Loss to follow-up and HIV incidence in female sex workers in Kaiyuan, Yunnan Province China: a nine year longitudinal study

Background

Longitudinal studies of female sex workers (FSWs) are vulnerable to loss to follow-up (LTFU) due to this population’s high mobility and low willingness to self-identify as FSWs. LTFU in cohort studies is a critical problem and may lead to bias in estimation of incidence and exposure-outcome associations. The aim of this study was to analyze LTFU and HIV incidence and their associated factors in a 9-year longitudinal study of FSWs in Kaiyuan, Yunnan Province, China.

Methods

This analysis includes all HIV-1 seronegative FSWs who were recruited into a prospective study in Kaiyuan with at least one follow-up visit after enrollment from March 2006 to November 2013. Participants were visited in 6-month intervals after enrollment. Their demographic and behavioral data and blood specimens for HIV and sexual transmitted disease testing were collected at enrollment and at each follow-up visit. The administrative censoring date was December 31, 2014. Participants were considered LTFU if their last visit occurred 1 year or more before the administrative censoring date. Univariate and multivariable Cox regression models with time-independent variables were used to investigate the hazard ratios (HR) and 95 % confidence intervals (CI) of the factors associated with LTFU and HIV acquisition.

Results

Of the 1158 FSWs, 950 were defined as LTFUs (LTFU rate: 29.69, 95 % CI: 27.85–31.62 per 100 person years [PYs]), and 33 experienced HIV seroconversions (cumulative incidence: 1.06, 95 % CI: 0.74–1.47 per 100 PYs). After adjustment, we found that FSWs who used drugs were less likely to be LTFU compared with non-drug users (adjust hazard ratio [AHR]= 0.62, 95 % CI: 0.51–0.76), though FSWs who used drug were associated with a higher risk of HIV acquisition (AHR = 3.06, 95 % CI: 1.49–6.30). Also, FSWs who always used condoms with clients in the previous month were associated with a higher risk of LTFU (AHR = 1.51, 95 % CI: 1.15–1.97), while they were negative associated with new HIV infection (AHR = 0.28, 95 % CI: 0.12–0.61).

Conclusions

A high LTFU rate exists in the Kaiyuan FSW cohort study, and LTFU did not occur at random. Participants retained in the cohort tended to be at higher risk of HIV acquisition, which may result in an overestimate of the incidence of HIV infection from the Kaiyuan FSW cohort.

Beyond homogenization discourse: Reconsidering the cultural consequences of globalized medical education

INTRODUCTION

Global medical education standards, largely designed in the West, have been promoted across national boundaries with limited regard for cultural differences. This review aims to identify discourses on cultural globalization in medical education literature from non-Western countries.

METHODS

To explore the diversity of discourses related to globalization and culture in the field of medical education, the authors conducted a critical review of medical education research from non-Western countries published in Academic Medicine, Medical Education and Medical Teacher from 2006 to 2014. Key discourses about globalization and culture emerged from a preliminary analysis of this body of literature. A secondary analysis identified inductive sub-themes.

RESULTS

Homogenization, polarization and hybridization emerged as key themes in the literature. These findings demonstrate the existence of discourses beyond Western-led homogenization and the co-existence of globalization discourses ranging from homogenization to syncretism to resistance.

CONCLUSIONS

This review calls attention to the existence of manifold discourses about globalization and culture in non-Western medical education contexts. In refocusing global medical education processes to avoid Western cultural imperialism, it will also be necessary to avoid the pitfalls of other globalization discourses. Moving beyond existing discourses, researchers and educators should work towards equitable, context-sensitive and locally-driven approaches to global medical education.

Effects of hospital accreditation on medical students: a national qualitative study in Taiwan

PURPOSE

Hospital accreditation has become a global trend for improving the quality of health care services. In Taiwan, nearly all hospitals are accredited. However, there is a paucity of literature on the effects of hospital accreditation on medical students and the universal applicability of hospital accreditation as developed in the West. The purpose of this study was to investigate the effects of hospital accreditation on medical students in Taiwan.

METHOD

From 2010 to 2012, the authors conducted semistructured interviews with 34 senior, clinical year students at 11 different medical schools in Taiwan. Following a grounded theory approach, the authors transcribed and analyzed the transcripts concurrently with data collection in order to identify emergent themes.

