Preferred strategies of men and women for managing chlamydial infection

OBJECTIVES

To determine men and women's preferred strategies for managing chlamydial infection: partner notification (patient referral), postal testing kit (PTK) or patient-delivered partner medication (PDPM).

DESIGN

Interviewer-conducted questionnaires (women) and anonymous, self-administered questionnaires (men).

POPULATION

Women infected with chlamydia who were participating in a randomised study assigning partners to patient referral, PTK or PDPM. Men attending genitourinary medicine, family planning and fracture clinics in Edinburgh.

METHODS

Men and women were asked their preferred strategy for testing/treating sexual partners (patient referral, PTK or PDPM) if they or their partner had a positive chlamydia test. Women were also asked the reasons for their choice and whether partners were satisfied with the intervention received.

MAIN OUTCOME MEASURES

Reported preferences of men and women for testing/treating partners.

RESULTS

Response rates were 97 and 81% for the women's questionnaires at study entry and 6 months, respectively, and 81% for the men's questionnaires. Of 174 women responding, 67% preferred PDPM for partners and 57% would prefer PDPM for themselves. The main reasons were that PDPM allows simpler, more convenient and faster treatment. Women reported that 65% of partners were satisfied with whichever intervention they received. Of 293 men responding, 70% would choose patient referral for partners and 53% would prefer patient referral for themselves. Men previously tested for chlamydia were significantly more likely to choose PDPM (n = 22) than those never tested (n = 7); P < 0.001. Only 3% of women and 9% of men preferred PTKs for partners.

CONCLUSION

The results suggest that women prefer PDPM and men, at least hypothetically, prefer patient referral. PTK appears unpopular with both sexes.

Influences of reduced expression of maternal bone morphogenetic protein 2 on mouse embryonic development

Bone morphogenetic protein 2 (BMP2) was originally found by its osteoinductive ability, and recent genetic analyses have revealed that it plays critical roles during early embryogenesis, cardiogenesis, decidualization as well as skeletogenesis. In the course of evaluation of the conditional allele for Bmp2, we found that the presence of a neo cassette, a selection marker needed for gene targeting events in embryonic stem cells, in the 3' untranslated region of exon 3 of Bmp2, reduced the expression levels of Bmp2 both in embryonic and maternal mouse tissues. Some of the embryos that were genotyped as transheterozygous for the floxed allele with the neo cassette over the conventional null allele (fn/-) showed a lethal phenotype including defects in cephalic neural tube closure and ventral abdominal wall closure. The number of embryos exhibiting these abnormalities was increased when, due to different genotypes, expression levels of Bmp2 in maternal tissues were lower. These results suggest that the expression levels of Bmp2 in both embryonic and maternal tissues influence the normal neural tube closure and body wall closure with different thresholds.

The early radiological follow-up of a medial rotational design of total knee arthroplasty

The objective of this study was to investigate the hypothesis that the increased constraint of a medial rotational knee promotes earlier loosening of the prosthesis. All patients with a Freeman-Samuelson 1000 knee arthroplasty (medial pivot design), (group 1), or a Freeman-Samuelson Modular knee arthroplasty, (group 2), with a minimum follow-up of 2 years (mean follow-up 4 years) were identified from our unit's arthroplasty database, and matched as closely as possible for age, length of follow-up and pre-operative diagnosis. Standardised anteroposterior and lateral radiographs were analysed for component migration and radiolucent lines as recommended by the Knee Society. There were 48 knees in each group. There were no failures in group 2. There was one failure requiring revision of the tibial component in group 1. There was no significant difference in overall radiolucent line scores between the two groups (p=0.66, at 5 years). Progressive radiolucent lines were detected in similar numbers of patients in both groups (FS1000 8/48, FSM 7/48, p=0.84). Our early radiological survey suggests that the increased constraint of the medial pivot knee prosthesis does not result in an increased incidence of radiographic loosening.

Influence of 4- and 6-color flow cytometers and acquisition/analysis softwares on the determination of lymphocyte subsets in HIV infection

BACKGROUND AND OBJECTIVES

Lymphocyte immunophenotyping provides valuable information for the diagnosis and monitoring of patients with cellular immunodeficiencies, such as HIV/AIDS. In this study, we have assessed the influence of 4-color and 6-color flow cytometers, and respective analytical softwares on the enumeration of lymphocytes in HIV infected individuals.

