Caregiver self-efficacy to talk about sex predicts conversations about HIV transmission risk with perinatally infected young people in Zimbabwe

Given advances in care and treatment for HIV, perinatally infected young people are surviving into adolescence. These young people are making decisions about engaging in sexual relationships and it is critical to ensure they have the information they need to engage responsibly in sexual activity, particularly in an era where adherence to treatment could make their virus undetectable. The main objective of this analysis was to examine whether an HIV-positive young person's knowledge about forward transmission is associated with caregiver self-efficacy to talk about sex and general caregiver communication. Using data from a 12-month prospective cohort of caregivers of HIV-positive children aged 9-15 on ART and pre-ART in rural Zimbabwe, we found that caregiver self-efficacy to talk about sex predicted whether conversations about HIV transmission would occur between caregiver and the young person. However, by the end of 12-months, nearly two-thirds of caregivers of HIV-positive teenagers in our sample had still not explained how their adolescents could spread the virus to others despite these caregivers saying their adolescent should know this information at baseline. We discuss the implications for designing sexual and reproductive health (SRH) programs among populations of young people perinatally infected with HIV to ensure that this breakthrough generation receives the SRH support they need.

[Implantation of a Salto 2 total ankle prosthesis]

AIM OF SURGERY

Operative treatment of advanced primary and secondary arthritis of the ankle was carried out with the aim of achieving pain-free movement and retention of mobility.

INDICATIONS

Surgery is indicated when conservative therapy is no longer sufficient for treatment of arthritis of the ankle with painful limited movement, sufficient bony joint conditions and correctable instability or axis malpositioning.

CONTRAINDICATIONS

Surgery is not recommended with general surgical or anesthesiological contraindications, rampant infections, severe disturbances of peripheral perfusion, bony defects in areas relevant for anchoring, unstable soft tissue conditions, talus necrosis >30 %, manifest osteoporosis and severe non-correctable instability or malpositioning.

OPERATION TECHNIQUE

Tibial and talar bone resection was carried out via ventral access to the ankle through an incision and if present, soft tissue correction of instability after insertion of test components. Cement-free implantation of the original implants followed by subtle reconstruction of the extensor retinaculum and layer for layer closure of the wound.

ADDITIONAL INTERVENTIONS

Additional measures were necessary on the periarticular soft tissues, the hindfoot and lower leg due to movement restrictions, instability and axis malpositioning which could be carried out in a one or two stage procedure depending on the extent and morphology.

RESULTS

Between February 2009 and February 2010 a total of 115 patients (52 % with posttraumatic arthritis) received a cement-free implantation with a Salto 2 prosthesis. Additional corrective interventions were carried out in the presence of varus and valgus deformities. The degree of movement for dorsal extension and plantar flexion could be increased by an average of 8.3°. The interventions resulted in a significant reduction in pain from an average preoperative visual analogue pain scale (VAS) score of 7.8 (range 5-10) to an average postoperative score of 1.9 (range 0-6.1).

Effects of massage under hypoxic conditions on exercise-induced muscle damage and physical strain indices in professional soccer players

Reports based on experiences from masseurs and players, mostly without any scientific background, suggest that the combination of a classical regeneration method (i.e. massage) with exposure to hypoxia may enhance regeneration in soccer. The aim of this study was to evaluate whether this specific combination could affect blood parameters related to muscle damage and physical strain after a soccer game. Approximately 15 hours after two separate championship games, 10 professional male outfield players of the first Austrian division were exposed to normobaric hypoxia (FiO2 13.5% ∼ 4000m) or normoxia for 1 hour (30 minutes rest followed by 30 min massage) (cross-over design). Creatine kinase (CK), urea and uric acid (UA) were measured 4 days before the first game, and 15 and 63 hours after the two games. Match play increased CK values independently of the intervention. No effect of the massage in combination with hypoxia was seen. A trend was found between Δ UA ([UA] 48 hours after exposure minus [UA] before exposure) in response to hypoxia and SaO2 measured in hypoxia (r=0.612, p=0.06). Results show that massage under hypoxic conditions had no additional positive effect on the measured parameters compared to massage alone. Solely the trend of a relationship for Δ UA and SaO2 might indicate that redox alterations are a potential consequence of hypoxic exposure.