RESULTS

Aside from the intended positive effects of hospital accreditation, this study revealed several unintended impacts on medical students, including decreased clinical learning opportunities, increased trivial workload, and violation of professional integrity. Taiwanese students expressed doubt and frustration concerning the value of hospital accreditation and reflected on the cultural and systemic context in which accreditation takes place. Their commentary addressed the challenges associated with the globalization of hospital accreditation processes.

CONCLUSIONS

This study suggests that, beyond the improvement of patient safety and quality assurance, medical educators must recognize the unintended negative effects of hospital accreditation on medical education and take into account differences in culture and health care systems amid the globalization of medicine.

A tale of two cities: understanding the differences in medical professionalism between two Chinese cultural contexts

PURPOSE

To compare stakeholders' constructs of medical professionalism in two Chinese cultural contexts.

METHOD

Between November and December 2011, the authors adopted the nominal group technique (NGT) to elicit professional competencies valued by 97 medical education stakeholders at Peking Union Medical College (PUMC) in Beijing, China. Participants categorized the professional competencies according to an existing framework developed at National Taiwan University College of Medicine (NTUCM) in Taipei, Taiwan; they also modified and developed new categories for the framework. The authors analyzed NGT transcripts to construct a visual medical professionalism framework for PUMC and compared it with that of NTUCM.

RESULTS

The Chinese stakeholders endorsed seven of the eight competencies identified in the Taiwanese framework: clinical competence, communication, ethics, humanism, excellence, accountability, and altruism. For the eighth competency, integrity, the Chinese participants preferred the term "morality." They also added the competencies of teamwork, self-management, health promotion, and economic considerations. Both frameworks differed from typical Western professionalism frameworks in emphasizing morality and the integration of social and personal roles.

CONCLUSIONS

The resemblance between the Chinese and Taiwanese frameworks in the prominence of morality and integrity suggests the influence of Confucianism. The exclusively Chinese articulations of teamwork, health promotion, and economic considerations appear to derive from social, political, and economic factors unique to Mainland China. This study demonstrates the dynamic influence of cultural values, social history, and health care systems on the construction of medical professionalism frameworks and calls for further research to adapt global frameworks to fit specific local contexts.

Building a professionalism framework for healthcare providers in China: a nominal group technique study

BACKGROUND

Medical professionalism is valued globally. However, Western frameworks of medical professionalism may not resonate with the cultural values of non-Western countries.

AIMS

This study aims to formulate a professionalism framework for healthcare providers at Peking Union Medical College (PUMC) in China.

METHODS

This study was conducted using nominal group technique (NGT) in a convenient sample of 97 participants at PUMC in November and December, 2011. Participants were sorted into 13 occupational groups, each discussing and ranking categories of medical professionalism. The authors compared the results of each group's ranked categories and analyzed meeting transcripts.

RESULTS

A pre-existing framework provided eight categories: clinical competence, communication, ethics, humanism, excellence, accountability, altruism, and integrity. Participants created four categories: teamwork, self-management, health promotion, and economic considerations. Clinical competence and communication ranked highly among most groups. Only hospital volunteers and resident physicians included self-management in their top-ranked items. Only public health experts prioritized health promotion. Standardized patients were unique in mentioning "economic considerations." Medical students and attending physicians both referenced Chinese traditional values.

CONCLUSIONS

Our study was able to document effects of East Asian cultural influences and conflicts between Western ideologies and Asian traditions that led to divergent interpretations of medical professionalism.

Prevalence and risk factors of hepatitis C and B virus infections in hemodialysis patients and their spouses: a multicenter study in Beijing, China

