Multi-Exposure Pathway Model to Compare Escherichia coli O157 Risks and Interventions

The relative contributions of exposure pathways associated with cattle-manure-borne Escherichia coli O157:H7 on public health have yet to be fully characterized. A stochastic, quantitative microbial risk assessment (QMRA) model was developed to describe a hypothetical cattle farm in order to compare the relative importance of five routes of exposure, including aquatic recreation downstream of the farm, consumption of contaminated ground beef processed with limited interventions, consumption of leafy greens, direct animal contact, and the recreational use of a cattle pasture. To accommodate diverse environmental and hydrological pathways, existing QMRAs were integrated with novel and simplistic climate and field-level submodels. The model indicated that direct animal contact presents the greatest risk of illness per exposure event during the high pathogen shedding period. However, when accounting for the frequency of exposure, using a high-risk exposure-receptor profile, consumption of ground beef was associated with the greatest risk of illness. Additionally, the model was used to evaluate the efficacy of hypothetical interventions affecting one or more exposure routes; concurrent evaluation of multiple routes allowed for the assessment of the combined effect of preharvest interventions across exposure pathways-which may have been previously underestimated-as well as the assessment of the effect of additional downstream interventions. This analysis represents a step towards a full evaluation of the risks associated with multiple exposure pathways; future incorporation of variability associated with environmental parameters and human behaviors would allow for a comprehensive assessment of the relative contribution of exposure pathways at the population level.

Geometric implications of the tibial wedge osteotomy for the treatment of cranial cruciate ligament disease in dogs

The tibial wedge osteotomy (TWO), a procedure that reduces the tibial plateau slope, has become an established surgical technique for the treatment of cranial cruciate ligament injuries in dogs, yet variation from the desired postoperative tibial plateau slope of 6° has been noted. The objectives of this study were to investigate the geometric implications of this procedure and to identify factors that affect the postoperative angles. The records of 35 consecutive cases that had a TWO performed were reviewed and comparisons were made between the alignment of the cortices and level of the osteotomy using duplicated tracings of a preoperative radiograph. The existing method for calculating the size of wedge to be removed was found to result in a postoperative slope greater than the expected 6°. Our results indicate that the desired postoperative angle is more likely to be achieved if the cranial cortices are aligned and the osteotomy is performed proximally.

Description of a multi-university education and collaborative care child psychiatry access program: New York State's CAP PC

OBJECTIVE

Although, child mental health problems are widespread, few get adequate treatment, and there is a severe shortage of child psychiatrists. To address this public health need many states have adopted collaborative care programs to assist primary care to better assess and manage pediatric mental health concerns. This report adds to the small literature on collaborative care programs and describes one large program that covers most of New York state.

PROGRAM DESCRIPTION

CAP PC, a component program of New York State's Office of Mental Health (OMH) Project TEACH, has provided education and consultation support to primary care providers covering most of New York state since 2010. The program is uniquely a five medical school collaboration with hubs at each that share one toll free number and work together to provide education and consultation support services to PCPs.

METHODS

The program developed a clinical communications record to track information about all consultations which forms the basis of much of this report. 2-week surveys following consultations, annual surveys, and pre- and post-educational program evaluations have also been used to measure the success of the program.

RESULTS

CAP PC has grown over the 6years of the program and has provided 8013 phone consultations to over 1500 PCPs. The program synergistically provided 17,523 CME credits of educational programming to 1200 PCPs. PCP users of the program report very high levels of satisfaction and self reported growth in confidence.

CONCLUSIONS

CAP PC demonstrates that large-scale collaborative consultation models for primary care are feasible to implement, popular with PCPs, and can be sustained. The program supports increased access to child mental health services in primary care and provides child psychiatric expertise for patients who would otherwise have none.

Investigating groundwater flow between Edwards and Trinity aquifers in central Texas

Understanding the nature of communication between aquifers can be challenging when using traditional physical and geochemical groundwater sampling approaches. This study uses two multiport wells completed within Edwards and Trinity aquifers in central Texas to determine the degree of groundwater inter-flow between adjacent aquifers. Potentiometric surfaces, hydraulic conductivities, and groundwater major ion concentrations and Sr isotope values were measured from multiple zones within three hydrostratigraphic units (Edwards and Upper and Middle Trinity aquifers). Physical and geochemical data from the multiport wells were combined with historical measurements of groundwater levels and geochemical compositions from the region to characterize groundwater flow and identify controls on the geochemical compositions of the Edwards and Trinity aquifers. Our results suggest that vertical groundwater flow between Edwards and Middle Trinity aquifers is likely limited by low permeability, evaporite-rich units within the Upper and Middle Trinity. Potentiometric surface levels in both aquifers vary with changes in wet vs. dry conditions, indicating that recharge to both aquifers occurs through distinct recharge areas. Geochemical compositions in the Edwards, Upper, and Middle Trinity aquifers are distinct and likely reflect groundwater interaction with different lithologies (e.g., carbonates, evaporites, and siliceous sediments) as opposed to mixing of groundwater between the aquifers. These results have implications for the management of these aquifers as they indicate that, under current conditions, pumping of either aquifer will likely not induce vertical cross-formational flow between the aquifers. Inter-flow between the Trinity and the Edwards aquifers, however, should be reevaluated as pumping patterns and hydrogeologic conditions change.