Abstract P6-08-02: Do personal, familial or counseling factors influence the choice for prophylactic mastectomy and/or bilateral salpingo-oöphorectomy of female BRCA mutation carriers?

Background: A germline mutation in the BRCA1 or BRCA2 gene predisposes for breast- and ovarian cancer. Female carriers of a BRCA-mutation ≥ 25 years of age, need to choose between surveillance and prophylactic surgery for their breasts and ovaries. Until now it remains unclear which factors contribute to these choices.

Aim: The aim of our study was to investigate whether psychosocial or care provider-related factors influence the choice for prophylactic surgery in BRCA mutation carriers.

Design: The cohort consisted of 635 women (mean age 46 (18–90) years), all living in the South East of The Netherlands and counseled between 1994 and April 2012. 323 women were carrier of a BRCA1 and 312 of a BRCA2 mutation. 239 had breast cancer, 38 ovarian cancer, 28 had breast and ovarian cancer and 330 women had no cancer history.

Univariable and multivariable logistic regression analyses were performed with either breast surveillance vs. mastectomy or ovarian surveillance vs. bilateral salpingo-oöphorectomy (BSO) as outcome. The following factors were investigated: – Personal: age at time of BRCA test and cancer history,– Familial: presence of first degree relative with breast and/or ovarian cancer, age of the relative and the BRCA carrier at time of cancer diagnosis in this relative, whether the BRCA carrier had children and if so age of the children(< 18 or ≥ 18),– Counseling: professional responsible of counseling (clinical geneticist vs genetic counselor), Psychsocial support (if needed) (genetic counselor vs psychologist) and whether the follow up was in specialized multidisciplinary teams or a peripheral hospital.

Results: Prophylactic mastectomy was chosen by 132 of the women, breast surveillance by 352 women. BSO was chosen by 268 women, most of them above 40 years of age; ovarian surveillance by 161 women. Ovarian surveillance was the choice of women younger than 40, women with a breast cancer history and older women.

Univariable analyses revealed that women more often chose for mastectomy when they had a younger age (OR 0.94 CI 0.919–0.964), breast cancer (OR 4.827 CI 2.843–8.198), children (OR: 1.889 CI 1.085–3.289), especially children under the age of 18 (OR 1.778 CI 1.103–2.866), a first degree relative with cancer (OR 0.41 CI 0.231–0.728) or consulted a psychologist (OR 5.299 CI 1.425–19.703).

The choice for mastectomy was not influenced by the counselor or the place where the follow-up was given.

Multivariable analysis showed that if all factors were considered together, 3 factors remained significant for choosing mastectomy: age, personal cancer history and first degree relative with cancer factors.

No factors were found that influence the choice for preventive measures for ovarian cancer. This was expected because since 2002 all women BRCA carriers where advised to chose BSO above 40 years of age.

Conclusion: Personal and familial factors play important roles in the choice for prevention of breast- and ovarian cancer in female BRCA mutation carriers. In our study counseling factors, such as type of counselor or place of follow-up did not influence the choice for prophylactic mastectomy.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-08-02.

Surfactant protein D and KL-6 serum levels in systemic sclerosis: correlation with lung and systemic involvement

OBJECTIVE

The aim of this study was to investigate the relationship between SP-D and KL-6 serum concentrations and the extent of interstitial lung involvement, as measured by a quantitative HRCT score and the functional impairment, in patients with systemic sclerosis (SSc). Moreover we analysed the association between these lung-specific biomarkers and skin involvement, anti-Scl-70 antibody titres and an index of disease activity.

METHODS

Serum SP-D, KL-6 and anti-Scl-70 concentrations were determined by ELISA in 25 SSc patients. Disease activity and lung function parameters were assessed, and the extent of ILD was measured by a HRCT score.

RESULTS

SP-D and KL-6 concentrations were higher in patients with SSc and lung fibrosis than in healthy controls. KL-6 correlated positively with the HRCT-fibrosis score (r=0.68, p<0.001), SP-D showed a weaker correlation (r=0.44, p=0.025). Increased KL-6 concentrations were associated with decreased DLCO and decreased FVC in SSc patients, SP-D showed no association. Furthermore KL-6, but not SP-D, showed a strong association with skin involvement as expressed by the modified Rodnan skin score (r=0.71, p<0.0001) and a disease activity index (r=0.73, p<0.0001).

