Outcomes of an Interprofessional Opioid Training Program for Graduate Students in Nursing and Social Work

Social workers and other behavioral health professionals trained to provide prevention, treatment, and recovery services for opioid use disorders (OUD) remain urgently needed in the U.S. particularly in states with widespread health professional shortage areas. To help mitigate this workforce gap, faculty in social work and nursing at a public university in Alabama developed and piloted an innovative HRSA-funded interprofessional traineeship to prepare graduate-level nursing and social work students to assess and treat opioid use disorders (OUD). The yearlong traineeship included specialized coursework on evidenced-based practice in addictions, interprofessional telemedicine and simulation training, and multi-semester field practica in outpatient treatment settings. Impact of the pilot training was evaluated using a pre-experimental one group design. Baseline and post-training surveys assessed knowledge, attitudes, and skills related to OUD and interprofessional practice and perceived program impact. Significant increases were observed for trainees' self-reported knowledge, attitudes, and skills. Moreover, at graduation students reported that the traineeship had improved their abilities to interact with underserved populations, collaborate interprofessionally, and understand ethical issues in SUD treatment as well as enhancing their professional competence, clinical problem-solving, and health workforce skills. Findings suggest that the interprofessional training program may prepare social work and nursing graduate students to effectively serve clients with OUD and help to address a critical workforce gap in medically underserved communities.

Using behavioral theory to understand partisan differences in COVID-19 vaccination and booster intentions

In 2020, the Food and Drug Administration granted emergency use authorization for two COVID-19 vaccines. Two years later, the Centers for Disease Control and Prevention estimated that more than 250 million individuals had received at least one dose of the vaccine. Despite the large numbers of individuals vaccinated against COVID-19, partisan differences surrounding the COVID-19 vaccine emerged, creating a potential challenge for health communications aimed at increasing vaccine uptake. A better understanding of partisan differences in attitudes and intentions towards vaccination may help guide public health strategies aimed at increasing vaccine uptake. To determine whether a commonly used theory of behavioral intentions used to craft public health messages explains partisan differences in intentions. Data were drawn from a national panel of US adults and collected between February 21, 2022, and March 3, 2022, using an online survey (n = 1845). Among respondents identifying as either Democrat or Republican (n = 1466), path analysis models were estimated to test whether partisan differences in vaccination or booster intentions were explained by the theoretical constructs of protection motivation theory (PMT). PMT accounted for approximately half of the covariate-adjusted mean difference in COVID-19 vaccination intentions between Democrats and Republicans, and nearly all the mean difference in booster intentions. Party affiliation indirectly affected intentions via its association with perceived susceptibility to COVID-19, vaccine/booster efficacy, and perceived costs of getting a COVID-19 vaccine or booster dose. Compared with Democrats, Republicans may be less likely to get vaccinated or receive a booster dose because of beliefs that they are less susceptible to COVID-19, that the vaccine is less effective, and that vaccination comes with disadvantages. Theories of behavioral intentions can help to identify the underlying theoretical determinants driving behavioral differences between political groups.

Prospective feasibility study of a mindfulness-based program for breast cancer patients in the southeastern US

BACKGROUND

Mindfulness interventions can improve psychological distress and quality of life (QoL) in cancer survivors. Few mindfulness programs for cancer recovery exist in Southeastern U.S. The primary objective of this study was to assess the feasibility of a modified mindfulness-based stress reduction (MBSR) program for breast cancer patients in Birmingham, Alabama. The secondary objective was to explore potential program effects on mindfulness skills and QoL.

METHODS

This study was a prospective, quasi-experimental feasibility study conducted over 10 months at a university hospital. Feasibility was achieved if 80% of eligible patients screened enrolled in the study and 70% of enrolled patients attended all 8 program sessions. Effectiveness was estimated by changes in mindfulness and QoL indicators measured with validated scales administered at 3 time points and assessed with a non-parametric Friedman test. Sessions included meditation, yoga, and an attention practice called body scan. There were 3 groups of 2-5 patients.

RESULTS

The sample totaled 12 patients. Forty-four percent (12/27) of eligible patients enrolled in the study, and two out of 12 enrolled patients completed 8 program sessions, resulting in 16.7% (2/12) retention. However, more than half (66.7%) of participants completed at least 7 sessions. Between baseline and 8-week follow-up, patients demonstrated statistically significant improvements in distress, general wellbeing, and fatigue-related QoL.

CONCLUSIONS

Feasibility objectives were not achieved. However, a majority of participants (66.7%) completed 7 of 8 program sessions. Program effects were promising for distress, fatigue, and wellbeing. Results warrant further research on MBSR-like programs for breast cancer patients in Alabama.

Laparoscopic guided liposomal bupivacaine injection compared to transversus abdominus plane block for postoperative pain after robotic gynecologic oncology surgery

OBJECTIVE

The purpose of this study was to determine if laparoscopically guided transversus abdominis plane block (Lap-Tap) with liposomal bupivacaine provides superior postoperative pain control when compared to ultrasound-guided block (US-Tap) with liposomal bupivacaine at the time of robotic surgery for gynecology oncology patients.

METHODS

This was a prospective randomized controlled trial assigning patients to one of two cohorts: Cohort 1 consisted of US-Tap administered before the procedure using liposomal bupivacaine, Cohort 2 consisted of Lap-Tap administration with laparoscopic visualization using the medication above. Primary outcomes were pain scores and total opioid use in Oral Morphine Equivalents (OME) during the first 72 h after surgery. Secondary outcomes were postoperative pain satisfaction and oral narcotic requirements.

RESULTS

There was a significant increase in oral narcotic use in the first 24 h in the US-Tap cohort compared to the Lap-Tap cohort: Lap-Tap mean = 6.73 ± 8.22 OME versus US-Tap mean = 12.69 ± 12.94 p = 0.018 OME. The increase was equivalent to one additional Hydrocodone-Acetaminophen 7.5 mg/325 mg in the first 24 h after surgery. However, total oral narcotic use over the first 72 h was not significantly different between the two cohorts: Lap-Tap mean = 21.73 ± 19.83 OME, US-Tap mean = 32.50 ± 29.47, p = 0.062 OME. In addition, there was no significant difference in satisfaction or pain scores between the US-Tap and Lap-Tap groups at 24, 48, or 72-hours.

CONCLUSIONS

Lap-Taps are comparable to US-Tap for postoperative analgesia during the first 72-h after surgery when performing robotic-assisted gynecologic oncology surgery.