Rotation of venus: continuing contradictions

Optical observations of Venus have yielded various values of the rotation period extending from less than one to several hundred days. Radar observations give a retrograde rotation of the solid globe in 244 +/- 2 days. Recent ultraviolet photographs, however, show relatively rapid displacements of clouds in the high atmosphere of Venus which suggest a retrogrode rotation in only 5 days. The two rates seem to be physically incompatible.

Voyager 2 in the uranian system: imaging science results

Voyager 2 images of the southern hemisphere of Uranus indicate that submicrometersize haze particles and particles of a methane condensation cloud produce faint patterns in the atmosphere. The alignment of the cloud bands is similar to that of bands on Jupiter and Saturn, but the zonal winds are nearly opposite. At mid-latitudes (-70 degrees to -27 degrees ), where winds were measured, the atmosphere rotates faster than the magnetic field; however, the rotation rate of the atmosphere decreases toward the equator, so that the two probably corotate at about -20 degrees . Voyager images confirm the extremely low albedo of the ring particles. High phase angle images reveal on the order of 10(2) new ringlike features of very low optical depth and relatively high dust abundance interspersed within the main rings, as well as a broad, diffuse, low optical depth ring just inside the main rings system. Nine of the newly discovered small satellites (40 to 165 kilometers in diameter) orbit between the rings and Miranda; the tenth is within the ring system. Two of these small objects may gravitationally confine the e ring. Oberon and Umbriel have heavily cratered surfaces resembling the ancient cratered highlands of Earth's moon, although Umbriel is almost completely covered with uniform dark material, which perhaps indicates some ongoing process. Titania and Ariel show crater populations different from those on Oberon and Umbriel; these were probably generated by collisions with debris confined to their orbits. Titania and Ariel also show many extensional fault systems; Ariel shows strong evidence for the presence of extrusive material. About halfof Miranda's surface is relatively bland, old, cratered terrain. The remainder comprises three large regions of younger terrain, each rectangular to ovoid in plan, that display complex sets of parallel and intersecting scarps and ridges as well as numerous outcrops of bright and dark materials, perhaps suggesting some exotic composition.

Determinants of passive hip range of motion in adult Greyhounds

OBJECTIVE

To determine the ranges of normal pelvic limb range of motion in adult Greyhound dogs, and to explore which factors influence hip range of motion in a population bred to meet the specific demands of racing. Design A cross-sectional study design.

METHOD

Thirty-two dogs (17 male and 15 female) 13 to 81 months old were randomly selected from a local pool of 160 Greyhounds. Goniometric measurements of hip, stifle and hock range of motion were recorded in triplicate. Signalment information collected included sex, weight and age of each Greyhound. The outcome factors for the study were range of hip flexion and hip extension. The theorised exposures, age, sex, weight, racing history and hock and stifle range of motion, were modelled against the outcome variables by linear regression analysis.

RESULTS

Male dogs were significantly heavier (P < 0.001) and older (P < 0.002) than female dogs. Mean hip flexion was 71.75 degrees and mean hip extension 128.10 degrees. The determinants of hip flexion were sex (P = 0.008) and range of stifle flexion (P = 0.002). Race training did not influence the range of hip flexion in the sample. Determinants of hip extension included range of stifle extension (P = 0.015), history of race training (P = 0.004) and hock flexion. The mean hip extension of raced Greyhounds was 134.95 degrees compared with 121.25 degrees for unraced Greyhounds (mean difference -13.70, 95% confidence interval -18.12, -9.29; P < 0.001).

CONCLUSIONS

This study has reported isolated pelvic limb joint range of motion in the racing Greyhound. Hip range of motion was affected by stifle range of motion, sex and race training. Dogs that had received race training had greater flexibility, possibly due to training having an active stretching role on muscles, tendons and other structures limiting the hip range of motion.

Reduced aerobic capacity and physical functioning in older HIV-infected men

Aerobic capacity and physical functioning decline with age and chronic illness. The extent of physical disability is unknown in older HIV-infected adults, who represent a rapidly growing proportion of HIV/AIDS patients in the United States. We performed functional performance testing including treadmill testing in 32 HIV-infected male veterans aged 40-69 years. Controls were 47 healthy male subjects tested previously in the same exercise laboratory. HIV-infected subjects were classified as younger (40-49 years, n = 12) or older age (50+ years, n = 20). Peak aerobic capacity (VO2peak) was significantly reduced in the older vs. younger HIV subjects [19.1 mL/kg/min +/- 5.7 (mean, SD) vs. 25.2 +/- 4.2, p = 0.01]. VO2peak was reduced 41% +/- 15% (mean, SD) in HIV-infected subjects compared to expected values from age-matched healthy controls. Regression analyses show a similar decline in VO2peak with age in HIV-infected and healthy controls. Mean 6-min walk distance was not significantly different between the HIV-infected age groups, and was reduced only 8% compared to expected values for healthy adults. Current CD4 count and HAART exposure were similar in the two age groups and were not significantly associated with VO2peak. Anemia (HCT <35%) was significantly associated with reduced VO2peak (p = 0.02), but this association was not independent of the effect of age (p = 0.1). We conclude that older HIV-infected adults have markedly impaired aerobic capacity but maintain the capacity to undertake day-to-day activities. Additional physiologic and metabolic testing is needed to measure the effect of HAART toxicity and primary aging on aerobic capacity, and to determine if older HIV-infected adults are at greater risk.