CONCLUSION

KL-6 is more strongly associated than SP-D with the HRCT-fibrosis score, and, different from SP-D, it correlates with skin involvement and disease activity. We suggest that KL-6 may be a useful biomarker in the assessment of scleroderma patients.

Nonlinear optical response in single alkaline niobate nanowires

We have synthesized and characterized three types of perovskite alkaline niobate nanowires: NaNbO(3), KNbO(3), and LiNbO(3) (XNbO(3)). All three types of nanowires exhibit strong nonlinear response. Confocal imaging has been employed to quantitatively compare the efficiency of synthesized nanowires to generate second harmonic signal and to show that LiNbO(3) nanowires exhibit the strongest nonlinear response. We also investigated the polarization response of the second harmonic generation (SHG) signal in all three types of alkaline nanowires for the two geometries tractable by our optical trapping setup. The SHG signal is highly influenced by the nanowire crystallinity and experimental geometry. We also demonstrate for the first time wave-guiding of SHG signal in all three types of alkaline niobate nanowires. By carefully examining nonlinear properties of (XNbO(3)) nanowires we suggest which type of wires are best suited for the given application.

Changes in hydration status of soccer players competing in the 2008 European Championship

AIM

Body composition is highly modifiable through exercise and may be changed by the physical stress of soccer training and competition. Especially body water as a constituent of body composition is assumed to be subjected to changes. It is speculated that during the most important soccer championship the combination of heat and the strenuous competitive program could lead to the development of a chronic state of hypohydration. However, no one tested this hypothesis. Therefore, the purpose of present work was to investigate the impact of the European Soccer Championship 2008 on players' body composition.

METHODS

Participants were 14 players of one team, split into Starters (N.=7) and Non-Starters (N.=7). Starters participated in the games, while Non-Starters served as substitutes, with marginal playing times. Body composition was examined by bioelectrical impedance analysis before the championship and 36 hours after the first and second game.

RESULTS

After the first game, Starters and Non-Starters showed decreased extra-cellular mass (-3.3% and -5.5%) and body cell mass (-4.1% and -6.1%) compared to prechampionship measurements. The impedance vector graph showed a significant lengthening in both groups (Starters T²=30.5, P=0.000; Non Starters T²=39.0, P=0.000). After the second game, extra-cellular mass (-3.4%) and body weight (-1.1%) decreased in Starters only. ANOVA revealed a significant difference in extra-cellular mass between Starters and Non-Starters (P=0.027). The impedance vector graph was lengthened in the Starters only (T²=17.5, P=0.000). The distance covered during the games was correlated to the percent drop in extra-cellular mass between the end of games 1 and 2 (r=-0.602; P=0.023).

CONCLUSION

Players competing in the European championship games experienced a decrease in extra-cellular mass and body weight. The impedance vector graph showed a lengthening, indicating fluid loss. Therefore, proper hydration of players requires diligent attention.

Effects of intermittent hypoxia on running economy

We investigated the effects of two 5-wk periods of intermittent hypoxia on running economy (RE). 11 male and female middle-distance runners were randomly assigned to the intermittent hypoxia group (IHG) or to the control group (CG). All athletes trained for a 13-wk period starting at pre-season until the competition season. The IHG spent additionally 2 h at rest on 3 days/wk for the first and the last 5 weeks in normobaric hypoxia (15-11% FiO2). RE, haematological parameters and body composition were determined at low altitude (600 m) at baseline, after the 5 (th), the 8 (th) and the 13 (th) week of training. RE, determined by the relative oxygen consumption during submaximal running, (-2.3+/-1.2 vs. -0.3+/-0.7 ml/min/kg, P<0.05) and total running time (+1.0+/-0.9 vs. +0.4+/-0.5 min, P<0.05) changed significantly between the IHG and CG only during the first 5-wk period. Haematological and cardiorespiratory changes indicate that the improved RE was associated with decreased cardiorespiratory costs and greater reliance on carbohydrate. Intermittent hypoxia did not affect RE during the second 5-wk period. These findings suggest that the effects of intermittent hypoxia on RE strongly depend on the training phase.