Identification and Pathogenicity of Fungal Pathogens Associated with Stem-End Rot of Avocado in California

Stem-end rot of harvested avocado fruit commonly occurs wherever the crop is cultivated. Multiple fungal species have been described as causal agents. To determine the causal pathogens of stem-end rot in California, fungal isolations were conducted from symptomatic fruit, and fungi were identified by morphological and molecular techniques. In 2010 and 2011, a total of 177 isolates were recovered from 290 avocado fruit collected from seven orchards in one of the major avocado growing areas in Southern California. The majority of isolates was identified as Neofusicoccum luteum (65%), with the remainder either as Colletotrichum gloeosporioides (33%) or Phomopsis sp. (2%). In a pathogenicity test, N. luteum caused significantly (P < 0.05) more severe stem-end rot than either C. gloeosporioides or Phomopsis sp. No significant (P > 0.05) differences in stem-end rot severity were observed between inoculations with N. luteum isolated from fruit stem-end rot and N. luteum or N. parvum isolated from branch cankers. This confirms that stem-end rot of avocado can be initiated by fungi causing branch cankers. Although low humidity and rainfall during much of the growing and harvest seasons in California are considered unfavorable conditions for the development of avocado stem-end rot, the identification of the causal pathogens is of value when decays have to be managed during outbreaks, and it stresses the importance of managing branch cankers.

Effect of Fungicide Application on the Management of Avocado Branch Canker (Formerly Dothiorella Canker) in California

Members of the Botryosphaeriaceae family have been associated with branch cankers of avocado trees (Persea americana) in California. Canker infections are initiated by spores entering the host plant through fresh wounds such as pruning wounds. With high-density planting becoming more common in the California avocado industry, more intensive pruning may increase the occurrence of branch canker. The objective of this study was to evaluate the preventive ability of some commercial fungicides belonging to different chemical families against fungal pathogens associated with avocado branch canker. Initially, 12 fungicides were tested in vitro for their effect on the inhibition of mycelial growth of three isolates of Dothiorella iberica and isolates (five per species) of Neofusicoccum australe, N. luteum, N. parvum, and Phomopsis sp. Subsequently, azoxystrobin, fludioxonil, metconazole, and pyraclostrobin, selected because of their low effective concentrations that reduce 50% of mycelial growth (EC₅₀ values), and myclobutanil, selected for its high EC₅₀ value, were tested in two field experiments. Azoxystrobin and fludioxonil were used in a premix with propiconazole and cyprodinil, respectively, in field trials. Significant differences (P < 0.05) were observed among fungicides in field trials. Azoxystrobin + propiconazole had the highest percent inhibition at 52 and 62% (internal lesion length) in trial 1 and trial 2, respectively, although this level of inhibition was not significantly different from that of metconazole. A significant correlation (r = 0.51, P < 0.05) was observed between internal lesion length data in the field experiment and EC₅₀ data from in vitro fungicide screening. Application of azoxystrobin + propiconazole and metconazole can play a key role in protecting Californian avocado against fungi causing avocado branch canker.

Innate immune responses against Cryptosporidium parvum infection

Cryptosporidium parvum infects intestinal epithelial cells and is commonly the parasite species involved in mammalian cryptosporidiosis, a major health problem for humans and neonatal livestock. In mice, immunologically mediated elimination of C. parvum requires CD4+ T cells and IFN-γ. However, innate immune responses also have a significant protective role in both adult and neonatal mice. NK cells and IFN-γ have been shown to be important components in immunity in T and B cell-deficient mice, but IFN-γ-dependent resistance has also been demonstrated in alymphocytic mice. Epithelial cells may play a vital role in immunity as once infected these cells have increased expression of inflammatory chemokines and cytokines and demonstrate antimicrobial killing mechanisms, including production of NO and antimicrobial peptides. Toll-like receptors facilitate the establishment of immunity in mice and are involved in the development of inflammatory responses of infected epithelial cells and also dendritic cells.

Rituximab for thrombotic thrombocytopenic purpura: benefit of early administration during acute episodes and use of prophylaxis to prevent relapse

BACKGROUND

Rituximab has been documented in the treatment of acute (≤ 3 days from admission), relapsed/refractory thrombotic thrombocytopenic purpura (TTP) and given as prophylaxis in selected cases to prevent acute relapse. The precise timing of rituximab in acute TTP has not been determined.

OBJECTIVE

To perform a retrospective analysis of rituximab use in a large TTP referral center over an 8-year period.

PATIENTS/METHODS

We assessed response to treatment and outcome for all patients treated with rituximab, including 91 patients presenting with 104 episodes of acute TTP and 15 patients given rituximab as prophylaxis to prevent relapse. In the acute TTP group we assessed the benefit of giving early (≤ 3 days from admission) vs. later (> 3 days) rituximab.

RESULTS

In acute de novo TTP, previously untreated with rituximab, rituximab was given ≤ 3 days from admission to 54 patients and > 3 days from admission to 32 patients. Earlier administration (≤ 3 days) was associated with faster attainment of remission (12 vs. 20 days, P < 0.001), fewer plasma exchanges (16 vs. 24, P = 0.03) and shorter hospital stay (16 vs. 23 days, P = 0.01). Eighty-two patients (95%) achieved complete remission within 14 days (4-52 days); four patients died acutely. Eleven out of 82 (13.4%) relapsed at a median of 24 months (4-49 months). Rituximab prophylaxis was associated with normalization of ADAMTS13 levels within 3 months in all but one case, with only one acute relapse at follow-up.

CONCLUSIONS

Although limited by being retrospective and non-randomized, this study demonstrates the potential benefit of early administration of rituximab in acute TTP, and prophylactic use to prevent acute relapse.

IL-10 promotes production of intestinal mucus by suppressing protein misfolding and endoplasmic reticulum stress in goblet cells

BACKGROUND & AIMS

Protein misfolding and endoplasmic reticulum (ER) stress have been observed in intestinal secretory cells from patients with inflammatory bowel diseases and induce intestinal inflammation in mice. However, it is not clear how immune factors affect ER stress and therefore disease symptoms.

METHODS

We analyzed the effects of interleukin (IL)-10 on ER stress in intestinal tissues in wild-type C57BL/6, Winnie, IL-10(-/-), and Winnie × IL-10(+/-) mice. In Winnie mice, misfolding of the intestinal mucin Muc2 initiates ER stress and inflammation. We also analyzed the effects of different inhibitors of IL-10 signaling and the N-glycosylation inhibitor tunicamycin in cultured human LS174T goblet cells.

RESULTS

Administration of neutralizing antibodies against IL-10 or its receptor (IL-10R1) to Winnie mice rapidly exacerbated ER stress and intestinal inflammation compared with mice given vehicle (controls). Antibodies against IL-10 also increased accumulation of misfolded Muc2 in the ER of goblet cells of Winnie mice and increased T-cell production of inflammatory cytokines. Winnie × IL-10(+/-) mice and IL-10(-/-) mice with a single Winnie allele each developed more severe inflammation than Winnie mice or IL-10(-/-) mice. Administration of tunicamycin to wild-type mice caused intestinal ER stress, which increased when IL-10R1 was blocked. In LS174T cells, induction of ER stress with tunicamycin and misfolding of MUC2 were reduced by administration of IL-10; this reduction required STAT1 and STAT3. In LS174T cells incubated with tunicamycin, IL-10 up-regulated genes involved in MUC2 folding and in ER-associated degradation and maintained correct folding of MUC2, its transport from the ER, and its O-glycosylation and secretion.

