Cigarette smoking, bacterial pneumonia, and other clinical outcomes in HIV-1 infection. Terry Beirn Community Programs for Clinical Research on AIDS

Cigarette smoking has been associated with impaired immune defenses and an increased risk of certain infectious and neoplastic diseases in HIV-1 seronegative populations. We examined the relationship between cigarette smoking and clinical outcome in a prospective cohort of 3221 HIV-1-seropositive men and women enrolled in the Terry Beirn Community Programs for Clinical Research on AIDS. Differences in clinical outcomes between never, former, and current cigarette smokers were assessed using proportional hazards regression analysis. After adjustment for CD4+ cell count, prior disease progression, use of antiretroviral therapy, and other covariates, there was no difference between current smokers and never smokers in the overall risk of opportunistic diseases [relative hazard (RH) = 1.05; 95% confidence interval (CI) 0.90-1.23; p = 0.52] or death (RH = 1.00; 95% CI 0.86-1.18; p = 0.97). However, current smokers were more likely than never smokers to develop bacterial pneumonia (RH = 1.57; 95% CI 1.14-2.15; p = 0.006), oral candidiasis (RH = 1.37; 95% CI 1.16-1.62; p = 0.0002), and AIDS dementia complex (RH = 1.80; 95% CI 1.11-2.90; p = 0.02). In addition, current smokers were less likely to develop Kaposi's sarcoma (RH = 0.58; 95% CI 0.39-0.88; p = 0.01) and several other non-respiratory tract diseases. If confirmed by other studies, these findings have important clinical implications.     

decapentaplegic is required for arrest in G1 phase during Drosophila eye development

During eye development in Drosophila, cell cycle progression is coordinated with differentiation. Prior to differentiation, cells arrest in G1 phase anterior to and within the morphogenetic furrow. We show that Decapentaplegic (Dpp), a TGF-&bgr; family member, is required to establish this G1 arrest, since Dpp-unresponsive cells located in the anterior half of the morphogenetic furrow show ectopic S phases and ectopic expression of the cell cycle regulators Cyclins A, E and B. Conversely, ubiquitous over-expression of Dpp in the eye imaginal disc transiently inhibits S phase without affecting Cyclin E or Cyclin A abundance. This Dpp-mediated inhibition of S phase occurs independently of the Cyclin A inhibitor Roughex and of the expression of Dacapo, a Cyclin E-Cdk2 inhibitor. Furthermore, Dpp-signaling genes interact genetically with a hypomorphic cyclin E allele. Taken together our results suggest that Dpp acts to induce G1 arrest in the anterior part of the morphogenetic furrow by a novel inhibitory mechanism. In addition, our results provide evidence for a Dpp-independent mechanism that acts in the posterior part of the morphogenetic furrow to maintain G1 arrest.     

Vulval lichen planus

The importance of easily available, high quality, and current biomedical literature within the clinical enterprise is now widely documented and accepted. Access to this information has been shown to have a direct bearing on diagnosis, choices of tests, choices of drugs, and length of hospital stay. However, many health professionals do not have adequate access to current health information, particularly those practicing in rural, isolated, or underserved hospitals. Thanks to a three-year telemedicine award from the National Library of Medicine, The University of Iowa (UI) has developed a high-speed, point-to-point telecommunications network to deliver clinical and educational applications to ten community-based Iowa hospitals. One of the services offered over the network allows health professionals from the site hospitals to access online health databases and order articles via an online document delivery service. Installation, training, and troubleshooting support are provided to the remote sites by UI project staff. To date, 1,339 health professionals from the ten networked hospitals have registered to use the Healthnet program. Despite the friendly interface on the computer workstations installed at the sites, training emerged as the key issue in maximizing health professional utilization of these programs.     