Luxation nach Ellenbogentotalendoprothese

BACKGROUND

Instabilities and dislocations after elbow arthroplasty, in particular in surface or unlinked prostheses, may cause functional impairments occasionally with the need for surgical revision. We provide a review of the literature about the frequency and causes of these complications and present some of our results obtained with the GSB III prosthesis.

PATIENTS AND METHODS

We examined the trigger mechanisms and frequency of joint instabilities as well as treatment strategies by studying five internationally used types of prostheses on the basis of published results. We evaluated 160 GSB III prostheses regarding the above complications and determined the causes for uncoupling.

RESULTS

Unlinked prostheses dislocate in 0-15% of cases, accounting for about 25% of the total complication rate described. All surface prosthesis models, including GSB III, were affected with variable frequency. For 160 GSB III prostheses, the dislocation rate was 7.4%. Frequent causes were errors of rotation of parts of the prostheses and displacements of the centre of rotation.

CONCLUSION

Elbow arthroplasty requires demanding surgery, which is still associated with a comparatively high rate of complications. With correct indication, adequate choice of the type of prosthesis used and sufficient experience gained in surgery techniques, it is possible to considerably lower the rate of disassembling.

Quantitative process evaluation of a community-based HIV/AIDS behavioural intervention in rural Uganda

This paper describes the implementation of a large community-based HIV/AIDS behavioural intervention in rural Uganda and presents 4 years' worth of quantitative process data. The intervention involved 560 field-based workers (57% male, 76% subsistence farmers, mean age 35 years), supervised by six central staff. Intervention channels included drama and video shows, Community Educators (CEs), as well as leaflet and condom distribution. Activities focused on one or more of 16 key topics. In total, 392 000 attendances (51% female) were recorded--a mean of over 6 for each of the 64 000 target adults--at 81 000 activities, with CEs attracting 71% of the total attendance; 164 000 leaflets and 242 000 condoms were also distributed. The annual cost of the intervention per target individual was approximately US$1.76. Our voluntary workforce experienced an annual attrition rate of 11%, with 'stable' workers more likely to be older, married or opinion leaders in their community than those who dropped out. We calculate that even a significant increase in the proportion of female field workers would have made little difference either to the sex ratio of attendees or to overall attendance. In spite of some initial resistance to the intervention, particularly in relation to condoms, we have demonstrated that people in rural Africa can accept and actively participate in the dissemination of HIV/AIDS prevention messages throughout their own communities.

Development of a new carbon-carbon bond forming reaction. new organic chemistry of sulfur dioxide. Asymmetric four-component synthesis of polyfunctional sulfones

At low temperature 1-alkoxy-1,3-dienes add to sulfur dioxide activated by a Lewis or Brønstedt acid and generate zwitterionic intermediates that can be quenched by enoxysilanes. The resulting beta,gamma-unsaturated silyl sulfinates can be desilylated and reacted with methyl iodide to provide polyfunctional sulfones. Exploratory studies of this four-component synthesis of sulfones are reported. Enantiomerically pure derivatives containing up to three new stereogenic centers can be obtained using enantiomerically pure (E,E)-1-alkoxy-2-methylpenta-1,3-dienes derived from alpha-methyl benzyl alcohols, including the Greene's chiral auxiliary. The stereochemistry of the reactions is consistent with a mechanism involving the suprafacial hetero-Diels-Alder addition of sulfur dioxide to the 1-alkoxy-1,3-dienes that are rapidly ionized into zwitterionic intermediates.

Synthesis and solution conformational analysis of 2,3-anhydro-3-C-[(1R)-2,6-anhydro-1-deoxy-1-fluoro-D-glycero-D-gulo-heptitol-1-C-yl]-beta-D-gulo-furanose: first example of a monofluoromethylene-linked C-disaccharide

Condensation of 2,3,4,6-tetra-O-benzyl-beta-D-glucopyranosylcarbaldehyde with isolevoglucosenone induced by Et(2)AlI, followed by epoxidation, gave an aldol that was fluorinated into a monofluoromethylene C-glucopyranoside that was converted into the title C-disaccharide 1. Its conformational behavior in water has been studied by using a combination of NMR spectroscopy (J and NOE data) and molecular mechanics calculations.