CONCLUSIONS

IL-10 prevents protein misfolding and ER stress by maintaining mucin production in goblet cells and helps the intestine preserve the mucus barrier.

First Report of Raffaelea canadensis Causing Laurel Wilt Disease Symptoms on Avocado in California

Laurel wilt disease is a newly described vascular disease of redbay (Persea borbonia (L.) Spreng.) and other members of the Lauraceae family in the southeastern United States. The disease, caused by the fungus Raffaelea lauricola and vectored by a nonnative redbay ambrosia beetle (Xyleborus glabratus Eichhoff), was first detected in Georgia in 2003 (1). Laurel wilt has caused extensive mortality of native redbay in Georgia, Florida, South Carolina, and recently, Mississippi. The avocado, Persea americana, is in the Lauraceae family and has been shown to be susceptible to the laurel wilt pathogen in Florida (3). The potential spread of this pathogen into California is of concern to the commercial avocado industry. During a survey in 2010 in a Temecula, CA avocado orchard with a history of root rot, an avocado (cv. Hass) tree with a diameter at breast height (DBH) of 45 cm was found to be showing typical laurel wilt disease symptoms. The crown was approximately 80% declined and exhibited dead branches without leaves. Black-to-brown discolored sapwood under the bark and many ambrosia beetle exit holes within 1 to 1.5 m up the bole were also observed. A Raffaelea sp. was consistently isolated from symptomatic branch tissue (from two different branches) plated onto cycloheximide-streptomycin malt agar (2) and incubated at room temperature for 2 weeks. Small subunit (18S) sequences of rDNA (approximately 1,150 bp) of three Raffaelea isolates were amplified using primers NS1 and NS4 (4) and deposited into GenBank under Accession Nos. JF327799, JF327800, and JF327801. A BLASTn search of all three sequences revealed high homology (98, 99, and 98% respectively) to an accession of R. canadensis associated with a species of ambrosia beetle (GenBank Accession No. AY858665). Pathogenicity testing was conducted by pipetting 50 μl of a 10⁵ conidia per ml suspension of each of two isolates (UCR1080 and UCR1081) into five 2-mm-diameter holes on each of two avocado (cv. Hass) trees (10 to 15 cm DBH). Isolate UCR1080 was inoculated into three holes on Tree 1 and two holes on Tree 2. Isolate UCR1081 was inoculated into two holes on Tree 1 and three holes on Tree 2. Sterile water was used as a control in five 2-mm-diameter holes on each tree. Holes were drilled to the cambium within 1 to 2 m up the bole using a 0.157-cm electric drill. Four months later, phloem tissue was peeled back, lesion lengths were measured, and pieces of necrotic tissue were cultured for completion of Koch's postulates. R. canadensis was consistently reisolated from necrotic tissue but not from control treatments. To our knowledge, this is the first report of R. canadensis associated with wilt on avocado in California. R. canadensis is closely related to R. lauricola, however, its impact on the California avocado industry is unknown at this time. References: (1) S. W. Fraedrich et al. Plant Dis. 92:215, 2008. (2) T. C. Harrington et al. Mycotaxon 111:337, 2010. (3) A. E. Mayfield et al. Plant Dis. 92:976, 2008. (4) T. J. White et al. Page 315 in: PCR Protocols: A Guide to Methods and Applications. M. A. Innis et al., eds. Academic Press, San Diego, 1990.

Ghrelin in gastrointestinal disease

Enteroendocrine cells of the gastric fundus are the predominant source of ghrelin production, although ghrelin gene transcripts and ghrelin-producing cells have been identified throughout the gastrointestinal tract. Various infectious, inflammatory and malignant disorders of the gastrointestinal system have been shown to alter ghrelin production and secretion and consequently to affect endocrine ghrelin levels and activity. Animal studies have demonstrated that ghrelin and synthetic ghrelin mimetics can reduce the severity of gastric and colonic inflammation and human clinical trials are underway to determine the efficacy of ghrelin in improving motility disorders. This review summarises the impact of gastrointestinal disease on ghrelin synthesis and secretion and the potential use of ghrelin and its mimetics for the treatment of these diseases.

Prophylactic penicillin by the full moon: a novel approach in Central Australia that may help to reduce the risk of rheumatic heart disease

INTRODUCTION

Uptake of penicillin prophylaxis to prevent recurrent rheumatic fever and its sequela rheumatic heart disease (RHD) is not optimal in the Northern Territory of Australia. The Full Moon Strategy (the Strategy) was introduced in the Central Australian region in June 2006 to improve the uptake of prophylactic penicillin: clients and healthcare workers were encouraged to use the full moon as a cue for the timing of the 4 weekly prophylactic penicillin injection.

OBJECTIVE

To determine the impact and effectiveness of the Strategy on knowledge and uptake of benzathine penicillin prophylaxis for clients at risk of RHD, and for primary healthcare workers in Central Australia.

METHODS

Clients at risk of RHD in four remote Aboriginal communities and the town camps of Alice Springs were identified from the RHD database. Consenting clients or their carers were interviewed about their knowledge of the Strategy and the health promotional tools used. Their healthcare records were then reviewed for prophylaxis uptake 2 years prior to and 2 years following the introduction of the Strategy. Primary healthcare workers in the four remote communities who were available at the time of the study visit were interviewed about their knowledge and use of the Strategy and the health promotional tools.

RESULTS

Fifty RHD clients and 19 healthcare workers were interviewed. Most were aware of the flipchart but less than half knew of the calendar poster, hand-held card or radio advertisement. Prophylaxis uptake increased significantly from 47% in the 2 years prior to the introduction of the Strategy, to 57% 2 years after the Strategy was introduced.

CONCLUSION

Introduction of the Strategy coincided with an improvement in uptake of prophylaxis but not around the time of the full moon. Uptake of benzathine penicillin remains inadequate and further innovative measures are needed to control rheumatic fever and its sequela in Aboriginal and Torres Strait Islander people.

Rituximab pharmacokinetics during the management of acute idiopathic thrombotic thrombocytopenic purpura

BACKGROUND

Increasingly, patients with acute, idiopathic, antibody mediated thrombotic thrombocytopenic purpura (TTP) are being treated with rituximab to achieve a durable remission, however, there is the potential that it is removed by plasma exchange (PEX).

OBJECTIVES

To look at the pharmacokinetics and pharmacodynamics of rituximab in patients with acute idiopathic TTP undergoing PEX.