Comparative analysis of p53 mutations in bladder washings and histologic specimens

PURPOSE: To analyze and compare the light energy distribution generated by multifocal intraocular lenses (IOLs). SETTING: Laser Laboratory of the Department of Electronics, Electrotechnics and Informatics, University of Trieste, Italy. METHODS: An optic system to examine the division of a laser beam in the various focal spots of multifocal IOLs was developed. The model consists of a helium-neon laser and an optical system: a triangular optical bench with a precision collimator, a micropositionable immersion stage supporting the IOL to be measured, and a digital image-processing system. Four bifocal and three multifocal IOLs were studied. This system is able to expand the distance between foci, leading to a sharper separation of the focal spots. The resolution of the images makes it possible to analyze the distribution of total light energy among the foci. RESULTS: Results showed the variation in light intensity of the focal spots of multifocal and bifocal IOLs, as well as their disposition in the dioptric range. CONCLUSION: Light distribution among various focal distances corresponded to the foci provided by monofocal, bifocal, and multifocal IOLs. The percentage of light energy distribution was related to the importance of each focus.     

Non-contact high resolution microwave scanning measurement technology

For non-contact inspection of microwave integrated and hybrid circuits a technical concept and realisation of a high resolution scanning technique for the detection of the electric field distribution has been developed. The near-field signal is measured in magnitude and phase allowing the calculation of the signal flow in the device under test.     

Strain relatedness in persistent and recurrent candiduria

PURPOSE: We assessed the value of determining strain relatedness in differentiating persistent from recurrent candiduria. MATERIALS AND METHODS: Prospective monitoring of patients with candiduria (10(4) or greater colony forming units per ml.) during a 5-month period. All patients with persistent or recurrent infection after documented clearance were selected. Pair isolates were typed using restriction endonuclease analysis of genomic deoxyribonucleic acid with SfiI. Isolates were considered related if all deoxyribonucleic acid bands matched. RESULTS: We encountered 22 and 5 patients with persistent and recurrent infection, respectively. The isolates were recovered 1 to 140 days apart (21.56 +/- 28.97). Most patients were women (85.2%) with a mean age of 66.41 +/- 18.11 years. Risk factors included antibiotics (100%), indwelling catheter (88.9%) and diabetes mellitus (40.7%). Of 15 individuals who received antifungal therapy candiduria persisted in 10 and resolved but recurred within 4 to 26 days (13.00 +/- 9.08) after treatment in 5. Candida albicans accounted for 34 of 58 isolates (58.6%), and it was mixed with other species in 4 cultures. Paired strains were genetically identical in 26 of 27 patients. Strain persistence was documented in 21 of 22 cases with persistent infection and in all 5 patients with recurrent disease. CONCLUSIONS: These findings show that strain persistence is exceedingly frequent in candiduria. These results imply that determining strain relatedness of Candida urinary isolates may not be reliable in differentiating persistent from recurrent infection.     

Atypical depression. A valid clinical entity?

The history of atypical depression is summarized, and the results of several treatment outcome studies are reviewed. A number of clinical course, family, and biologic variables in patients with atypical depression are investigated, and these patients are compared with patients with other depressive conditions. The Atypical Depression Diagnostic Scale Question Book also is presented.     

Management of threats of violence under California's duty-to-protect statute

OBJECTIVE: This is the first study to assess clinical practices under one of the new duty-to-protect statutes, some version of which has been passed in many states. In 1985, California enacted a statute enabling psychotherapists to limit their liability when a patient makes a serious threat of violence by 1) making reasonable efforts to warn the victim of the threat and 2) notifying local police. METHOD: The authors examined all duty-to-protect notifications over a 5-year period in San Francisco by reviewing police and court records. RESULTS: Police received only 337 notifications, typically made by nondoctoral staff members at public facilities such as psychiatric hospitals and crisis clinics. Patients most commonly directed their threats toward family members. Of the patients who made threats resulting in notifications, 51% had prior arrest records, and 14% had subsequent arrests. Only 52% of the patients who made threats were civilly committed. CONCLUSIONS: The findings suggest that 1) clinicians rarely discharge the duty to protect in the manner specified by the law, 2) many patients whose threats result in notifications have extensive involvement with the criminal justice system, and 3) family intervention may have clinical relevance in many duty-to-protect situations.