Hemodialysis patients are at risk for hepatitis C and B virus infections. This study investigated the prevalences and risk factors of HCV and HBV infection and the distribution of HCV genotypes among hemodialysis patients and their spouses. From August to November 2011, a cross-sectional study was conducted on 20 hemodialysis units in Beijing to investigate prevalences and risk factors for markers of HCV and HBV among 2,120 patients and 409 spouses. In hemodialysis patients, prevalences of anti-HCV, HCV RNA, and hepatitis B surface antigen (HBsAg) were 6.1%, 4.6%, and 7.0%, respectively. The prevalence of HCV antibodies among spouses was 0.5%, of HCV RNA was 0.2%, and of HBsAg was 4.2%. Risk factors for HCV infection were dialysis duration, blood transfusion, and attending more than one dialysis unit. HBV infection was independently associated with age, family member with hepatitis infection, gender, and surgery. The predominant HCV genotypes were 1b (89.0%) and 2a (7.7%), and genotypes 3a, 3b, and 6a were each 1.1%. A significant decrease in HCV and HBV prevalences in Chinese dialysis units showed that infection control measures were effective. However, because nosocomial transmissions persist, strict adherence to infection control measures should be emphasized to reduce the risk of transmission.

Incidence of hepatitis C virus infection in patients on hemodialysis: a systematic review and meta-analysis

Hepatitis C virus infection is a perennial concern for hemodialysis units because the prevalence of hepatitis C is significantly higher there than in the general population. Through a systematic review and meta-analysis, we aim to assess the incidence rate of hepatitis C virus infection in hemodialysis units and explore its potential risk factors. Five electronic databases were used to search articles from 1990 to 2012, including PubMed, Embase, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and Wanfang. A random-effects analysis was used to estimate the overall incidence rate of hepatitis C virus infection. A subgroup analysis and meta-regression analysis were conducted to explore factors associated with heterogeneity between studies. Twenty-two eligible articles were found, including 23 incidence rate estimates. The overall incidence rate of hepatitis C virus infection was 1.47 per 100 patient-years (95% confidence interval [CI] 1.14 to 1.80). In the subgroup analysis, the pooled incidence rate was 4.44 (CI 2.65, 6.23) per 100 patient-years in the developing world and 0.99 (CI 0.66, 1.29) per 100 patient-years in the developed world. [Correction added on 2 November 2012, after first online publication: Pooled incidence rate in the developed world has been changed.] In addition, in hemodialysis units with higher prevalence, the incidence rate of hepatitis C virus infection also tended to be higher. Meta-regression analysis showed that the country's development level and initial HCV prevalence combined could explain 67.91% of the observed heterogeneity. The incidence rate of hepatitis C virus infection among patients on hemodialysis was significantly high. Efforts should be taken to control hepatitis C virus infection in hemodialysis units, especially in developing countries.

Incidence of hepatitis C virus infection in patients on hemodialysis: a systematic review and meta-analysis

Hepatitis C virus infection is a perennial concern for hemodialysis units because the prevalence of hepatitis C is significantly higher there than in the general population. Through a systematic review and meta-analysis, we aim to assess the incidence rate of hepatitis C virus infection in hemodialysis units and explore its potential risk factors. Five electronic databases were used to search articles from 1990 to 2012, including PubMed, Embase, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and Wanfang. A random-effects analysis was used to estimate the overall incidence rate of hepatitis C virus infection. A subgroup analysis and meta-regression analysis were conducted to explore factors associated with heterogeneity between studies. Twenty-two eligible articles were found, including 23 incidence rate estimates. The overall incidence rate of hepatitis C virus infection was 1.47 per 100 patient-years (95% confidence interval [CI] 1.14 to 1.80). In the subgroup analysis, the pooled incidence rate was 4.44 (CI 2.65, 6.23) per 100 patient-years in the developing world and 0.99 (CI 0.66, 1.29) per 100 patient-years in the developed world. [Correction added on 2 November 2012, after first online publication: Pooled incidence rate in the developed world has been changed.] In addition, in hemodialysis units with higher prevalence, the incidence rate of hepatitis C virus infection also tended to be higher. Meta-regression analysis showed that the country's development level and initial HCV prevalence combined could explain 67.91% of the observed heterogeneity. The incidence rate of hepatitis C virus infection among patients on hemodialysis was significantly high. Efforts should be taken to control hepatitis C virus infection in hemodialysis units, especially in developing countries.

Health-related attitudes and risk factors for sexually transmitted infections of Chinese women who have sex with women

BACKGROUND

Previous studies have shown evidence of health-related risk behaviors among women who have sex with women (WSW), such as sex with men, multiple bisexual partners, and drug use. Women who have sex with women have also been known to avoid routine physical examinations and conceal their same-sex history from physicians, which can affect their ability to receive an accurate diagnosis and treatment. No previous research has targeted women who have sex with women in China. We sought to describe women who have sex with women in China and explore risk factors for their reproductive tract infections (RTI)/sexually transmitted infections (STI).