PATIENTS AND METHODS

Patients who received rituximab for acute idiopathic TTP (group 1, n = 30) and a control group (group 2, n = 3) of TTP patients in remission receiving rituximab electively as maintenance were included. Rituximab levels were measured before/after each infusion, before/after PEX and in follow-up. ADAMTS-13 activity, anti-ADAMTS-13 IgG and CD19% were measured to assess response.

RESULTS

The median number of PEX to remission after rituximab was 10 (range 4-25). In group 1 there was no significant incremental rise in the peak serum rituximab level until dose 4. Trough levels were lower in patients who had had PEX since their last rituximab infusion. In the control group, there was an incremental rise in the peak serum rituximab level and all patients had detectable trough levels. The median fall in rituximab per PEX was 65%. All patients achieved CD19 < 1%. In group 1, the median time to undetectable rituximab was 5 months (range 0-12 months) and to B cell return was 7 months (range 3-24 months). ADAMTS-13 increased and anti-ADAMTS-13 fell after therapy. There were three deaths and two relapses in group 1. Relapse was not temporally related to B cell return.

Human leukocyte antigen association in idiopathic thrombotic thrombocytopenic purpura: evidence for an immunogenetic link

BACKGROUND

Thrombotic thrombocytopenic purpura (TTP) is a rare, acute, life-threatening disorder, associated with a deficiency in ADAMTS 13. The majority of acute, idiopathic, adult TTP cases are associated with anti-ADAMTS 13 IgG antibodies. However, the factor(s) precipitating an acute TTP episode are not always obvious; indeed, a multifactorial etiology is likely.

OBJECTIVES AND METHODS

DNA was used for human leukocyte antigen (HLA) class II typing, using polymerase chain reaction (PCR)-sequence-specific primer and PCR-sequence-specific oligonucleotide probe to methodology to investigate 50 European acquired idiopathic TTP cases.

RESULTS

There was an increase in the frequency of HLA-DQB1*0301 (HLA-DQ7) in patients with TTP as compared with controls [58.0% vs. 34.5% (P=0.048)]. The frequencies of HLA-DRB1*11 and HLA-DRB3* were also significantly increased in TTP patients as compared with controls [44.0% vs. 12.0% (P=0.0024) and 84.0% vs. 58.0% (P=0.024)], although it remains uncertain whether susceptibility is influenced by HLA-DQ or HLA-DR molecules or other genes in this haplotype. The frequencies of HLA-DRB1*04 and HLA-DRB4 (HLA-DR53) were significantly decreased in the patient group as compared with controls [10.0% vs. 35.0% and 26.0% vs. 61.5% (P=0.0096 and P=0.0024, respectively)], and may have a protective effect against the development of TTP.

CONCLUSION

Analysis identified HLA class II types associated with susceptibility to and a protective effect against the development of acute acquired TTP in European patients. This provides the first description of a genetic factor predicting the risk of developing acquired antibody-mediated TTP.

First Report of Neofusicoccum australe, N. luteum, and N. parvum Associated With Avocado Branch Canker in California

In 1953, branch cankers on California avocado (Persea americana Mill.) trees were attributed to a Botryosphaeria anamorph, Dothiorella gregaria (teleomorph B. ribis) (2), and the disease was known as Dothiorella canker. Since this time, it has been suggested that this fungus should probably be classified as Fusicoccum aesculi Corda (teleomorph B. dothidea) (3). To our knowledge, B. dothidea is the only reported Botryosphaeriaceae species causing Dothiorella canker on avocado in California. Between the summer of 2008 and the winter of 2009, five trees from each of eight avocado orchards in five counties (San Diego, Riverside, Ventura, Santa Barbara, and San Luis Obispo) were surveyed for Dothiorella canker symptoms to verify the associated Botryosphaeriaceae species. Typical Dothiorella canker symptoms observed included darkened and friable bark with a dried, white, powdery exudate. Underneath the bark, cankers were variable in shape and some penetrated into the heartwood. Small sections of tissue (0.5 cm²) were excised from two to four separate cankers per tree and placed onto potato dextrose agar amended with tetracycline (0.01%) (PDA-tet). The most frequently isolated fungi, based on general growth pattern, speed, and colony color, were in the Botryosphaeriaceae with the following percent recovery by county: Riverside-40 and 100% (site 1 and 2, respectively); San Diego-60% (site 3); Ventura-42 and 53% (site 4 and 5, respectively); Santa Barbara-33% (site 6); and San Luis Obispo-32 and 60% (site 7 and 8, respectively). Pycnidia of Botryosphaeriaceae species were also observed on old diseased avocado tree branches. Sequenced rDNA fragments (ITS1, 5.8S rDNA, ITS2, amplified with ITS4 and ITS5 primers) were compared with sequences deposited in GenBank. Four different Botryosphaeriaceae species were identified and included Neofusicoccum australe, B. dothidea, N. luteum, and N. parvum, with species nomenclature based on the work of Crous et al. (1). Pathogenicity tests were conducted in the greenhouse on 1-year-old avocado seedlings, cv. Hass, with one randomly chosen isolate from each of the Botryosphaeriaceae species noted above. Four replicate seedlings were stem-wound inoculated with a mycelial plug and covered with Parafilm. Sterile PDA plugs were applied to four seedlings as a control. Over a period of 3 to 6 months, seedlings were assessed for disease symptoms that included browning of leaf edges and shoot dieback. Mean vascular lesion lengths on stems were 64, 66, 64, and 18 mm for B. dothidea, N. parvum, N. luteum, and N. australe, respectively. Each fungal isolate was consistently reisolated from inoculated seedlings, thus fulfilling Koch's postulates. To our knowledge, this is the first report of N. australe, N. luteum, and N. parvum recovered from branch cankers on avocado in California. These results are significant because Botryosphaeriaceae canker pathogens are known to enter the host plant through fresh wounds (pruning, frost, and mechanical). With high-density planting becoming more common, which requires intensive pruning, the transmission rate of these pathogens could increase in California avocado groves. References: (1) P. W. Crous et al. Stud. Mycol. 55:235, 2006. (2) F. F. Halma and G. A. Zentmyer. Calif. Avocado Soc. Yearb. 38:156, 1953. (3) W. F. T. Hartill and K. R. Everett. N. Z. J. Crop Hortic. Sci. 30:249, 2002.

New insights into the roles of dendritic cells in intestinal immunity and tolerance

Dendritic cells (DCs) play a critical key role in the initiation of immune responses to pathogens. Paradoxically, they also prevent potentially damaging immune responses being directed against the multitude of harmless antigens, to which the body is exposed daily. These roles are particularly important in the intestine, where only a single layer of epithelial cells provides a barrier against billions of commensal microorganisms, pathogens, and food antigens, over a huge surface area. In the intestine, therefore, DCs are required to perform their dual roles very efficiently to protect the body from the dual threats of invading pathogens and unwanted inflammatory reactions. In this review, we first describe the biology of DCs and their interactions with other cells types, paying particular attention to intestinal DCs. We, then, examine the ways in which this biology may become misdirected, resulting in inflammatory bowel disease. Finally, we discuss how DCs potentiate immune responses against viral, bacterial, parasitic infections, and their importance in the pathogenesis of prion diseases. We, therefore, provide an overview of the complex cellular interactions that affect intestinal DCs and control the balance between immunity and tolerance.