Laparoscopic cholecystectomy for acalculous gallbladder disease

Use of laparoscopic cholecystectomy (LC) to treat patients with symptoms due to gallstone disease is well established. However, use of LC for patients with acalculous gallbladder disease remains controversial. In this study, we examined the use of hepatobiliary iminodiacetic acid (HIDA) scans with cholecystokinin (CCK) infusion to identify patients with acalculous gallbladder disease who would benefit from LC. From December 1991 to February 1997, 4480 patients underwent cholecystectomy at Baylor University Medical Center, including 72 patients who underwent LC for acalculous disease following preoperative HIDA scan. We retrospectively analyzed their preoperative symptoms and workup. Follow-up was obtained by telephone questionnaire in 59 of 72 patients (82%). Overall, 48 of 59 patients (82%) reported an excellent outcome following LC. We found no significant difference in outcome in patients who underwent HIDA scan with CCK infusion, regardless of gallbladder ejection fraction or exacerbation of symptoms caused by the infusion. Preoperative symptom complex was also not predictive of postoperative outcome. LC is an effective treatment for patients with acalculous gallbladder disease. A preoperative HIDA scan with CCK infusion does not accurately predict treatment success or failure. Patients with a normal ejection fraction and absence of symptoms from a HIDA scan can still have excellent relief of symptoms after LC.

Comparison of Methods to Estimate Physical Activity and Energy Expenditure in African American Children

Low levels of physical activity and high levels of obesity among children in the US is a public health concern. Accurate methods to estimate physical activity are needed to determine the efficacy of intervention programs and to explore relationships between daily physical activity and health status in children. The purpose of this study was to compare the simultaneous use of the Tritrac-R3D accelerometer (Tritrac), Yamax SW-200 Digiwalker step-counter (Digiwalker) and the Self Administered Physical Activity Checklist (SAPAC) to assess physical activity (PA) and energy expenditure (EE) in African-American children aged 7 to 10 years, using the doubly-labeled water (DLW) as the criterion method. Physical activity and energy expenditure were measured over seven consecutive days under free-living conditions. Resting metabolic rate and peak VO(2) were measured before the experimental period. There was no difference in physical activity energy expenditure (PAEE) measured by Tritrac or DLW (p > 0.05). Tritrac activity counts were highly correlated with DLW-PAEE (r = 0.81). High correlations between Digiwalker and DLW were observed when body weight was considered. A low correlation (r = 0.49) was observed between the physical activity energy expenditure by SAPAC and DLW. In conclusion, with some limitations the Tritrac and Digiwalker can provide useful and accurate information about PA and EE in 7- to 10-year-old children.

Self-expanding metal stents in the palliation of malignant dysphagia: outcome analysis in 100 consecutive patients

SUMMARY. Patients with inoperable esophageal malignancy often undergo palliative self-expanding metal stent insertion. This analysis of cases shows that although such stents provide good palliation of dysphagia, complications frequently occur. Complications reported were pain after insertion, bleeding, food bolus impaction, stent migration and increased gastroesophageal reflux. Furthermore, in patients with esophageal adenocarcinoma, survival was less if the distal end of the stent entered the stomach, rather than lying entirely within the esophagus. Reduced survival, in this group with gastroesophageal junction tumors, may be a result of increased gastroesophageal reflux leading to pulmonary aspiration. Stents incorporating an antireflux valve have been shown to reduce symptomatic gastroesophageal reflux. It may be that such valves offer a survival advantage where stent insertion ablates the function of the lower esophageal sphincter. Further studies are needed to assess the role of antireflux stents on survival in patients with gastroesophageal junction tumors.

Prehospital 80-LAD mapping: Does it add significantly to the diagnosis of acute coronary syndromes?

Early detection of acute myocardial infarction (MI) is vital in the management of acute coronary syndromes (ACS). Hence we compared the diagnostic capability of the standard 12-lead electrocardiogram (ECG) with the 80-lead ECG body surface map (BSM) prehospital.

METHODS

Consecutive patients (n = 294) presenting prehospital with ischemic type chest pain were included. All had an ECG and BSM pretreatment and a baseline and 12-hour cardiac troponin-T or I (cTnT or cTnI). Acute MI was defined as cTnT > 0.09 or cTnI > 0.1 ng/mL. Acute MI on the BSM was defined as ST elevation measured at the J-point, > or = 1 mm inferior/right ventricular/high right anterior/lateral regions, > or = 2 mm anterior region, > or = 0.5 mm posterior region.

RESULTS

Acute MI occurred in 182/294 (62%) based on cTnT or I. ST elevation on the standard ECG predicted acute MI in 103 (sensitivity 57%, specificity 94%; c-statistic 0.73). The optimal model for the standard ECG included ST elevation, summed ST depression and past history of MI (c-statistic 0.82; Chi-square (Wald) 120.7, 3df). The BSM predicted acute MI in 146 (sensitivity 80%, specificity 92%; c-statistic 0.86). The optimal model for the BSM included BSM criteria for acute MI and past history of MI (c-statistic 0.91; Chi-square (Wald) 180.3, 2df).

CONCLUSION

The 80-lead BSM is superior to the standard 12-lead ECG in predicting acute MI prehospital.