METHODS

The expression of various cell surface markers on lymphocytes was measured from the EDTA blood of 66 HIV infected patients on the FACSCalibur (4-color) and FACSCanto (6-color) flow cytometers. Percentage of lymphocytes expressing a particular cell surface marker was analyzed on FACSCalibur using the Cell Quest Pro software (v 5.2), while the analysis on FACSCanto was done using FACSCanto (v 1.0.3) and FACSDiva (v 4.1) softwares respectively.

RESULTS

The data shows significantly higher mean CD3 T-cell counts on FACSCalibur, Cell Quest Pro (1,864 +/- 1,044 cells/microl) as compared to FACSCanto (1,840 +/- 1,040 cells/microl) (P < 0.05). The CD4 T-cell counts were also higher on FACSCalibur, Cell Quest Pro (885 +/- 770 cells/microl), and FACSDiva (892 +/- 773 cells/microl) versus FACSCanto (867 +/- 767 cells/microl) (P < 0.05). FACSCalibur, Cell Quest Pro, and FACSDiva showed similar values except for CD8 T-lymphocytes where FACSDiva had significantly lower values (P < 0.05). The B-cell counts were unaffected when either of the instruments or softwares were used, while the natural killer (NK) cells (CD16 + 56 positive cells) showed similar trend like CD3 and CD4 counts with significant differences in the mean cell counts between FACSCalibur, Cell Quest Pro (240 +/- 165 cells/microl), and FACSDiva (238 +/- 163 cells/microl) versus FACSCanto with higher NK cell counts (260 +/- 176 cells/microl).

CONCLUSIONS

The enumeration of lymphocyte subsets was comparable between FACSCalibur, Cell Quest Pro, and FACSDiva, based analysis and it was significantly different than FACSCanto software based analysis. Our observations suggest that FACSDiva software should be preferred over the FACSCanto software for immunophenotyping on FACSCanto flow cytometer and the laboratories should report the instrument and software used for the specimen analysis while reporting immunophenotyping results.

Willingness of gynaecologists, doctors in family planning, GPs, practice nurses and pharmacists to adopt novel interventions for treating sexual partners of women with chlamydia

OBJECTIVE

To determine willingness of health professionals to adopt new interventions for treating sexual partners of women with chlamydia.

DESIGN

Anonymous, self-administered questionnaires of doctors, practice nurses and community pharmacists regarding novel testing/treatment options for partners of women with chlamydia.

SETTING

Local (Scotland) and national (UK) clinical meetings in reproductive health, and community pharmacy (Lothian).

POPULATION

Doctors (general practice, gynaecology, family planning) and practice nurses who were delegates at selected meetings in reproductive health and community pharmacists attending pharmacy meetings.

METHODS

Doctors and nurses were invited to complete a questionnaire indicating their preferred strategy for testing/treating sexual partners of women with chlamydia if given choice of partner notification, postal testing kit (PTK), patient delivered partner medication (PDPM) with azithromycin or combined PDPM and PTK. Community pharmacists were invited to complete a questionnaire regarding their willingness to introduce chlamydia testing and treatment services.

MAIN OUTCOME MEASURES

Reported preferences of doctors and nurses for partner testing/treatment strategies and willingness of pharmacists to offer new services.

RESULTS

Questionnaires were completed by 211 doctors, 73 practice nurses and 50 pharmacists. The most popular choice of doctors (30%) and nurses (23%) was a combination of PDPM with PTK, with partner notification the least popular (8 and 3%, respectively). One in four doctors had previously used PDPM for treating partners. Most pharmacists were willing to supply free PTKs (98%), offer testing (75%) and treatment services (100%) and give women PDPM for partners (80%).

CONCLUSION

Relevant health professionals, who are increasingly involved in managing chlamydia, are largely in favour of introducing new strategies for treating sexual partners.

Knowledge-Driven Multidimensional Indexing Structure for Biomedical Media Database Retrieval

Today, biomedical media data are being generated at rates unimaginable only years ago. Content-based retrieval of biomedical media from large databases is becoming increasingly important to clinical, research, and educational communities. In this paper, we present the recently developed entropy balanced statistical (EBS) k-d tree and its applications to biomedical media, including a high-resolution computed tomography (HRCT) lung image database and the first real-time protein tertiary structure search engine. Our index utilizes statistical properties inherent in large-scale biomedical media databases for efficient and accurate searches. By applying concepts from pattern recognition and information theory, the EBS k-d tree is built through top-down decision tree induction. Experimentation shows similarity searches against a protein structure database of 53 363 structures consistently execute in less than 8.14 ms for the top 100 most similar structures. Additionally, we have shown improved retrieval precision over adaptive and statistical k-d trees. Retrieval precision of the EBS k-d tree is 81.6% for content-based retrieval of HRCT lung images and 94.9% at 10% recall for protein structure similarity search. The EBS k-d tree has enormous potential for use in biomedical applications embedded with ground-truth knowledge and multidimensional signatures.