Eimeria praecox: selection and characteristics of precocious lines

Precocious lines of Eimeria praecox were obtained both from the Houghton laboratory strain and the progeny of a single sporocyst (derived from the Houghton strain) by selection for early development of oocysts in the mature host. The prepatent times of the parasites were reduced from 84 to less than 64 hours. The evolution of the trait for precocious development appeared to be a step-wise process culminating in the depletion of, probably, the fourth generation of schizont. Studies on the precocious line selected from the Houghton strain showed that it had a multiplication rate of less than 10% of its parent strain, yet chickens given small numbers of oocysts were almost completely immune to challenge with either the Houghton strain or any one of five field strains. The precocious line was also slightly less pathogenic. Examination of a sub-line subjected to 10 generations of relaxed passage showed that there was no marked loss of the traits for early prepatent time or for reduced fecundity.

A potential role for interleukin-18 in inhibition of the development of Cryptosporidium parvum

Accumulating evidence suggests that intestinal epithelial cells (IECs) constitutively express the immunoregulatory cytokine interleukin (IL)-18. IECs also serve as the host cell for the intracellular parasitic protozoan Cryptosporidium parvum. In the present study, C. parvum infection of a human enterocyte cell-line HCT-8 resulted in increased expression of IL-18 mRNA as measured by quantitative reverse transcription-polymerase chain reaction (RT-PCR). IL-18 protein was detected in control uninfected cells and following infection there was increased expression as measured by enzyme-linked immunosorbent assay (ELISA). Gene expression revealed the presence of the IL-18 receptor subunits not only in cell-lines but also in freshly isolated IECs, suggesting that IL-18-mediated signalling events may contribute to epithelial host defence during infection. Recombinant IL-18 inhibited intracellular development of the parasite in HCT-8 and HT-29 cells. Increased expression of bactericidal antibiotic peptides LL-37 and alpha-defensin 2 by IL-18 in HCT-8 and HT-29 cells may represent one mode of action by which this pluripotent cytokine aids in limiting the development of intracellular pathogens such as C. parvum in the gastrointestinal tract.

Thalidomide induced remission of refractory diffuse large B-Cell Lymphoma post-allogeneic SCT

Patients who relapse after High dose therapy and autologous stem cell transplant (ASCT) for Diffuse large B cell Lymphoma (DLBCL) have a poor prognosis with a median survival of only 3-6 month.1-2 This case demonstrates the ability of thalidomide at low doses to induce durable response in a patient with DLBCL who relapsed after full intensity allogeneic transplantation.

Nebulised hypertonic saline for cystic fibrosis

BACKGROUND

Lung disease in cystic fibrosis is characterised by impaired mucociliary clearance. Hypertonic saline has been shown to enhance mucociliary clearance in vitro and this may act to lessen the destructive inflammatory process in the airways.

OBJECTIVES

To investigate the effects of treatment with nebulised hypertonic saline on people with cystic fibrosis compared to placebo and or other treatments that enhance mucociliary clearance.

SEARCH STRATEGY

'We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register, comprising references identified from comprehensive electronic database searches, handsearches of relevant journals and abstract books of conference proceedings. Most recent search of the Trials Register: September 2004.

SELECTION CRITERIA

All controlled trials assessing the effect of hypertonic saline compared to placebo or other mucolytic therapy, for any duration or dose regimen in people with cystic fibrosis of any age or severity.

DATA COLLECTION AND ANALYSIS

Two authors independently reviewed all identified trials and all data collected. Trial quality was assessed along with allocation concealment.

MAIN RESULTS

Fourteen controlled trials were identified. Nine trials met the inclusion criteria involving 235 participants with an age range of 6 years to 46 years. Two short-term trials of immediate effect on mucociliary clearance demonstrated that hypertonic saline increased isotope clearance compared to control. Lung function, measured by improvement in forced expiratory volume at one second (FEV1 litre per minute), was observed in four trials. When 3% to 7% saline was used in a volume of 10 ml twice-a-day, in comparison to placebo, hypertonic saline led to a significant increase in FEV1, weighted mean difference 12.20 (95%CI 4.28 to 20.10). Two further trials compared a similar concentration and volume of hypertonic saline to recombinant deoxyribonuclease. Over a three-week period one trial showed a non-significant difference, mean difference 1.60 (95% CI -7.96 to 11.16). However, in a further trial, after 12 weeks treatment in participants with moderate to severe lung disease, recombinant deoxyribonuclease led to a greater increase in FEV1 than hypertonic saline (5 ml twice-daily), mean difference 8.00 (95%CI 2.00 to 14.00). No serious adverse events were noted.

AUTHORS' CONCLUSIONS

Nebulised hypertonic saline improves mucociliary clearance in short-term clinical trials and appears to increase lung function compared to control. In comparison to recombinant deoxyribonuclease it may be less effective at improving lung function after three months. Currently there is insufficient evidence to support the use of hypertonic saline as routine treatment for people with cystic fibrosis.

Nitazoxanide for persistent diarrhoea in Zambian acquired immune deficiency syndrome patients: a randomized-controlled trial

BACKGROUND

Adults with acquired immune deficiency syndrome and persistent diarrhoea in Zambia have intestinal infection, predominantly protozoa.

AIM

To search for treatment which can be offered with minimal investigation, we carried out a double-blind, randomized-controlled trial of nitazoxanide (a drug with a range of activity against parasites and bacteria).

METHODS

Patients with diarrhoea of 1 month duration or longer were randomized to receive nitazoxanide (1000 mg twice daily) or placebo for 2 weeks. End-points were clinical response, parasitological clearance and mortality.

RESULTS

Two hundred and seven adults were randomized; 42 died during the study. The primary assessment of efficacy was made after 17 days. Clinical response was observed in 56 (75%) of 75 patients receiving nitazoxanide and 45 (58%) of 77 patients receiving placebo (P = 0.03). The rate of improvement was markedly higher in patients with CD4 counts under 50 cells/microL receiving nitazoxanide (P = 0.007). The benefit was largely restricted to the period when the drug was being administered. No difference was seen in parasitological clearance between the two groups. Mortality was 19% by 4 weeks of follow-up and did not differ with treatment allocation.

CONCLUSIONS

Nitazoxanide given orally for 14 days was associated with clinical improvement in Zambian acquired immune deficiency syndrome patients with diarrhoea, especially those with very low CD4 counts.