METHODS

Participants were recruited through outreach in venues and online for a cross-sectional study. Data were collected using interviews and laboratory tests.

RESULTS

We recruited 224 women who have sex with women. In the year preceding their participation in the study, 92% (206/224) of women reported sexual relations with women. The RTI rates were: gonorrhea (15.8%), chlamydia (3.5%), syphilis (0.5%), bacterial vaginosis (14.4%), hepatitis B virus (HBV) (0.9%), hepatitis C virus (HCV) (0.5%), and candidiasis (6.9%). No HIV or herpes simplex virus (HSV) positive cases were detected. Factors associated with gonorrhea infection were non-Beijing local residency (odds ratio (OR) = 2.1, 95% confidence interval (CI): 1.2 - 3.8) and genital-genital contact (OR = 3.1, 95%CI: 1.3 - 7.2); factors associated with curable STI (excluding bacterial vaginosis, candidiasis, HBV and HCV) were non-Beijing local residency (OR = 1.9; 95%CI: 1.2 - 3.0) and bleeding during or after sex (OR = 18.1; 95%CI: 5.2 - 62.6); and the factor associated with RTI (including all the infections tested) was bleeding during or after sex (OR = 37.8, 95%CI: 11.2 - 127.4).

CONCLUSIONS

Behaviors that may cause RTI/STI exist among Chinese women who have sex with women. Researchers should consider these behaviors when planning corresponding prevention and interventions.

Risk behaviors for reproductive tract infection in women who have sex with women in Beijing, China

OBJECTIVES

To assess risk behaviors for reproductive tract infections (RTI) including sexually transmitted infections (STI) among women who have sex with women (WSW) in Beijing, China.

METHODS

A cross-sectional study of women recruited from venues and internet outreach analyzed using interviews.

RESULTS

We recruited 224 WSW, among whom were 37 couples. The average age of participants was 25.6 years. Sex with men in the past year was reported by 10.7% of participants. During the past year, 34.3% (77/224) had had >1 sexual partner and 72.4% (162/224) had ever had >1 sexual partner. Condom use in the last sex with a man was reported by 54.2% (13/24) of women; 12.5% (3/24) reported never having used a condom with a man in the past year. In the past year, 13.4% (30/224) reported using sex toys with their female partners; of these, 43.3% (13/30) reported consistent condom use with the sex toys and 36.7% (11/30) had shared sex toys. Among participants 65.2% (120/184) reported that their "G-spot" had been stimulated during sex, 49.2% (59/120) of whom reported bleeding during or after sex. Only 12.5% (8/64) of those never reporting "G spot" stimulation reported bleeding during or after sex (P<0.001).

CONCLUSIONS

WSW in Beijing engaged in high-risk sexual behaviors that may carry a substantial risk of being infected with STI/RTI. To implement STI/RTI prevention and intervention among women, women-women sexual behavior should be considered when doing research and intervention programs.

HIV prevalence and influencing factors analysis of sentinel surveillance among men who have sex with men in China, 2003 - 2011

BACKGROUND

Men who have sex with men (MSM) have been impacted by HIV and now as an important driver of the HIV/AIDS epidemic in China. This study collected HIV sentinel surveillance system data on the MSM population to describe the characteristics and trends of the HIV epidemic among MSM in China from 2003 to 2011.

METHODS

Data on HIV prevalence and risk behaviors from 2003 to 2011 were obtained from the national HIV sentinel surveillance database.

RESULTS

MSM sentinel surveillance data for 2011 showed that proportions of MSM who consistently used condoms during anal sex in the last six months and at last anal sex encounter were 43.3% and 74.1%, respectively. Between 2005 and 2011 there were no significant changes in the proportion of consistent condom use. The proportion of MSM who had multiple male sex partners in the last six months increased. Overall HIV prevalence over the years showed a rising trend from 0.9% in 2003 to 6.3% in 2011. The syphilis antibody positive rate was 7.8% in 2011. In addition, the proportion of MSM in heterosexual marriages was rising, AIDS awareness was also increasing, and the proportion of MSM who had taken an HIV test in the last year and was aware of the results rose. The proportion who had received intervention services in the last year stabilized.