Role of dietary copper in enhancing resistance to Escherichia coli mastitis

The role of dietary copper in enhancing resistance to Escherichia coli mastitis was investigated in first-lactation heifers. Twenty-three primigravid Holstein heifers were maintained on a basal (6.5 ppm copper; -Cu) diet or a diet supplemented (20 ppm) with copper sulfate (+Cu) beginning 60 d prepartum through 42 d of lactation. Liver biopsies and blood samples were taken for liver and blood minerals and plasma ceruloplasmin. Milk samples were taken weekly postpartum for bacteriology. The overall mean liver Cu concentration was about threefold higher, and the overall mean plasma Cu concentration was greater in the +Cu group than the -Cu group. At 34 d of lactation, one pathogen-free quarter per animal was infused with 22 cfu of Escherichia coli strain 727. Plasma Cu was greater at -24, 0, 18, 24, 36, 96, 192, and 240 h relative to infusion for +Cu animals. Plasma Zn concentration was higher at 24 h for the +Cu group. Milk bacterial count (log10 cfu/ml) was lower at 12, 18, and 48 h for the +Cu group. Somatic cell count (log10/ml) was lower at 18 h in +Cu animals. Clinical score at 24 h was lower for +Cu cows, while at 144 h, clinical score was lower for -Cu cows. Rectal temperature was lower at 18 h for the +Cu group. Plasma ceruloplasmin and Fe, dry matter intake and milk production did not differ. Copper supplementation reduced the clinical response during experimental E. coli mastitis, but duration was unchanged.

First Report of Peanut stunt virus in Perennial Peanut in North Florida and Southern Georgia

In spring 2001, symptoms similar to aphid-vectored peanut stunt disease caused by Peanut stunt virus (PSV) were observed on perennial peanut (Arachis glabrata) cv. Floragraze in Jackson and Gulf counties, FL and Lowndes County, GA. Symptoms observed in commercial hay fields and at the North Florida Research and Education Center in Marianna and Quincy included malformed leaves, plant chlorosis, leaf mottling, and stunted plants, which resulted in reduced foliage yield. Leaf symptoms were visible throughout the growing season. Stunting was more common in spring and early summer. No symptoms were seen on rhizomes. Diagnosis of PSV (genus Cucumovirus) from symptomatic leaves and rhizome materials of 12 plants was confirmed by a direct antigen-coated enzyme-linked immunosorbent assay (DAC-ELISA). ELISA tests were repeated three times. Antibodies specific to the Clemson isolate, serotype E, were obtained from Clemson University, Clemson, SC. DAC-ELISA (1) values of 0.1 A₄₀₅ above the healthy control for perennial peanut were considered positive for foliage and rhizome material tested. ELISA values ranged from 0.4 to 2.1. The mean ELISA value of the positive controls was 2.65. Symptomatic plants were also tested with ELISA using available antibodies from Agdia Inc., Elkart, IN, for Tomato spotted wilt virus, from ATCC for Peanut stripe virus, and from Clemson University (Cowpea isolate) for Cucumber mosaic virus, but all results were negative. To our knowledge, this is the first report of PSV on perennial peanut in Florida and southern Georgia. At this time, it is not known what role perennial peanut may play as a reservoir of the virus in the vicinity of peanut fields. Little is known about the potential for forage production loss and stand longevity. Next season, molecular detection techniques and epidemiological studies on peanut and perennial peanut will be conducted to ascertain the incidence and possible impact of PSV in Georgia and Florida. Reference: (1) A. G. Gillaspie, Jr. et al. Plant Dis. 79:388, 1995.

The early years of chiropractic in California: the people versus C.D. Greenall

During the dawning years of the chiropractic profession, many of our brethren ventured forth to the fertile land of California to establish thriving practices and schools. These early pioneers practiced outside the laws of California, and many became subject to persecution by the authorities. With these persecutions came counter-attacks which shaped the future battles to be waged. Some of these counter-attacks were successful; most were not. These early laws and challenges influence our practice rights through the present and will continue to do so. C.D. Greenall, D.C., stood up to the medical authorities and won his case at the California Supreme Court fifteen years before the California electorate approved the Chiropractic Initiative Act in 1922.

Molecular replacement by evolutionary search

Stochastic search algorithms can be used to perform rapid six-dimensional molecular-replacement searches. A molecular-replacement procedure has been developed that uses an evolutionary algorithm to simultaneously optimize the orientation and position of a search model in a unit cell. Here, the performance of this algorithm and its dependence on search model quality and choice of target function are examined. Although the evolutionary search procedure is capable of finding solutions with search models that represent only a small fraction of the total scattering matter of the target molecule, the efficiency of the search procedure is highly dependent on the quality of the search model. Polyalanine models frequently provide better search efficiency than all-atom models, even in cases where the side-chain positions are known with high accuracy. Although the success of the search procedure is not highly dependent on the statistic used as the target function, the correlation coefficient between observed and calculated structure-factor amplitudes generally results in better search efficiency than does the R factor. An alternative stochastic search procedure, simulated annealing, provides similar overall performance to evolutionary search. Methods of extending the evolutionary search algorithm to include internal optimization, selection and construction of the search model are now beginning to be investigated.