The role of Cryptosporidium parvum-derived phospholipase in intestinal epithelial cell invasion

In the Cryptosporidium parvum-infected intestinal epithelial cell, the parasite occupies an unusual extracytoplasmic location at the luminal surface, but how the invading zoites interact with the host cell to achieve this niche is poorly understood. This study examined the role of secretory phospholipase A(2) (sPLA(2)), a known virulence factor for several pathogenic microorganisms, in establishing C. parvum intracellularly. Initially, it was established that there was sPLA(2) activity in homogenates of C. parvum oocysts. C. parvum reproduction in two human enterocyte cell lines was significantly reduced by a specific PLA inhibitor, p-bromophenacylbromide, and by sheep anti-sPLA(2) antibodies developed against PLA(2) of bee ( Apis mellifera) venom. Treatment of either C. parvum sporozoites or enterocytes with sPLA(2) derived from cobra ( Naja naja) venom before initiation of infection increased the numbers of intracellular parasites. Thus, C. parvum PLA(2 )may play an important part in establishing the parasite within the enterocyte.

Nebulised hypertonic saline for cystic fibrosis

BACKGROUND

The lung disease in cystic fibrosis is characterised by impaired mucociliary clearance. Hypertonic saline (HS) has been shown to enhance mucociliary clearance in-vitro and this may act to lessen the destructive inflammatory process in the airways.

OBJECTIVES

To investigate the effects of treatment with nebulised hypertonic saline on people with CF compared to placebo and or other treatments that enhance mucociliary clearance.

SEARCH STRATEGY

'We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group trials register which comprises references identified from comprehensive electronic database searches, handsearching relevant journals and handsearching abstract books of conference proceedings. Date of the most recent search of the Group's register: October 2001.

SELECTION CRITERIA

All controlled trials (any language) assessing the effect of hypertonic saline compared to placebo or other mucolytic therapy, for any duration or dose regimen in people with cystic fibrosis of any age or severity.

DATA COLLECTION AND ANALYSIS

All identified trials were independently reviewed by both reviewers & all data collected. Trial quality was assessed along with allocation concealment.

MAIN RESULTS

Fourteen controlled trials were identified. Nine trials met the inclusion criteria; these involved 235 participants with an age range of 6 to 46 years. Two short-term trials of immediate effect on mucociliary clearance demonstrated that HS increased isotope clearance compared to control. Lung function as measured by improvement in Forced Expiratory Volume at one second (FEV1 l/min) was observed in four trials. When 3% to 7% saline was used in a volume of 10mls twice a day, in comparison to placebo, HS led to a significant increase in FEV1, WMD 12.20 (95%CI 4.30 to 20.10). In comparison to deoxyribonuclease (DNase) two trials used a similar concentration and volume of HS. Over a three week period the groups showed a similar increase in FEV1, WMD -1.60 (95%CI -11.16 to 7.96). However after 12 weeks treatment in participants with moderate to severe lung disease compared to DNase, HS 5mls twice a day showed less benefit to FEV1, WMD -13.00 (95%CI -22.46 to -3.54). No serious adverse events were noted.

REVIEWER'S CONCLUSIONS

Nebulised hypertonic saline improves mucociliary clearance in short term clinical trials and appears to increase lung function compared to control. In comparison to DNase it may be less effective at improving lung function, after three months. At this stage there is insufficient evidence to support the use of hypertonic saline as routine treatment for people with cystic fibrosis.

A method for diagnosis of microsporidiosis adapted for use in developing countries

Microsporidiosis in AIDS patients has emerged as an important cause of morbidity, but diagnosis requires special stains, equipment and expertise. Here we describe a modification to an existing staining technique to allow more rapid preparation, without additional equipment, facilitating research in the tropics into these important pathogens.

Interferon gamma induces enterocyte resistance against infection by the intracellular pathogen Cryptosporidium parvum

BACKGROUND & AIMS

Interferon (IFN)-gamma plays an important role in the immunologic control of infection by the protozoan enteropathogen Cryptosporidium parvum. We tested the hypothesis that IFN-gamma may directly inhibit infection of enterocytes by this pathogen.

METHODS

HT-29, Caco-2, and H4 human enterocyte cell lines were grown in monolayers and incubated with IFN-gamma before exposure with C. parvum. IFN-gamma receptor expression in the cell lines was determined by Western blot analysis.

RESULTS

IFN-gamma inhibited C. parvum infection of both HT-29 and Caco-2 cells but not H4 cells. Response to IFN-gamma was related to the expression of the IFN-gamma receptor in the respective cell lines. The effect of IFN-gamma was partially reversed by inhibition of the JAK/STAT signaling pathway. IFN-gamma mediated its action by at least 2 mechanisms: (1) inhibition of parasite invasion and (2) by modification of intracellular Fe(2+) concentration. No role for tryptophan starvation or nitric oxide synthase activity was found. TNF-alpha and IL-1beta also had anti-C. parvum activity but had no synergistic effect with IFN-gamma.

CONCLUSIONS

IFN-gamma directly induces enterocyte resistance against C. parvum infection; this observation may have important consequences for our understanding of the mucosal immune response to invasive pathogens.

Host cell-mediated responses to infection with Cryptosporidium

The coccidian Cryptosporidium infects epithelial cells of a variety of vertebrate hosts and is the causative agent of cryptosporidiosis. In mammals, including humans and domestic animals, C. parvum infects the gastrointestinal tract producing an acute watery diarrhoea and weight loss. CD4+ T-cell-deficient hosts have increased susceptibility to infection with the parasite and may develop severe life-threatening complications. The host responses which induce protective immunity and contribute to pathogenesis are poorly understood. In the immunological control of infection, recent studies with murine infection models suggest that IFN-gamma plays a key role in a partially protective innate immunity against infection identified in immunocompromised mice and also in the elimination of infection mediated by CD4+ T-cells. At the mucosal level, CD4+ intraepithelial lymphocytes are involved in the control of cryptosporidial infection, acting at least in part through production of IFN-gamma which has a direct inhibitory effect on parasite development in enterocytes. Primary infection of ruminants induces an intestinal inflammatory response in which increased numbers of various T-cell subpopulations appear in the villi. In addition, infection results in increased intestinal expression of pro-inflammatory cytokines such as IL-12, IFN-gamma and TNF-alpha. Because these cytokines appear to be important in the aetiology of inflammatory bowel disease, it is possible that they are involved in the mucosal pathogenesis of cryptosporidiosis.

Gut intraepithelial lymphocytes and immunity to Coccidia

Little is known about the physiological functions of the intra-epithelial lymphocytes (IELs) of mucosal tissues, including their role in immunity to infection. Most IELs are T cells, but their surface phenotype and activation characteristics are different from those of peripheral T cells. Here, Vincent McDonald outlines the distinctive features of IELs and presents evidence, particularly from studies of Coccidia, that these cells have an important role in the control of intracellular infection at the mucosal surface.