CONCLUSIONS

HIV prevalence in MSM populations is rapidly and widely distributed. MSM who are in heterosexual marriages may be a bridge group transmitting HIV to their heterosexual partners. The risky sexual behavior among MSM will remain a serious and important driver of China's AIDS epidemic over the next period of time. Intervention need to be strengthened, as does the effective implementation of measures to control AIDS and prevent it from spreading further.

Visual localization ability influences cross-modal bias

The ability of a visual signal to influence the localization of an auditory target (i.e., "cross-modal bias") was examined as a function of the spatial disparity between the two stimuli and their absolute locations in space. Three experimental issues were examined: (a) the effect of a spatially disparate visual stimulus on auditory localization judgments; (b) how the ability to localize visual, auditory, and spatially aligned multisensory (visual-auditory) targets is related to cross-modal bias, and (c) the relationship between the magnitude of cross-modal bias and the perception that the two stimuli are spatially "unified" (i.e., originate from the same location). Whereas variability in localization of auditory targets was large and fairly uniform for all tested locations, variability in localizing visual or spatially aligned multisensory targets was much smaller, and increased with increasing distance from the midline. This trend proved to be strongly correlated with biasing effectiveness, for although visual-auditory bias was unexpectedly large in all conditions tested, it decreased progressively (as localization variability increased) with increasing distance from the midline. Thus, central visual stimuli had a substantially greater biasing effect on auditory target localization than did more peripheral visual stimuli. It was also apparent that cross-modal bias decreased as the degree of visual-auditory disparity increased. Consequently, the greatest visual-auditory biases were obtained with small disparities at central locations. In all cases, the magnitude of these biases covaried with judgments of spatial unity. The results suggest that functional properties of the visual system play the predominant role in determining these visual-auditory interactions and that cross-modal biases can be substantially greater than previously noted.

Oncogenic Ras enhances NF-kappaB transcriptional activity through Raf-dependent and Raf-independent mitogen-activated protein kinase signaling pathways

Tumors frequently contain mutations in ras genes, resulting in constitutive activation of Ras-activated signaling pathways. The ultimate targets of these signal transduction cascades are transcription factors required for cellular proliferation. Understanding how constitutive activation of Ras contributes to tumorigenesis requires an understanding of both the signaling pathways that Ras activates and how these pathways in turn regulate gene expression. Gene expression from kappaB sites is enhanced in cells transformed with activated Ras and NF-kappaB activity is required for oncogenic Ras to transform NIH-3T3 and Rat-1 fibroblasts. Both dominant negative and constitutively active components of signaling pathways have been tested for their ability to regulate NF-kappaB. These experiments show that Ras utilizes Raf-dependent and Raf-independent pathways to activate NF-kappaB transcriptional activity, both of which require the stress-activated kinase p38 or a related kinase. In the case of Raf, activation of NF-kappaB by an autocrine factor stimulates kappaB-dependent transcriptional activity.

Tarsometatarsal subluxation in dogs: partial arthrodesis by plate fixation

In a retrospective study of tarsometatarsal joint subluxation in eight dogs, secondary fractures were identified in six dogs, particularly of the fourth tarsal bone and the proximal fifth metatarsal bone. Common causes of tarsometatarsal joint injury included jumping or falling and direct trauma to the foot. Partial tarsal arthrodesis, with the use of bone-plate stabilization and cancellous bone grafting of joint spaces after removal of articular cartilage, led to progressive bone healing in all dogs. Implant breakage did not occur in any dog.

Oncogenic Ha-Ras-induced signaling activates NF-kappaB transcriptional activity, which is required for cellular transformation

Ras proteins function in stimulating cell proliferation and differentiation through the activation of Raf-dependent and Raf-independent signal transduction pathways and the subsequent activation of specific transcription factors. The transcription factor NF-kappaB has been widely studied as a regulator of genes involved in immune and inflammatory responses. A variety of stimuli activate NF-kappaB through the induced phosphorylation and degradation of the inhibitor IkappaB followed by nuclear translocation of NF-kappaB. We show here that oncogenic forms of Ha-Ras activate NF-kappaB, not through induced nuclear translocation, but rather through the activation of the transcriptional function of the NF-kappaB RelA/p65 subunit. Importantly, RelA/p65 -/- cells are inefficient in the activation of kappaB-dependent gene expression in response to oncogenic Ras expression. Furthermore, IkappaBalpha expression blocks focus formation in NIH3T3 cells induced by oncogenic Ras. These results demonstrate that NF-kappaB is a critical downstream mediator of Ha-Ras signaling and oncogenic potential.