Postnatal passive immunization of neonatal macaques with a triple combination of human monoclonal antibodies against oral simian-human immunodeficiency virus challenge

To develop prophylaxis against mother-to-child human immunodeficiency virus (HIV) transmission, we established a simian-human immunodeficiency virus (SHIV) infection model in neonatal macaques that mimics intrapartum mucosal virus exposure (T. W. Baba et al., AIDS Res. Hum. Retroviruses 10:351-357, 1994). Using this model, neonates were protected from mucosal SHIV-vpu(+) challenge by pre- and postnatal treatment with a combination of three human neutralizing monoclonal antibodies (MAbs), F105, 2G12, and 2F5 (Baba et al., Nat. Med. 6:200-206, 2000). In the present study, we used this MAb combination only postnatally, thereby significantly reducing the quantity of antibodies necessary and rendering their potential use in humans more practical. We protected two neonates with this regimen against oral SHIV-vpu(+) challenge, while four untreated control animals became persistently infected. Thus, synergistic MAbs protect when used as immunoprophylaxis without the prenatal dose. We then determined in vitro the optimal MAb combination against the more pathogenic SHIV89.6P, a chimeric virus encoding env of the primary HIV89.6. Remarkably, the most potent combination included IgG1b12, which alone does not neutralize SHIV89.6P. We administered the combination of MAbs IgG1b12, 2F5, and 2G12 postnatally to four neonates. One of the four infants remained uninfected after oral challenge with SHIV89.6P, and two infants had no or a delayed CD4(+) T-cell decline. In contrast, all control animals had dramatic drops in their CD4(+) T cells by 2 weeks postexposure. We conclude that our triple MAb combination partially protected against mucosal challenge with the highly pathogenic SHIV89.6P. Thus, combination immunoprophylaxis with passively administered synergistic human MAbs may play a role in the clinical prevention of mother-to-infant transmission of HIV type 1.

Passive immunization against oral AIDS virus transmission: an approach to prevent mother-to-infant HIV-1 transmission?

To develop immunoprophylaxis regimens against mother-to-child human immunodeficiency virus type 1 (HIV-1) transmission, we established a simian-human immunodeficiency virus (SHIV) model in neonatal macaques that mimics intrapartum mucosal virus exposure (T.W. Baba, J. Koch, E.S. Mittler et al: AIDS Res Hum Retroviruses 10:351-357, 1994). We protected four neonates from oral SHIV-vpu+ challenge by ante- and postpartum treatment with a synergistic triple combination of immunoglobulin (Ig) G1 human anti-HIV-1 neutralizing monoclonal antibodies (mAbs) (T.W. Baba, V. Liska, R. Hofmann-Lehmann et al: Nature Med 6:200-206, 2000), which recognize the CD4-binding site of Env, a glycosylation-dependent gp120, or a linear gp41 epitope. Two neonates that received only postpartum mAbs were also protected from oral SHIV-vpu+ challenge, indicating that postpartum treatment alone is sufficient. Next, we evaluated a similar mAb combination against SHIV89.6P, which encodes env of primary HIV89.6. One of four mAb-treated neonates was protected from infection and two maintained normal CD4+ T-cell counts. We conclude that the epitopes recognized by the three mAbs are important determinants for achieving protection. Combination immunoprophylaxis with synergistic mAbs seems promising to prevent maternal HIV-1 transmission in humans.

Assessment of hunger and appetite and their relationship to food intake in persons with HIV infection

Assessments of hunger and/or appetite are common methods of screening for development of illness-related anorexia. There are limited data to determine whether these methods predict actual food intake in persons with HIV disease. Therefore, the authors examined the relationship between self-reported food intake and subjective ratings of hunger and appetite in 31 adults with HIV infection. Participants also indicated presence of additional factors that can decrease amount of food eaten. Subjective ratings of appetite and hunger correlated with each other but not with food intake. Twenty-four additional factors that can affect food intake were reported to be present. The most common were illness-related and factors such as eating with friends or family. These results indicate that measures of hunger and appetite are not sufficient to screen for decreased food intake. Additional factors that can affect food intake should also be included in a comprehensive assessment of adults with HIV infection.

Aerobic exercise: effects on parameters related to fatigue, dyspnea, weight and body composition in HIV-infected adults

OBJECTIVES

The purpose of the study was to examine the effects of aerobic exercise on physiological fatigue (time on treadmill), dyspnea [rate of perceived exertion (RPE) and forced expiratory volume at 1 s (FEV1)], weight, and body composition in HIV-1-infected adults (200-499 x 106 CD4+ cells/l).

DESIGN

The study was a randomized, wait-listed, controlled clinical trial of aerobic exercise in HIV-1-infected adults on signs and symptoms associated with HIV-1 infection or its treatment.

METHODS

Sixty subjects were recruited and randomized to two groups. Experimental subjects completed a 12-week supervised exercise program. Control subjects continued usual activity from baseline to week 12 and were then were enrolled in the exercise program.

RESULTS

At baseline, the groups were similar in age, weight, body mass index [mean body mass index (BMI) > 27], time since diagnosis, number of symptoms, CD4+ cell count, and number on protease inhibitor therapy (n = 7). Despite disproportionate attrition from the exercise group (38%), exercise subjects were able to remain on the treadmill longer, lost weight, decreased BMI, subcutaneous fat, and abdominal girth when compared to controls. The improvement in weight and body composition occurred without a decrease in kilocalories consumed. Exercise did not seem to have an effect on RPE, a surrogate for dyspnea, and FEV1. There was no significant difference in either the change in CD4+ cell count, percentage or copies of plasma HIV-1 RNA between groups.

CONCLUSIONS

We conclude that supervised aerobic exercise training safely decreases fatigue, weight, BMI, subcutaneous fat and abdominal girth (central fat) in HIV-1-infected individuals. It did not appear to have an effect on dyspnea.