The characteristics of asthma education programs within New South Wales

The aim of the study was to examine the characteristics of asthma education programs within NSW. A cross-sectional questionnaire survey concerning the aims and characteristics of 42 asthma education programs was administered to members of the Asthma Educators Association (AEA) of NSW. While most programs sought to improve asthma knowledge (78%), only a small number sought to improve asthma management skills (38%), asthma control (33%) and attitudes (10%). Most programs performed one-to-one (69%) education. Medical intervention was under-utilized by most programs and only 4% gave feedback to the referring doctor. Program evaluation was incompletely linked to program aims. There was incomplete evaluation of knowledge gain as an outcome. The study reviewed the characteristics of education programs within NSW Existing programs appropriately employ a variety of educational methods and target a broad range of people with asthma. There remains a need to use a combined approach utilizing education and medical management, and to employ methods to evaluate programs.

Transjugular intrahepatic portosystemic shunt (TIPS) for Budd-Chiari syndrome or portal vein thrombosis: review of indications and problems

OBJECTIVE

The aim of this study was to evaluate the role of transjugular intrahepatic portosystemic shunt (TIPS) in patients who present with portal vein thrombosis (PVT) or Budd-Chiari Syndrome (BCS).

METHODS

Nine patients with recent PVT and four patients with BCS underwent TIPS. The diagnosis was confirmed by color Doppler ultrasound and by angiogram in most patients. Patients were followed clinically and had TIPS checked periodically for patency. The end point was mortality, subsequent surgical shunting or orthotopic liver transplantation (OLT).

RESULTS

TIPS was placed in 13 of 15 (87%) patients with BCS or PVT. The mean decrease in pressure gradient was 56%. Median and mean follow-up were 14 months and 16.9 months. Procedure related complications occurred in two of 13 (15%), both in the PVT group. Direct procedural mortality was one of 13 (8%). The majority of patients with PVT (five of eight) underwent OLT. Of the remaining three, one patient subsequently developed a cavernous transformation of portal vein but is stable, one patient is stable, without further variceal bleeding, and one patient died because of multiple organ failure. In patients with BCS, three of four (75%) did well with TIPS, but one patient required immediate surgical shunting after occlusion of the TIPS. Two patients underwent OLT and the fourth patient is stable 2 yr later but has cirrhosis on biopsy.

CONCLUSIONS

In patients with BCS, TIPS placement is effective and can be used as a bridge to liver transplantation. TIPS in the noncavernous PVT group should only be recommended when cirrhosis and uncontrollable variceal bleeding are present.

Posture, locomotion, spatial orientation, and motion sickness as a function of space flight

This article summarizes a variety of newly published findings obtained by the Neuroscience Laboratory, Johnson Space Center, and attempts to place this work within a historical framework of previous results on posture, locomotion, motion sickness, and perceptual responses that have been observed in conjunction with space flight. In this context, we have taken the view that correct transduction and integration of signals from all sensory systems is essential to maintaining stable vision, postural and locomotor control, and eye-hand coordination as components of spatial orientation. The plasticity of the human central nervous system allows individuals to adapt to altered stimulus conditions encountered in a microgravity environment. However, until some level of adaptation is achieved, astronauts and cosmonauts often experience space motion sickness, disturbances in motion control and eye-hand coordination, unstable vision, and illusory motion of the self, the visual scene, or both. Many of the same types of disturbances encountered in space flight reappear immediately after crew members return to earth. The magnitude of these neurosensory, sensory-motor and perceptual disturbances, and the time needed to recover from them, tend to vary as a function of mission duration and the space travelers prior experience with the stimulus rearrangement of space flight. To adequately chart the development of neurosensory changes associated with space flight, we recommend development of enhanced eye movement systems and body position measurement. We also advocate the use of a human small radius centrifuge as both a research tool and as a means of providing on-orbit countermeasures that will lessen the impact of living for long periods of time with out exposure to altering gravito-inertial forces.

Characterisation of a Cryptosporidium parvum-specific cDNA clone and detection of parasite DNA in mucosal scrapings of infected mice

A cDNA library was constructed using total RNA extracted from oocysts and sporozoites of the protozoan parasite Cryptosporidium parvum. The expression library was screened with an anti-C. parvum antiserum and a clone, Cp3.4, with a 2043 bp insert, was extracted. Southern blot analysis demonstrated a single copy gene that was located on a 1.6 Mb chromosome. The gene was found to be C. parvum specific as Cp3.4 did not cross-hybridise with chromosomal DNA from three other apicomplexan parasites. The cDNA encodes a polypeptide with a predicted membrane helix at its C-terminal end which is flanked by stretches of acidic amino acids. Overall, the polypeptide has a low isoelectric point (pI) of 3.94. A total of 21 glycine/proline-rich octapeptides were identified which represented variations of a consensus sequence. The function of this protein is yet unknown. Using Cp3.4-specific PCR primers, this C. parvum gene could be amplified from as little as 0.8 pg of purified parasite DNA in a single polymerase chain reaction. Less than 0.1 ng of DNA from the ileum mucosa of immunosuppressed adult mice that had been infected with C. parvum oocysts was required to detect the parasites. In non-immunosuppressed mice that were infected and which did not shed oocysts in numbers detectable by acid-fast staining, parasite development could be detected in 25 ng of total mucosa DNA. This PCR approach may be a valuable technique for the detection of parasite infections in situations where conventional staining methods fail, such as chronic, low-grade infections or the detection of parasites in potential reservoir hosts.

Comparative pharmacokinetics of three doses of percutaneous dihydrotestosterone gel in healthy elderly men--a clinical research center study

Twenty-five men, 60-80 yr old, participated in a pharmacokinetic study to compare three doses (16, 32, and 64 mg/day, n = 8 or 9 in each group) of 5alpha-dihydrotestosterone (DHT) gel (0.7% hydroalcoholic gel with 2.3 g gel delivering 16 mg DHT) applied daily over one upper arm (16 mg); both arms and shoulders (32 mg); and bilateral arms, shoulders, and upper abdomen (64 mg), respectively. Multiple blood samples for the pharmacokinetic profile for DHT and testosterone (T) were drawn over a 24-h period before application, after first application, and after 14 days of daily application of DHT gel. Additional blood samples for DHT, T, and estradiol were obtained 24 h after application on days 3, 5, 7, and 11 and after discontinuation of DHT gel for 3, 5, 7, and 14 days (days 17, 19, 21, and 28 after first instituting treatment). No skin irritation was observed in any of the subjects. Before treatment, mean serum DHT and T levels were not different among the three dose groups. The serum DHT levels increased gradually after gel application on the first day, reaching a plateau between 12-18 h. During the 14 days of daily application of DHT gel, the mean baseline DHT levels reached steady state by day 2 or 3 and were elevated considerably above baseline. Mean serum DHT levels varied between 8-11, 12-17, and 14-24 nmol/L in the 16-, 32-, and 64-mg groups, respectively. The area under curve (AUC) of serum DHT levels over 24 h on day 14 were 6.0-, 6.9-, and 16.1-fold above pretreatment levels for the three doses. Concomitant with the increase in serum DHT levels, the AUC produced by endogenous serum T levels decreased to 75, 56, and 36% of baseline after 14 days of 16, 32, and 64 mg/day DHT gel. Similar patterns of decreases in AUC of serum estradiol levels were found. The calculated mean total androgen levels (T + DHT) rose with DHT gel application in all groups (P < 0.0001) on both days 1 and 14. We conclude that the three doses of DHT gel tested might provide adequate androgen replacement in hypogonadal men at the low, middle, and high physiological androgen (T + DHT) range.