Immature CD4+CD8+ thymocytes and mature T cells regulate Nur77 distinctly in response to TCR stimulation

The orphan steroid receptor, Nur77, is thought to be a central participant in events leading to TCR-mediated clonal deletion of immature thymocytes. Interestingly, although both immature and mature murine T cell populations rapidly up-regulate Nur77 after TCR stimulation, immature CD4+CD8+ thymocytes respond by undergoing apoptosis, whereas their mature descendants respond by dividing. To understand these developmental differences in susceptibility to the proapoptotic potential of Nur77, we compared its regulation and compartmentalization and show that mature, but not immature, T cells hyperphosphorylate Nur77 in response to TCR signals. Nur77 resides in the nucleus of immature CD4+CD8+ thymocytes throughout the course of its expression and is not found in either the organellar or cytoplasmic fractions. However, hyperphosphorylation of Nur77 in mature T cells, which is mediated by both the MAPK and PI3K/Akt pathways, shifts its localization from the nucleus to the cytoplasm. The failure of immature CD4+CD8+ thymocytes to hyperphosphorylate Nur77 in response to TCR stimulation may be due in part to decreased Akt activity at this developmental stage.

The shortcomings of computer-aided measurement of migration for the prediction of failure of three forms of acetabular fixation by survival analysis and migration study to ten years

We studied, to ten years, migration by vertical displacement and angular change using a digitizer and standard radiographs and survival of three methods of acetabular fixation in primary hip replacement. Two implants were uncemented metal-backed components, one version of which was hydroxyapatite-coated. Both types had 28 mm polyethylene inserts. The third type was a cemented all-polyethylene cup with a 28 mm internal diameter. All cups articulated with a Freeman neck-retaining stem. The purpose was to see if the early migration data predicted the long-term outcome and could be used to forecast implants that would fail for the purpose of pre-market assessment. No statistical differences were found between the groups in the parameters studied. At the threshold accuracies of our migration measurements (three millimetres and three degrees) at three years, we could not identify components that would subsequently fail. However, migration less than these threshold values and the absence of radiolucent lines were strongly associated with implant survival at ten years. Our system was insufficiently accurate for pre-market surveillance.;

An evaluation of contaminated estuarine sites using sediment quality guidelines and ecological assessment methodologies

Toxic contaminants may enter estuarine ecosystems through a variety of pathways. When sediment contaminant levels become sufficiently high, they may impact resident biota. One approach to predict sediment-associated toxicity in estuarine ecosystems involves the use of sediment quality guidelines (ERMs, ERLs) and site-specific contaminant chemistry while a second approach utilizes site-specific ecological sampling to assess impacts at the population or community level. The goal of this study was to utilize an integrated approach including chemical contaminant analysis, sediment quality guidelines and grass shrimp population monitoring to evaluate the impact of contaminants from industrial sources. Three impacted sites and one reference site were selected for study. Grass shrimp populations were sampled using a push-netting approach. Sediment samples were collected at each site and analyzed for metals, polycyclic aromatic hydrocarbons (PAHs), polychlorinated biphenyls (PCBs) and pesticides. Contaminant levels were then compared to sediment quality guidelines. In general, grass shrimp population densities at the sites decreased as the ERM quotients increased. Grass shrimp densities were significantly reduced at the impacted site that had an ERM exceedance for chromium and the highest Mean ERM quotient. Regression analysis indicated that sediment chromium concentrations were negatively correlated with grass shrimp density. Grass shrimp size was reduced at two sites with intermediate levels of contamination. These findings support the use of both sediment quality guidelines and site-specific population monitoring to evaluate the impacts of sediment-associated contaminants in estuarine systems.

Nephrogenic systemic fibrosis among liver transplant recipients: a single institution experience and topic update

Nephrogenic systemic fibrosis (NSF) is a recently characterized systemic fibrosing disorder developing in the setting of renal insufficiency. NSF's rapidly progressive nature resulting in disability within weeks of onset makes early diagnosis important. Two reports of NSF after liver transplantation are known of. We present three cases of NSF developing within a few months after liver transplantation and review the current literature. Loss of regulatory control of the circulating fibrocyte, its aberrant recruitment, in a milieu of renal failure and a recent vascular procedure appear important in its development. Known current therapies lack consistent efficacy. Only an improvement in renal function has the greatest likelihood of NSF's resolution. Delayed recognition may pose a significant barrier to functional recovery in the ubiquitously deconditioned liver transplant patient. Early recognition and implementation of aggressive physical therapy appear to have the greatest impact on halting its progression.