The Influence of Sex, Gender, Self-Discrepancies, and Self-Awareness on Anger and Verbal Aggressiveness Among U.S. College Students

Among a sample of 445 U.S. college students, the authors examined the extent to which individual differences (e.g., sex, gender, self-discrepancies, self-awareness) explained anger tendencies and verbal aggressiveness. Regression analyses showed that (a) the tendency to repress anger (anger-in) was explained by masculinity, desire to be masculine, and public self-awareness, R2 = .19, F(11, 433) = 8.44, p < .001; (b) the tendency to express anger (anger-out) was explained by sex, masculinity, and public self-awareness, R2 = .17, F(11, 433) = 7.38, p < .001; and (c) willingness to be verbally aggressive was explained by sex, femininity, and private self-awareness, R2 = .32, F(11, 433) = 16.94, p < .001. In addition, different types of individual difference variables accounted for anger tendencies and verbal aggressiveness across sex and gender categories, suggesting that anger and verbal aggressiveness may be driven by different psychological processes across types of participants.

Identification of genes involved in human urothelial cell-matrix interactions: implications for the progression pathways of malignant urothelium

Interactions between epithelial cells and the extracellular matrix are central to tissue homeostasis and have a dynamic role in tissue remodeling and repair. Regulation of these pathways is balanced by positive and negative feedback elements, many of which have been implicated in the pathways of malignant progression. We have used differential display to identify genes that are up-regulated in normal human urothelial cells in response to exposure to extracellular matrix proteins (Matrigel) in vitro. This approach has identified genes that have key roles in cell-cell and cell-matrix interactions and that have been implicated in the progression of carcinomas of urothelial or other epithelial cell origins. One confirmed but unknown differentially expressed sequence was used to isolate a full-length gene, MIG-C4, from a human urothelial cDNA library. This gene was found to encode a novel urokinase plasminogen-activator receptor-like member of the Ly-6 family of glycosyl-phosphatidylinositol-anchored glycoproteins, and was identified as the human homologue of the rat metastasis-associated C4.4A gene. By in situ hybridization, MIG-C4 was expressed variably in normal urothelium and intensely in the tumor component of some noninvasive superficial lesions and in invasive and metastatic urothelial cancers. Thus, our approach has identified previously nonimplicated gene products involved in normal urothelium-matrix interactions that could be tumor-invasion or suppressor-gene targets in the development of invasive and metastatic tumor phenotypes.

Persistence of infectious HIV on follicular dendritic cells

Follicular dendritic cells (FDCs) trap Ags and retain them in their native state for many months. Shortly after infection, HIV particles are trapped on FDCs and can be observed until the follicular network is destroyed. We sought to determine whether FDCs could maintain trapped virus in an infectious state for long periods of time. Because virus replication would replenish the HIV reservoir and thus falsely prolong recovery of infectious virus, we used a nonpermissive murine model to examine maintenance of HIV infectivity in vivo. We also examined human FDCs in vitro to determine whether they could maintain HIV infectivity. FDC-trapped virus remained infectious in vivo at all time points examined over a 9-mo period. Remarkably, as few as 100 FDCs were sufficient to transmit infection throughout the 9-mo period. Human FDCs maintained HIV infectivity for at least 25 days in vitro, whereas virus without FDCs lost infectivity after only a few days. These data indicate that HIV retained on FDCs can be long lived even in the absence of viral replication and suggest that FDCs stabilize and protect HIV, thus providing a long-term reservoir of infectious virus. These trapped stores of HIV may be replenished with replicating virus that persists even under highly active antiretroviral therapy and would likely be capable of causing infection on cessation of drug therapy.

DNA adduct measurements, cell proliferation and tumor mutation induction in relation to tumor formation in B6C3F1 mice fed coal tar or benzo[a]pyrene

Coal tar is a complex mixture containing hundreds of compounds, at least 30 of which are polycyclic aromatic hydrocarbons, including the carcinogen benzo[a]pyrene (BaP). Although humans are exposed to complex mixtures on a daily basis, the synergistic or individual effects of components within a mixture on the carcinogenic process remain unclear. We have compared DNA adduct formation and cell proliferation in mice fed coal tar or BaP for 4 weeks with tumor formation in a 2 year chronic feeding study. Additionally, we have analyzed tumor DNA for mutations in the K-ras, H-ras and p53 genes. In the forestomach of mice fed either coal tar or BaP an adduct indicative of BaP was detected, with adduct levels increasing in a dose-responsive manner. K-ras mutations were detected in the forestomach tumors, with the incidence being similar in mice fed coal tar or BaP. These results suggest that the BaP within coal tar is associated with forestomach tumor induction in coal tar-fed mice. DNA adduct levels in the small intestine were not predictive of tumor incidence in this tissue; instead, the tumors appeared to result from compound-induced cell proliferation at high doses of coal tar. K-ras mutations were detected in lung tumors. Since lung tumors were not increased by BaP, coal tar components other than BaP appear to be responsible for the tumors induced in this tissue. H-ras mutations, primarily occurring at codon 61, were the most common mutation observed in liver tumors induced by coal tar. Since this mutation profile is observed in spontaneous hepatic tumors, components in the coal tar may be promoting the expansion of pre-existing lesions.