Rapid activation of Na+/H+-exchange in MDCK cells by aldosterone involves MAP-kinase ERK1/2

The mineralocorticoid aldosterone is essential for the adequate regulation of electrolyte homeostasis, extracellular volume and blood pressure. As a steroid hormone it influences cellular functions by genomic actions. Previously it has been shown that aldosterone can activate Na+/H+-exchange (NHE) by a rapid, nongenomic mechanism. Because (1) NHE can be regulated by ERK1/2 (extracellular signal-regulated kinase) and (2) steroids have been reported to rapidly activate ERK1/2, we tested the hypothesis that activation of NHE by aldosterone involves ERK1/2, using MDCK-C11 cells. We show that nanomolar concentrations of aldosterone induce a rapid, non-genomic activation of NHE, which is characterized by an increased affinity for H+ with minor changes in the maximum transport rate. Accordingly, aldosterone led to an increase of cytosolic steady-state pH. The aldosterone-induced activation of NHE was prevented by the two specific inhibitors of ERK1/2 activation, PD 98059 (2.5 x 10(-5) mol/l) and U0126 (10(-5) mol/l). Furthermore, in the presence of U0126 there was no aldosterone-induced increase of steady-state pH. Finally, aldosterone induced a rapid phosphorylation of ERK1/2, indicating its ability to activate ERK1/2. The data presented here support the hypothesis that the rapid activation of NHE by aldosterone at nanomolar concentrations involves ERK1/2. Thus, in certain cell types, the MAPK cascade may represent an additional pathway mediating rapid aldosterone effects.

[Microbiological and immunological monitoring in polyarticular rheumatoid arthritis after total joint replacement]

HISTORY AND ADMISSION FINDINGS

A 51-year-old man with polyarticular rheumatoid arthritis since the age of 10 years, which had required three total joint replacements, presented in a generally good condition for replacement of the left elbow joint, which was swollen and had reduced movement.

TREATMENT AND COURSE

The postoperative condition was without complication until the 7th day when arthritic signs set in, interpreted as part of the underlying disease, and cortisone was administered. After microbiological tests had been done and the patient's general state had deteriorated, antibiotic treatment with flucloxacillin and gentamycin as well as local irrigation and suction-drainage of all involved joints was started. Granulocyte and monocyte functions were analysed. Staphylococcal isolates from the patient induced reduced "respiratory burst" activity of the neutrophil granulocytes, apparently the cause of the septic dissemination. He was discharged on the 32. postoperative day, to be followed-up as an out-patient.

CONCLUSION

Both adequate antibiotic administration and, especially, thorough local reduction of pathogens are needed for efficacious treatment. Rapid restoration of granulocyte function and of the "immunocompetence" of monocytes within normal limits are part of the reason for a good therapeutic response. This indicates the need for up-to-date preoperative immunological diagnosis in patients with suppressed immunity to assess the risk of infection and thus plan elective intervention.

17O NMR spectroscopy of sulfolenes (2,5-dihydrothiophene-1,1-dioxides) and sultines (3,6-dihydro-1,2-oxathiin-2-oxides)--experiment and quantum calculations: synthesis of 4,9-dioxo-1,2-oxathiacyclodecane-2-oxide, a new heterocycle

The products of hetero-Diels-Alder reactions (sultines) and cheletropic addition reactions (sulfolenes) between 1,3-dienes and sulfur dioxide can be distinguished by their 17O NMR shifts. Experimental data have been collected for derivatives of 3,6-dihydro-1,2-oxathiin-2-oxide and of 2,5-dihydrothiophene-1,1-dioxide. This data was then compared with that calculated by the gauge independent atomic orbital (GIAO) method at the HF/6-31 + G(d,p) and HF/6-311 + G(3df, 2p) levels of theory with geometries optimized by MP2/6-31G(d) calculations. GIAO-MBPT(2) calculations were also performed with the 6-31 + G(d,p) basis set. The adduct between (E)-1-methoxybutadiene and SO2 is sulfolene 3, the ozonolysis of which in SO2 followed by work-up with ethanol provided (2RS,3SR,6SR)-(31), (2RS,3RS,6SR)-(32), and (2RS,3RS, 6RS)-2,6-diethoxy-3-methoxy-1,4-oxathiane-4,4-dioxide (33). Single-crystal X-ray diffraction studies are reported for 32 and 33. Ozonolysis of the hetero-Diels-Alder adduct of SO2 with 1,2-dimethylidenecyclohexane produced 4,9-dioxo-1,2-oxathiacyclodecane-2-oxide (34), the first member of a new class of sulfur heterocycles.