Metacarpal and metatarsal fractures in dogs

Metacarpal fractures were more common than metatarsal fractures in this retrospective study of 37 dogs. Fractures of one metacarpal or metatarsal bone occurred in 24 per cent of the dogs, two metacarpal bones in 16 per cent, three metacarpal or metatarsal bones in 19 per cent, and four metacarpal or metatarsal bones in 41 per cent. Eighty-seven per cent of the dogs with fractures of four bones had fracture displacement or malalignment of at least one digit. Progressive fracture healing usually occurred irrespective of stabilisation method. For malaligned fractures, however, external coaptation did not consistently improve alignment. Fracture alignment was consistently improved by open reduction and internal fixation of acute fractures with bone plates. Fractures of four bones occurred most often in the distal metacarpus as opposed to the proximal metatarsus. Therefore, open reduction and internal fixation may be more commonly indicated for severe metacarpal fractures, because fracture displacement or axial malalignment was significantly associated with fractures of the mid or distal regions of the metacarpus or metatarsus (P = 0.052).

A naturalistic study of the impact of acute physical activity on feeling states and affect in women

This field study used experience sampling procedures to examine the relationship of feeling states and affect to acute bouts of physical activity in women. Participants (N = 86) completed brief affect and feeling state measures (a) in response to random stratified pager tones and (b) before and after acute bouts of vigorous physical activity for 6 weeks. Analysis of averaged difference scores revealed that acute vigorous physical activity was associated with significant improvements in affect and feeling states, particularly in feelings of revitalization. Moreover, within-subject analyses indicated that the effects were moderated by preactivity scores, with the greatest improvements seen when women felt worst before activity.

A naturalistic study of the impact of acute physical activity on feeling states and affect in women

This field study used experience sampling procedures to examine the relationship of feeling states and affect to acute bouts of physical activity in women. Participants (N = 86) completed brief affect and feeling state measures (a) in response to random stratified pager tones and (b) before and after acute bouts of vigorous physical activity for 6 weeks. Analysis of averaged difference scores revealed that acute vigorous physical activity was associated with significant improvements in affect and feeling states, particularly in feelings of revitalization. Moreover, within-subject analyses indicated that the effects were moderated by preactivity scores, with the greatest improvements seen when women felt worst before activity.

Functional interactions between the pelle kinase, Toll receptor, and tube suggest a mechanism for activation of dorsal

A complex signal transduction pathway functions in the early Drosophila embryo to establish dorsal-ventral polarity. Activation of this pathway results in the nuclear transport of the protein dorsal (dl), a member of the rel/NF-kappaB family of transcription factors. Genetic studies have identified three intracellular components whose activity is required for activation of dl: Toll, a transmembrane receptor; pelle (pll), a serine/threonine protein kinase; and tube, a protein of unknown function. Here we examine the activities of these proteins when coexpressed in Drosophila Schneider cells. Coexpression of pll with dl enhanced dl nuclear localization and resulted in a modest increase in transcriptional activity. However, when pll was coexpressed with a specific mutant derivative of Toll (TlNaeI), although not with wild-type Toll, a striking synergistic activation of dl was detected. Unexpectedly, coexpression of pll plus TlNaeI, in the absence of dl, resulted in a similar synergistic activation of a GAL4-tube fusion protein. Based on these and other results, we propose a model in which pll receives a signal from activated Toll and phosphorylates tube, which then participates directly in dl activation.