The effect of a neck-retaining femoral implant on leg-length inequality following total hip arthroplasty

The aim of this study was to assess whether a femoral component which retained the neck reduced the incidence of leg-length inequality following total hip arthroplasty. A retrospective review was undertaken of 130 consecutive primary total hip arthroplasties performed between April 1996 and April 2004 using such an implant. There were 102 suitable patients for the study. Standardised pre- and post-operative pelvic radiographs were measured by an independent investigator to the nearest millimetre.

The leg-length inequality was reduced from a mean pre-operative value of −0.71 cm to a mean of 0.11 cm post-operatively. Of the 102 patients 24 (23.5%) had an equal leg-length post-operatively, and 95 (93.1%) had a leg-length inequality between −1 cm and 1 cm.

A rapid method for identifying high-risk patients consenting for HIV testing: introducing The Edinburgh Risk Assessment Table for HIV testing

Lack of time for conducting standard HIV pre-test counselling has been reported as a barrier to HIV testing. Use of a risk assessment table will identify high-risk patients to whom pre-test counselling may be limited. The aim of this study is to investigate the performance of a Risk Assessment Table for HIV testing designed in the Department of Genitourinary (GU) Medicine, Edinburgh. A prospective study was carried out on patients attending the Department of GU Medicine, Edinburgh between June 30th 2002 and July 1st 2003, who consented to HIV testing. Patients with any risk factor had standard pre-and post-test counselling. Those without any risk factor were tested and provided with leaflets on HIV testing.A total of 3337 patients were tested in the study period and 727 (22%) had risk factor for HIV infection. Twenty-nine patients (0.9%) were HIV-infected. The Risk Assessment Table failed to identify two infected patients. Routine use of the Risk Assessment Table saves time of the medical staff by only providing pre-test counselling to high-risk patients.

Impact of annual legume 'break' crops on the yield and quality of canola in comparison with the impact on yield of wheat

This study investigated the yield, oil and protein content of canola in response to alternative single-season legume crops, and compared the yield response with that of wheat. Two field trials were conducted in consecutive years at Wagga Wagga on the South West Slopes of New South Wales. The soil type was Red Kandasol. The legume treatments were field pea and vetch managed for silage production, vetch managed for green manure, a mixture of aerial seeding clovers (Berseem, Arrowleaf, Persian: 6 : 3 : 3) managed for silage, hay or green manure, and field pea and narrow-leaf lupin managed for grain. There was one wheat treatment managed for grain. In terms of growing season rainfall, the rainfall-use efficiency of canola was low and similar to that achieved on farms (5.1 kg/ha.mm rainfall). Yields of canola were less than potential water-limited yields and the canola equivalent wheat yields were less than comparative wheat yields. The constraint(s) on canola yield meant that nitrogen-limited yield potential was not reached, and in contrast to wheat in adjacent plots, there was no relationship between canola seed yield and soil mineral nitrogen available during seedling establishment of canola. However, relative to other legume treatments, antecedent crops of the clover mix depressed yield and total oil content, particularly in one year. It was concluded that under field conditions that constrained canola productivity to that similar to on-farm productivity, wheat may make more efficient use of legume nitrogen than canola. Were canola to be used as the response crop, antecedent legumes of vetch or pea, rather than aerial seeding clover, would give higher potential yield and total oil content of the canola.

Failure of a "screw-in" acetabular component: ten-year results, survivorship analysis, and the prediction of failure

The Rotalok screw-in threaded acetabular component was prospectively reviewed with 10-year clinical and radiological follow-up for 60 patients. Nine patients died and 5 were lost to follow-up. Clinically, 28 patients were pain-free, 13 had mild pain, and 3 had moderate pain. Thirteen patients underwent revision for loosening and 3 required revision but were unfit. Superior migration, angular migration, and zone lucency were measured radiologically. Cumulative survival was 70.75% with revision surgery as the end point and 60% with combined clinical failure and revision as the end point. Angular migration of 3 degrees or more was a significant predictor of clinical failure and revision (P < .0001), with 5 degrees being very highly predictive with a sensitivity of 0.72 and a specificity of 1.00. Revision was associated with younger patients (P = .03) and autograft use without screw stabilization (P = .024). The high failure rate of the Rotalok necessitates careful clinical and radiological follow-up, with asymptomatic radiological angular migration often the first predictor of failure.

