls) was carried out in 10 wards in a large, acute hospital, using primary and secondary data from patients, nurses and records. Folstein's Mini-Mental State test was used to measure the mental status of patients. The mental status of the controls was significantly better than that of the cases. Nurses' responses indicated that significantly more accident patients were incontinent of urine than non-accident patients. There were also indications from patients of three additional unreported accidents. Further study was needed to estimate, more closely, the frequency of unreported patient accidents. This is the second paper in a series of three. The first appeared in Nursing Times on August 17, and the final one will be published on September 28, along with implications for practice and recommendations.     

Posttreatment changes in male and female patients: a comparative study

The purpose of this study was to determine whether the posttreatment changes in patients with Class II, Division 1 malocclusions who were treated with either extraction or nonextraction express similar trends in the male and female patients. The material for this investigation was obtained from the records available in the Graduate Orthodontic Clinic at the University of Iowa. Ninety-one patients were treated for their Class II, Division 1 malocclusions, 44 subjects (21 males and 23 females) had four first premolar extractions and 47 subjects (20 males and 27 females) were treated with nonextraction. Matched normal subjects included 20 male and 15 female subjects for whom complete sets of data were available for the period of this study. None of these subjects had undergone orthodontic therapy. Thirty-nine cephalometric anteroposterior and vertical skeletal, dental, and soft tissue linear and angular measurements were derived. Twenty-four dental arch parameters were evaluated and included: overbite, overjet, maxillary and mandibular arch lengths, and arch widths, as well as tooth size-arch length discrepancies. Student t tests were used to compare male and female subjects for the following parameters: (1) absolute dimensions recorded before treatment, after treatment, and at retention; (2) the incremental changes between the various stages; (3) the relative posttreatment changes. The level of significance was predetermined at p < 0.05. From the current findings the following can be concluded: (1) There were significant differences in the size as well as the incremental changes of the various cephalometric dentofacial parameters between normal male and female subjects. (2) There were significant differences in the absolute posttreatment cephalometric changes between male and female subjects, particularly in linear dimensions. Similar, but less frequent, findings were observed in the relative posttreatment changes. (3) Significant differences in the posttreatment dental arch changes between male and female subjects were the least frequent. (4) Male and female subjects expressed similar statistical trends in the direction of posttreatment changes. Therefore clinicians should not expect to observe significant differences in the posttreatment trends on the basis of the gender of the patient. On the other hand, the changes in linear dimensions are larger in male than female subjects. Therefore, for a more accurate interpretation of growth and/or treatment changes, it is advisable to independently analyze data on male and female subjects.     

Pupil response of hetero- and homosexual males to pictures of men and women: A pilot study.

The pupil response of each individual in a group of heterosexual males was greater when looking at pictures of women than when looking at pictures of men. Homosexual male Ss responded in the opposite direction. Measurement of changes in pupil size permitted clear-cut discrimination between the 2 groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Declining HIV-2 prevalence and incidence among men in a community study from Guinea-Bissau

OBJECTIVE: To assess the present level of HIV-2 infection in an adult population in Bissau and to evaluate sex and age-specific changes in HIV-2 prevalence and incidence between 1987 and 1996. DESIGN AND METHODS: Sex and age-specific changes in HIV-2 prevalence were evaluated comparing a survey from 1987 in a sample of 100 houses with a survey performed in 1996 in an independent sample of 212 houses from the same study area. HIV-2 incidence rates were examined in an adult population (age > or = 15 years) from 100 randomly selected houses followed with four consecutive HIV serosurveys from 1987 to 1996. RESULTS: The HIV-2 prevalence in 1996 was 6.8% (men, 4.7%; women, 8.4%). Compared with the 1987 survey there was a significant decrease in prevalence among men [age-adjusted relative risk (RR), 0.50; 95% confidence interval (CI), 0.31-0.83], whereas it remained unchanged in women (RR, 1.00; 95% CI, 0.67-1.48). The male-to-female RR decreased from 0.99 (95% CI, 0.61-1.61) in 1987 to 0.51 (95% CI, 0.34-0.76) in 1996. The overall annual incidence rate was 0.54 per 100 person-years of observation (PYO), being higher in women (0.72 per 100 PYO) than in men (0.31 per 100 PYO). With the observation time divided into an early and a late period, there was a decrease in incidence with time among men (0.66 to 0.00 per 100 PYO), but no major change among women (0.59 to 0.85 per 100 PYO). The two trends differed significantly (P = 0.03). We observed a higher annual incidence rate amongst older women aged > 44 years (1.77 per 100 PYO) than among younger women (0.55 per 100 PYO; P = 0.05). CONCLUSION: There are no signs of an epidemic spread of HIV-2 in Bissau even though the HIV-1 prevalence is increasing rapidly. A significant reduction in the male HIV-2 prevalence and incidence rates has resulted in a major shift in the pattern of spread of HIV-2, from being equally distributed to being predominantly a female infection. Currently, older women in particular seem to have a high risk of getting infected.     