Rings in the Planetesimal Disk of beta Pictoris

The nearby main-sequence star beta Pictoris is surrounded by an edge-on disk of dust produced by the collisional erosion of larger planetesimals. Here we report the discovery of substructure within the northeast extension of the disk midplane that may represent an asymmetric ring system around beta Pic. We present a dynamical model showing that a close stellar flyby with a quiescent disk of planetesimals can create such rings, along with previously unexplained disk asymmetries. Thus we infer that beta Pic's planetesimal disk was highly disrupted by a stellar encounter in the last hundred thousand years.

Continuous handrail support, oxygen uptake, and heart rate in women during submaximal step treadmill exercise

Past research suggests that continuous handrail support during exercise attenuates physiologic responses to exercise and reduces aerobic benefits; however, this phenomenon has not been systematically studied in women exercising on the step treadmill. The effects of three levels of handrail support (continuous light, continuous very light, or no handrail support) on oxygen uptake and heart rate during step treadmill exercise were examined in 15 healthy women. Measures were obtained during 6 bouts of exercise, 3 bouts at 25 steps/min followed by 3 bouts at 33 steps/min. At both step rates, mean oxygen uptake was significantly reduced during continuous light and continuous very light handrail support as compared with no handrail support, and mean heart rate was significantly reduced during continuous light versus no handrail support. At 25 steps/min only, mean heart rate was significantly reduced during continuous very light versus no handrail support. Findings indicate that women who use even continuous light or continuous very light handrail support attenuate physiologic responses during step treadmill exercise, thereby reducing aerobic requirements and gaining suboptimal benefits from exercise.

Ethical and methodologic benefits of using a reflexive journal in hermeneutic-phenomenologic research

PURPOSE

To illustrate the importance of considering the researcher's written reflections on the qualitative research process as a valuable source of data and as a means of enhancing ethical and methodologic rigour.

ORGANIZING CONSTRUCT

Excerpts from the researcher's reflexive journal are presented as evidence of an audit trail. Ethical and methodologic concerns arising during the research process are outlined and the value of reflecting on these issues is addressed.

METHODS

A hermeneutic-phenomenologic study, conducted in Scotland, included in-depth interviews with six problem drinkers to explore the lived experience of their suffering. The researcher was considered to be a primary data-collection tool, whose reflections on the research process added to the contextual richness of the study. For an interpretative approach to data analysis, the researcher found metaphors to convey the participants' stories to a new audience. This intuitive, creative process was analysed and reported in the reflexive journal.

CONCLUSIONS

The researcher's self-awareness, fostered by the use of a reflexive journal, is mirrored by the participants' ability to reflect on the final interpretation of their stories and on the therapeutic benefits of the research process. The researcher's reflexive journal reveals previously hidden contextual information which enhances the prime ethical and methodologic aim of the study--to understand the lived experience of suffering by problem drinkers.

Sequence specificity of Hprt lymphocyte mutation in rats fed the hepatocarcinogen 2-acetylaminofluorene

Rats fed the hepatocarcinogen 2-acetylaminofluorene (2-AAF) have a low, but significantly increased, frequency of lymphocyte Hprt mutants. In this study, mutants from 2-AAF-fed and control F344 rats were examined for mutations in the Hprt gene in order to determine if the 2-AAF treatment resulted in an agent-specific mutation profile. The most common mutation from 2-AAF-treated rats was G:C-->T:A transversion (32% of all mutations) followed by 1-basepair (bp) deletion (19%); there were very few (5%) G:C-->A:T transitions. Among mutations from control rats, G:C-->A:T transition was the most common (43%), and there were very few G:C-->T:A transversions (5%) and no 1-bp deletions. The profile of mutations from 2-AAF-fed rats was significantly different from control rats (P = 0.003) and was consistent with the types of mutations produced by 2-AAF in vitro. The results of this study indicate that even weak mutational responses in the lymphocyte Hprt assay are capable of producing mutation profiles that reflect the DNA damage inducing them.

Thomas Henry Storey, D.O., D.C. 1843 to 1923

Who was Thomas Henry Storey? Dedicated healer or charlatan? A danger to his patients or hero to the profession? He graduated from the Palmer School and Infirmary of Chiropractic in 1901. One of the largest chiropractic colleges, the Los Angeles College of Chiropractic, would be founded by one of his patients in 1910 and incorporated in 1911. He led the founder of chiropractic on his first expedition to Los Angeles. Thomas' seventy-nine year life span took him from Canada through the north central United States to the West Coast from Washington to California and south into Mexico. He was, at various times, a taxidermist, a farmer and, in later years, a rancher. He studied and practiced many types of healing and even operated a chiropractice school for a time. He invented the most ubiquitous of all chiropractic equipment, the bifid table. Whether he desired it or not, Thomas was often thrust into the spotlight, usually under less than admirable circumstances. Even in death, the remnants of his life remained a complicated morass that took sixteen years to resolve in the courts. It is hoped this article will shine some light on a colorful chiropractic pioneer who has been shrouded in a veil of mystery.

The Circumstellar Disk of HD 141569 Imaged with NICMOS

Coronagraphic imaging with the Near-Infrared Camera and Multiobject Spectrometer on the Hubble Space Telescope reveals a large, approximately 400 AU (4&arcsec;) radius, circumstellar disk around the Herbig Ae/Be star HD 141569. A reflected light image at 1.1 µm shows the disk oriented at a position angle of 356&j0;+/-5&j0; and inclined to our line of sight by 51&j0;+/-3&j0;; the intrinsic scattering function of the dust in the disk makes the side inclined toward us, the eastern side, brighter. The disk flux density peaks 185 AU (1&farcs;85) from the star and falls off to both larger and smaller radii. A region of depleted material, or a gap, in the disk is centered 250 AU from the star. The dynamical effect of one or more planets may be necessary to explain this morphology.