Quality assessment of South African herbal medicines by means of HPLC fingerprinting

An estimated 70% of South Africans regularly use traditional plant medicines. Incorporation of these medicines within the formal health care system, which is the stated intention of the Health Ministry, requires the establishment of standards for quality control. Except in the case of a handful of South African plant species, such standards are lacking. Of central importance with respect to quality control is correct identification of the species concerned, whether in the fresh, dried or powdered state. In cases where botanical identification is impossible, high performance liquid chromatography (HPLC) with diode array detection (DAD), offers an alternative qualitative profile and is being increasingly used for the authentication of crude drugs or their extracts. As a contribution to establishing quality standards for South African plant species used as traditional medicines, HPLC-DAD "fingerprints" of 60 commonly-used species have been generated in our laboratory. One of these species is presented here, together with UV spectra of individual components represented by major peaks in the HPLC profiles.

The significance of surface changes on retrieved femoral components after total knee replacement

We investigated the changes in surface roughness of retrieved femoral components in 18 men and four women at revision knee surgery. The mean age at revision was 68.4 years and the mean period of implantation was for 55.6 months. Eighteen implants were retrieved for aseptic loosening and four for infection. The surface changes in the articulating areas were inspected visually and the roughness (Ra) analysed with a profilometer. Parallel scratching and burnishing were the two main forms of damage. The mean Ra measurements in the articulating areas showed no statistically significant difference when compared with those in a control area on either side of the patellar groove at the apex of the femoral flange. This suggests that it is not essential to revise a well-fixed and correctly aligned femoral component where the polished surface has become burnished or bears fine parallel scratches, if the revision is conducted solely for failure of the tibial component.

The use of tranexamic acid to reduce blood loss during total hip arthroplasty: an observational study

INTRODUCTION

To test the hypothesis that the fall in haemoglobin following total hip arthroplasty is reduced by tranexamic acid administration.

PATIENTS AND METHODS

A cohort of 64 patients were studied, 32 received tranexamic acid 20 mg/kg on induction. Surgery was performed by the senior author in a standardised fashion. Haemoglobin levels were measured 2 weeks pre- and 3 days postoperatively. Any complications were noted. The study group was matched using the bone and joint research database for age, sex, procedure, disease and pre-operative haemoglobin level.

RESULTS

In the group receiving no tranexamic acid, the mean fall in haemoglobin was 3.8 g/dl (CI of mean 3.4-4.3) and in the group treated with tranexamic acid 2.8 g/dl (CI of mean 2.5-3.2) P < 0.05. Complications included one non-fatal pulmonary embolus in the tranexamic acid group.

CONCLUSIONS

The administration of 20 mg/kg of tranexamic acid on induction of surgery is an effective method of reducing the haemoglobin fall following hip arthroplasty.

Isolation and Characterization of the ALP1 Protease from Aspergillus fumigatus and Its Protein Inhibitor from Physarium polycephalum

It is known that Aspergillus fumigatus secretes a serine protease ALP1 of the subtilisin family in the presence of extracellular protein substrates. We found conditions of A. fumigatus culturing that provide a high ALP1 activity inside cells without induction by extracellular proteins. The identity of the properties of the secreted and intracellular enzymes was shown. A thermostable protein inhibitor of the ALP1 protease was isolated from the plasmodium of the myxomycete Physarum polycephalum. Its molecular mass is 32-33 kDa. The inhibitor inhibits the ALP1 protease activity with IC50 of 0.14 microM. This protein was also shown to be a less efficient inhibitor of the activity of HIV-1 protease (IC50 2.5 microM). The English version of the paper: Russian Journal of Bioorganic Chemistry, 2005, vol. 31, no. 3; see also http://www.maik.ru.

Hip resurfacing following previous proximal femoral osteotomy

Until recently, the options for patients with a degenerative hip and a previous femoral osteotomy included arthrodesis, total hip arthroplasty with osteotomy or CADCAM total hip arthroplasty. Technological improvements have allowed the reintroduction of hip resurfacing. We report the results of hip resurfacing in four patients with previous valgus or extension proximal femoral osteotomies. Patients were assessed for pre and post-operative pain, walking distance and range of movement. All patients had an abnormal angulation, of the femoral neck, of 30 degrees or more in either coronal or sagittal plane. They are within the severe group of disordered proximal femoral anatomy according to Harris et al. The mean age at operation was 32 years (range 30 - 34). The mean follow-up was 3 years (range 1 - 8). Postoperatively no patient required analgesia and all patients had a minimum uninterrupted walking ability of 30 or more minutes with the exception of the patient who had undergone previous leg lengthening. We recommend this comparatively straightforward operation compared to current alternatives. (Hip International 2005; 15: 119-22).