Unreliability of the infrared tympanic thermometer in clinical practice: a comparative study with oral mercury and oral electronic thermometers

BACKGROUND: This study was designed to determine the magnitude and frequency of measurement errors with infrared tympanic thermometers in the clinical setting. METHODS: In a convenience sample of 137 adult inpatients, we compared body temperatures measured by a Diatek 9000 Infrared Aural Thermometer and an IVAC 2090 CoreCheck Tympanic Thermometer between themselves, in right versus left ears, and against concurrently measured oral temperatures using both an electronic thermoprobe and conventional glass mercury thermometer. RESULTS: There was a significant between-brand difference of 0.6 degrees C (IVAC 相似文献   

The importance of comorbidity in HIV-infected patients over 55: a retrospective case-control study

PURPOSE: To study the impact of comorbidity on the course of HIV disease in older patients as compared to a matched cohort of younger patients. METHODS: In a retrospective case-control study, we compared 43 HIV-infected patients > 55 years old to a randomly selected cohort of 86 patients < 45 years old, matched by date of HIV diagnosis. We collected data on non-HIV-related morbidity (as assessed by the Charlson comorbidity index), initiator of HIV testing, HIV stage at time of HIV diagnosis (TOHD), AIDS defining diagnoses, AIDS-related illnesses (ARI), observed AIDS-free interval, survival, and frequency of HIV-related and unrelated hospitalizations. RESULTS: The older cohort was more likely to have had HIV testing initiated by a health care provider (36 of 36 versus 50 of 66, P = 0.003), and to have acquired HIV from a transfusion (5 of 43 versus 0 of 86, P = 0.001), had lower CD4 cell counts at TOHD (205 versus 429, P = 0.02), a shorter observed AIDS-free interval (24.0 versus 52.8 months, P = 0.0002) and a shorter survival (28.2 versus 58.9 months, P = 0.0002). The older cohort had more HIV-related (13.4 versus 9.2 per 100 patient-months, P = 0.024) and non-HIV-related hospitalizations (12.9 versus 8.1 per 100 patient-months, P = 0.0001). The comorbidity index was significantly higher in the older cohort (0.907 versus 0.198, P = 0.0001) and was a strong predictor of mortality, independent of age group (risk ratio = 1.38 per comorbidity point, P = 0.0003). CONCLUSIONS: Older HIV-infected patients presented with more advanced disease, which may have been due to lack of HIV awareness in this population. Older patients had a shorter observed AIDS-free interval and shorter survival. In addition, they had more HIV- and non-HIV-related comorbidity. The more rapid course and decreased survival in the elderly may be related to the increase in comorbidity.     

Postural balance and its sensory-motor correlates in 75-year-old men and women: a cross-national comparative study

BACKGROUND: There are no earlier cross-national comparative studies analyzing the functions of the posture control mechanisms and its sensory-motor correlates in elderly subjects. We investigated whether there are differences in balance between elderly subjects living in different geographical areas, and analyzed the sensory-motor associates of balance in men and women separately. METHOD: Using a force platform method, the functioning of the posture control system under three standardized conditions (normal standing, eyes open; normal standing, eyes closed; and tandem standing, eyes open) was studied among samples of 75-year-old residents in three Nordic localities, namely Glostrup in Denmark, G?teborg in Sweden, and Jyv?skyl? in Finland. The associations of the variables describing performance in each test with other sensory and motor functions were studied using correlation analyses and multivariate regression models. RESULTS: Differences between the populations were observed in both tests with visual control, favoring the participants from Glostrup and Jyv?skyl? compared with those from G?teborg. However, only minor differences between the subjects from different localities were observed in the test performed with the eyes closed. In all localities there was a primary sex difference in favor of the women which, however, mainly disappeared when body height was taken into the analyses as a covariate. A good performance in the balance tests (body height-adjusted values) was associated with good visual acuity, low vibrotactile thresholds, and high psychomotor speed. Also, isometric muscle strength, especially hand grip and body extension, was positively associated with good performance in the balance tests. Among the women, a poorer balance was observed in women with a smaller body mass. The results of the multivariate analyses showed that among the men, the most important predictors of good performance in the balance tests were low vibrotactile threshold on the foot, high isometric hand grip strength, and low body stature. Among the women, the most important predictors were low body stature, high body mass, high isometric body extension strength, and high psychomotor speed. However, only a small proportion of the variance in balance (about 13% in the men and 11% in the women) could be explained by the help of these factors. CONCLUSIONS: As the same procedure was applied to the analysis of postural balance, some differences between the populations living in different localities could be detected in some of the tests. The better performance of the women in the balance tests may partly be explained by anthropometric factors, especially differences in body height. There may also be differences in sensory-motor associates of balance in elderly men and women. On the basis of the associations observed, it is difficult to explain the differences in balance between the sexes or subjects living in different localities. Within the sexes, only a small proportion (10-13%) of the variation in balance during normal standing with eyes open could be explained by the factors included in the study.