Effects of baseline responses, in-task feelings, and duration of activity on exercise-induced feeling states in women

This study investigated the hypothesis that the effects of acute aerobic exercise on feeling states may be influenced by the objective dose of activity, subjective responses during exercise, and preexisting levels of feeling states. College-age women (N = 80) completed baseline measures and were then randomly assigned to 1 of 4 conditions: attention control for 10 min, or exercise for 10 min, 25 min, or 40 min. Levels of exertion and affect were assessed during exercise, and posttesting occurred 20 min following activity. Exercise enhanced revitalization in comparison with the control condition; however, this effect occurred only for participants scoring low to moderate on the pretest. In addition, in-task feeling states predicted postexercise revitalization even after we controlled for the treatment, the pretest, and the Pretest x Treatment interaction.

Effects of baseline responses, in-task feelings, and duration of activity on exercise-induced feeling states in women

This study investigated the hypothesis that the effects of acute aerobic exercise on feeling states may be influenced by the objective dose of activity, subjective responses during exercise, and preexisting levels of feeling states. College-age women (N = 80) completed baseline measures and were then randomly assigned to 1 of 4 conditions: attention control for 10 min, or exercise for 10 min, 25 min, or 40 min. Levels of exertion and affect were assessed during exercise, and posttesting occurred 20 min following activity. Exercise enhanced revitalization in comparison with the control condition; however, this effect occurred only for participants scoring low to moderate on the pretest. In addition, in-task feeling states predicted postexercise revitalization even after we controlled for the treatment, the pretest, and the Pretest x Treatment interaction.

Regulation of dorsal in cultured cells by Toll and tube: tube function involves a novel mechanism

We described previously a transient cotransfection assay that allows us to study regulation of the Drosophila Dorsal protein (dl) in cultured cells. For example, we showed that over-expression of the Toll transmembrane receptor was sufficient to cause relocalization of dl from the cytoplasm to the nucleus. Here we present data that the tube protein, shown previously by genetic studies to act downstream of Toll, can function in a novel way to enhance dl activity. In the absence of dl, or when dl is cytoplasmic, tube is also found in the cytoplasm of transfected cells. But when dl is localized to the nucleus, so is tube. tube can then function to enhance reporter gene expression, either by cooperation with dl or as a GAL4-tube fusion protein. tube thus appears capable of acting both as a chaperon or escort for dl as it moves to the nucleus, and then as a transcriptional coactivator. We also show that the intracytoplasmic domain of Toll, and specifically the region sharing homology with the interleukin-1 receptor, is sufficient to induce dl-tube nuclear translocation.

Fire safety in the operating room

The operating room environment is considered a potentially significant fire hazard. The role of the anesthetist in preventing and handling fires is pivotal to patient survival. Means of preventing fires as well as extinguishing them are discussed.

Selective nuclear transport of the Drosophila morphogen dorsal can be established by a signaling pathway involving the transmembrane protein Toll and protein kinase A

Establishment of dorsal-ventral polarity in the early Drosophila embryo requires a concentration gradient of the maternal morphogen dorsal (dl). This concentration gradient is established by selective nuclear transport of dl so that dl protein is present only in ventral nuclei. The activity of 11 genes is required for dl nuclear localization. One of these genes, Toll, encodes a transmembrane protein that appears to play the most direct role in regulating dl localization. We have examined the effects of Toll on dl in cotransfected Schneider cells to gain insight into the nature of the interaction between these proteins. We have found that Toll can enhance the nuclear localization of dl and, independently, the ability of dl to activate transcription once in the nucleus. We present evidence that the signaling pathway from Toll to dl involves protein kinase A (PKA) and that nuclear transport and activation of dl results from phosphorylation of dl by PKA. We discuss the significance of these results with respect both to Drosophila embryogenesis and to the regulation of the mammalian transcription factor NF-kappa B.

Bimanual endoscopic orbital biopsy. An emerging technique

Diagnostic biopsy specimens from six posterior orbital lesions have been obtained under direct endoscopic view with either a fine needle aspiration or an intracannular microbiopsy forcep. This method is comparable to earlier fine needle aspiration techniques, but has the decided advantage of providing a specimen from visually indentified abnormal tissue. In those cases where inadequate specimens are obtained by fine needle aspiration, a microforcep is used to obtain a substantial specimen. The microinvasive endoscopic biopsy technique of the Orbital Unit at Pacific Medical Center is described with an analysis of six cases. The emerging technology of fiberoptic illumination, minified color video cameras, sophisticated imaging, efficient microsurgical instruments and laser delivery methods make the potential for deep orbital endoscopic microinvasive surgery exciting.