[Experiences with the GSB (Geschwend-Scheier-Bähler) III total endoprosthesis in the elbow joint]

Studies on the results with elbow prostheses published in the seventies reported on marked problems such as high loosening rates and instabilities of the joints. However, enormous progresses in elbow replacements have been made in the meantime. Therefore, we analyzed the results of the GSB III-elbow-prostheses that were implanted in our department for 9 years. Between January 1, 1987 and April 1995 at our department 34 total elbow replacements were performed in 32 patients. In this study, we reviewed 25 patients with elbow replacements both clinically and radiologically. The clinical outcome was rated according to the score of INGLIS and PELLICI. The mean follow-up time was 3.7 years. Our follow up examination revealed a total complication rate of 22%. Septic prosthesis loosening with explantation of the prostheses occurred in 3 patients resulting in a prosthesis survival-rate of 88%. However, clinical assessment revealed 80% excellent or good results. While the range of motion could only be improved to a small degree, a marked reduction of the preoperative pain could be achieved. Patients were satisfied with the outcome of the operation in 97%. Although the results of total elbow arthroplasties cannot be compared with those of hip or knee arthroplasties, in selected patients with rheumatoid arthritis and osteoathrosis the use of elbow replacements proved to be a successful procedure with satisfactory results. The implantation of elbow prostheses should mainly be considered when debilitating pain, strongly limited range of motion and instability of the joint are the main problems.

[Covering extensive soft tissue defects in infected knee endoprostheses by gastrocnemius flap]

Total knee arthroplasty has become a routine procedure in surgery. Deep infections have an incidence of 2-5%. Major risk factors are large prostheses, rheumatoid arthritis, diabetes mellitus and postoperative wound-healing complications. In large soft-tissue defects with skin necrosis, local wound care shows poor results, especially if loosening of the prosthesis and necrosis of the patellar ligament are evident. In these cases, no standard surgical therapy has been developed yet. Thus, we consider meticulous débridement with synovialectomy to be mandatory. Exchange of the prosthesis may be necessary. Soft-tissue coverage ought to be performed with a gastrocnemius muscle flap covered with a split-thickness skin graft. In the last three years, 11 patients with large soft-tissue defects and necrosis of the ligament were treated according to this concept. In all cases the muscle flap healed primarily and soft tissue coverage was excellent. Two patients who underwent single-stage removal and reimplantation of the prosthesis showed reinfections of the prosthesis. Reconstruction of the ligament was performed with the flap tendon. The patients with two-stage removal and reimplantation of the prosthesis and those who retained their implants had a good functional outcome. The gastrocnemius muscle flap provides easy and reliable soft-tissue reconstruction in large defects. In our patients a two-stage operation for reimplantation of the prosthesis was superior to a single-stage procedure. The reconstructed ligament should be reinforced with autologous material to prevent a secondary rupture. Early reconstruction with sufficient soft-tissue coverage and reconstruction of the ligament offers the patient the best chances of obtaining a good functional result and prevents arthrodesis or amputation. In addition, reconstructive surgery reduces the length of hospital stay and costs.

Hexamethylenetetramine suberate, a strongly anharmonic modulated structure

Hexamethylenetetramine suberate is an organic compound presenting a one-dimensional modulation with strong satellite reflections between 123 and 300 K. Single-crystal X-ray intensities of main reflections and satellites up to fourth order have been measured and used for refining a model based on displacive atomic modulation functions. Harmonic terms up to eighth order were necessary to describe the strongly anharmonic modulation. The structure consists of alternating sheets of hexamethylenetetramine and suberic acid connected by hydrogen bonds. Each layer of suberic acid chains consists of alternating areas, each of which is characterized by a common orientation for all chains. These orientations subtend an angle of roughly 60°. At the interfaces, neighbouring chains in adjacent areas adopt intermediate orientations. The two carboxyl groups participate in hydrogen bonds, the character of which depends on the internal coordinate t. In one group and for all values of t, the same oxygen forms a double bond with the α-carbon and the other a single bond, and in the other the carboxylate form is observed for all values of t. The packings of both moieties are incompatible and are conjectured to be responsible for the incommensurability of the structure.