Differentiation between human and animal isolates of Cryptosporidium parvum using molecular and biological markers

Isolates of Cryptosporidium parvum obtained from infected humans, calves and lambs were typed using arbitrary primed polymerase chain reaction (AP-PCR) and isoenzyme electrophoresis. All animal isolates tested (n = 17) showed similar profiles in AP-PCR and isoenzyme typing. In AP-PCR assays, 9 out of 15 human isolates showed a distinct "human" profile while the remaining 6 isolates showed the "animal" profile. In isoenzyme typing, 5 human isolates which had shown "human" profiles in AP-PCR demonstrated a unique isoenzyme banding pattern, while 2 isolates which had shown "animal" profiles in AP-PCR gave the "animal" banding pattern. In a murine model of infection, all four animal isolates tested were highly infective but only one of four human isolates identified as "human" type in the AP-PCR and isoenzyme typing systems was infective. The good correlation between the data from the different typing systems supports the hypothesis that there are genetically distinct human and animal populations of C. parvum.

Androgen-behavior correlations in hypogonadal men and eugonadal men. II. Cognitive abilities

Sex-typed cognitive abilities were assessed in 33 hypogonadal men receiving testosterone replacement therapy, 10 eugonadal men receiving testosterone in a male contraceptive clinical trial, and 19 eugonadal men not administered testosterone. Prior to and following hormone administration, men completed four tests measuring visuospatial ability, three tests measuring verbal fluency, two tests measuring perceptual speed, and a measure of verbal memory. Group differences in testosterone levels were unrelated to performance on most cognitive measures, including visuospatial ability. Relative to other men, hypogonadal men were impaired in their verbal fluency and showed improved verbal fluency following treatment with testosterone. These data suggest that testosterone may enhance verbal fluency in hypogonadal men and support the general hypothesis that current levels of testosterone may influence some aspects of cognitive function.

Graded testosterone infusions distinguish gonadotropin negative-feedback responsiveness in Asian and white men--a Clinical Research Center study

Recently, multicenter clinical trials to determine male contraceptive efficacy disclosed that testosterone-induced suppression of spermatogenesis to azoospermia occurred in about 90% of Asian but only 60-70% of white men. To test whether there are ethnic differences in the sensitivity of gonadotropin secretion to suppression by testosterone, we administered constant infusions of testosterone at 0, 7, 14, and 28 mg/1.7 m2 x 24 h i.v. for 48 h to 9 Asian and 8 white normal male volunteers (22-42 yr old). During the last 8 h of each infusion dose, 10-min frequent blood sampling was carried out for later LH and FSH measurements by sensitive fluoroimmunoassays. Analyses of LH secretory pulses showed that LH pulse width, height, area, and total area under the curve (LH concentration vs. time) were significantly more suppressed in Asians than in whites during the lowest infusion dose of testosterone. With increasing testosterone dose, the suppression of pulsatile LH secretion was not different in the two ethnic groups. In contrast to pulsatile LH secretion, the responsiveness of pulsatile FSH secretion to exogenous testosterone infusion was not different between the two ethnic groups. At baseline, Asian men had a significantly higher mean number of FSH pulses and mean incremental pulse heights than did white men. Serum inhibin B levels were not distinguishable in the two ethnic groups, but the FSH profiles were quantifiably more irregular (higher approximate entropy) in the Asian volunteers. Our data suggest that, compared with white men, Asian men respond earlier and with more marked suppression of pulsatile LH secretion to ramped testosterone infusions. The elevated basal serum FSH concentrations (and more irregular FSH release pattern) observed in Asian men may suggest a small relative decrease in spermatogenic reserve and/or gonadal negative feedback. Whether these differences contribute to the observed differences in suppression of spermatogenesis in Asians vs. non-Asians in male contraceptive studies is not yet known.

Genetic counselling: information given, recall and satisfaction

The aims of this study are to categorise the key points given in genetic counselling, assess the amount and type of information recalled, and examine the relationships between counsellees' knowledge, satisfaction with information received, the meeting of expectations, concern and anxiety. Because of the variety of consultations, a knowledge questionnaire of the key points was constructed for each individual counsellee, with acceptable inter-rater reliability. The information items judged to be the key points in the consultations were assigned to 13 different content categories. Thirty-two counsellees were sent a questionnaire assessing knowledge and other outcomes two to four weeks after attending a genetic counselling consultation. The mean percentage of key points recalled correctly was 76% (s.d. 17%) with 100% recall for family issues and 68-78% recall for genetic or medical information. Knowledge was not associated with satisfaction with information received nor with level of concern or anxiety following genetic counselling. These results suggest the importance of assessing multiple outcomes of genetic counselling.

Effect of increased scrotal temperature on sperm production in normal men

OBJECTIVE

To determine whether application of polyester-lined athletic supports to bring the testes closer to the abdomen increases scrotal temperature and decreases sperm production.

DESIGN

Prospective clinical study.

SETTING

University academic medical center.

PATIENT(S)

Twenty-one healthy male volunteers.

INTERVENTION(S)

The study consisted of a pretreatment period of 6 weeks, a treatment phase of 52 weeks, and a recovery phase until return to normal sperm production. During the treatment phase, the men wore polyester-lined athletic supports (single layer, double layer, or double layer impregnated with aluminum) throughout the day.

MAIN OUTCOME MEASURE(S)

Semen parameters and sperm function tests.

RESULT(S)

In all three groups of subjects, scrotal temperature was consistently increased by 0.8 to 1 degree C while the subjects were wearing the athletic supports. Mean sperm concentration; sperm motility, morphology, and viability; sperm hyperactivation; and ability of spermatozoa to penetrate zone-free hamster oocytes were not affected by the increase in scrotal temperature.

CONCLUSION(S)

The increase in scrotal temperature induced by polyester-lined athletic supports was insufficient to cause significant suppression of spermatogenesis or alteration of sperm function.