Autosomal dominant exudative vitreoretinopathy

Eight family members had familial exudative vitreoretinopathy. They exhibited a variety of clinical stages of the disease process. Some clinical findings included retinal detachment, fibrovascular masses with dragged disc and macula, neovascular fronds and intraretinal deposits. The fundus and angiographic findings were found to be similar to those in cases reported previously. Electroretinograms were normal. Of particular interest in this pedigree was the sole clinical finding of isolated intraretinal deposits in four family members. This characteristic may represent a mild expression of the disease and warrant appropriate genetic counseling. Our study confirms the variable clinical expression of the disease.

Intraocular foreign body removal by endoscopy

Pars plana endoscopy was used to guide removal of a large nonmagnetic intraocular foreign body from an eye with corneal scarring and irregularity of such a degree the view through the operating microscope was not adequate to permit such surgery.

Intraocular endoscopic surgery

We have successfully used a new small endoscope in posterior segment surgery in situations where the operating microscope or binocular indirect ophthalmoscope provided an inadequate view. In this series of 18 procedures, we preformed posterior vitrectomies, removed retained foreign bodies, and reattached persistent retinal detachments. The only major complication was a retinal detachment. Learning to use a monocular system requires practice and preparation with experimental animals.

Comparison of radionuclide and contrast ventriculography for detection and quantitation of regions of myocardial ischemia in dogs

Radionuclide and contrast ventriculography were evaluated for their ability to estimate myocardial ischemia. In 14 closed-chest, sedated dogs, a small and larger region of ischemia were produced by inflating balloon occluders on the left anterior descending coronary artery. The systemic arterial pressure, atrial-paced heart rate, global ejection fraction by radionuclide and contrast ventriculography, regional wall-motion abnormalities (as the percentage of abnormally contracting segments), and regional myocardial blood flow (using the microsphere technique) were measured during an initial control period, two separate ischemic periods, and a final control period. The regional ischemic weights based on myocardial blood flow ranged from 0 to 38.5 g and were grouped as zero, small (range 0 to less than 10 g, mean 3.40 g), and large regions of ischemia (greater than 10 g, mean 24.8 g). Regional wall-motion abnormalities were sensitive qualitative indicators of ischemia. Receiver operating characteristic analysis showed that both ventriculographic methods were highly sensitive, specific, and accurate for detecting regional ischemia. Contrast ventriculography was slightly superior for detecting small regions less than 4 g, but the methods were equal for regions greater than 4 g. The arterial pressure and heart rate were unchanged during ischemia. For small regions of ischemia, the global ejection fraction did not fall using either the contrast or radionuclide technique, but it fell significantly when large regions were produced. There was a quantitative relationship between the percentage of abnormally contracting segments and the grams of myocardial ischemia (for radionuclide ventriculography, r = 0.65, P = 0.003, and for contrast ventriculography, r = 0.75, P less than 0.001), but for many small regions of ischemia, wall-motion changes were greater than anticipated, suggesting hypofunction of the continguous normal tissue. This study demonstrated that both radionuclide and contrast ventriculography were quite sensitive and specific for detecting measured amounts of regional ischemia. The functional changes resulting from ischemia are quantitatively related to the extent of regional ischemia, small areas resulting in regional wall motion abnormalities, and large areas producing both reduced global ejection fraction and wall motion changes.

Endoscopic orbital surgery

Orbital endoscopy is useful in managing various types of orbital problems. A hand-held endoscope can be used for simple procedures. Surgery and prolonged observation require a mounted endoscope. These two techniques provided good results in 15 patients. Endoscopy proved useful in finding and removing orbital foreign bodies. It is potentially useful in the management of orbital tumors, but experience in this area is still limited.

An endoscope for ophthalmology

An endoscope with a 1.7-mm diameter shaft has unique properties of focus, magnification, and large field of view that make it useful for both orbital and intraocular surgery.

An unusual case of congenital hypertrophy of the retinal pigment epithelium

Photographic documentation of enlargement of congenital hypertrophy of the retinal pigment epithelium is shown in a 42-year-old white woman. No other reports of enlargement have been made and previous articles have stated that these lesions do not grow.