Hprt lymphocyte mutant frequency in relation to DNA adduct formation in rats fed the hepatocarcinogen 2-acetylaminofluorene

The lymphocyte hypoxanthine-guanine phosphoribosyltransferase (Hprt) assay is frequently used as a biomarker for the exposure of both humans and laboratory animals to potentially carcinogenic agents. To obtain information concerning the sensitivity of the rat Hprt lymphocyte assay toward aromatic amine carcinogens, male F344 rats were fed 0.02% 2-acetylaminofluorene (2-AAF) for 1 month and then returned to control diet for 2 months. At 4, 27, 48, 62, and 90 days after the initiation of 2-AAF-feeding, the frequency of mutants in the Hprt gene was determined. In addition, DNA was isolated from liver nuclei, spleen lymphocytes, bone marrow, and thymus, and DNA adducts were analyzed by 32P-postlabeling. 2-AAF feeding resulted in a significant induction of 6-thioguanine-resistant T-lymphocytes and the mutant frequency continued to increase after the 2-AAF feeding was stopped. The same major DNA adduct, N-(deoxyguanosin-8-yl)-2-aminofluorene, was detected in liver, spleen lymphocytes, bone marrow, and thymus. DNA adduct levels were greatest in the tumor target tissue (liver) but occurred in all T-lymphocyte compartments, being highest in spleen lymphocytes. The DNA adduct levels were highest at the end of the 1-month 2-AAF feeding period and decreased rapidly in all tissues. The data indicate that the Hprt lymphocyte mutagenesis assay detects arylamine carcinogens, but with relatively low sensitivity.

C.D. Greenall, D.C. and the 1907 California Medical Practice Act

The development of the legal status of the chiropractic profession often resulted from continual persecution by the medical authorities who held almost exclusive power to license health care providers. While the medical boards may seem to offer an "olive branch" in the legislative wars over licensure in the form of drugless practitioner licenses, naturopathic endorsements, or licenses under the "all other" category, their goal was to contain and eliminate all rival professions. A previous article dealt with the prosecution of C.D. Greenall, D.C., at the hands of the medical board. Since writing that article, I have had the opportunity to read The Chiropractor and to develop more fully an understanding of Dr. Greenall and his actions. Not all prosecutions of chiropractic doctors were instigated by the medical profession; some were insisted upon by other chiropractic doctors. Dr. Greenall and his legal counsel were just such a team. With a goal of having California's 1907 Medical Practice Act declared unconstituional, Dr. Greenall presented himself for prosecution. This article more fully details Dr. Greenall and his attempts to gain some form of recognition for the chiropractic profession.

Uroplakin gene expression by normal and neoplastic human urothelium

cDNA sequences for human uroplakins UPIa, UPIb, UPII, and UPIII were cloned and used to investigate uroplakin transcription by normal and neoplastic urothelial cells. Normal urothelium expressed mRNA for all four uroplakins, although UPIII could be detected only by ribonuclease protection assay. By in situ hybridization, UPIa and UPII were confined to superficial cells and UPIb was also expressed by intermediate cells. Cultured normal human urothelial cells showed a proliferative basal/intermediate cell phenotype and constitutive expression of UPIb only. Uroplakin expression by transitional cell carcinoma cell lines was related to their differentiated phenotype in vitro. RT4 cells expressed all uroplakins, VM-CUB-3 expressed three uroplakins, RT112 and HT1376 cells expressed only UPIb in high abundance, and COLO232, KK47, and EJ cells had no detectable expression. These results correlated with patterns of uroplakin expression in tumors. UPIa and UPII were detected superficially only in well differentiated transitional cell carcinoma papillae. UPIb was positive in seven of nine and overexpressed in five of nine noninvasive transitional cell carcinomas and was also present in four of eight invasive transitional cell carcinomas. Lymph node metastases retained the same pattern of UPIb expression as the primary tumor. Unlike the three differentiation-regulated uroplakins, UPIb may have an alternative role in urothelial cell/tissue processes.

A qualitative assessment of inner city elementary school children's perceptions of their neighborhood

Three hundred seventy-nine youths from an inner city elementary school were surveyed to determine their perceptions of their neighborhood. Using a qualitative, word association format, older students responded to 20 descriptive words (e.g., dirty, safe, quiet, dangerous) while younger youths drew pictures in response to three words (safe, sad, happy). Using content analysis techniques, findings indicated that the youths found neighborhood areas and residents that were perceived as safe, quiet, beautiful, friendly, fun/happy, and helpful. However, safety issues and a dirty, noisy neighborhood also emerged as major themes. Collaborative initiatives focusing on cleaning up the neighborhood and reducing violence are suggested, as are areas of intervention and further research.

Stepping as an exercise modality for improving fitness and function

This article describes three stepping modes, summarizes research on stepping in healthy adults and patients with peripheral vascular disease, and discusses clinical implications and directions for future research. Stepping exercise has been shown to increase cardiorespiratory fitness in healthy adults and increase physical function in patients with peripheral vascular disease. Although further research is warranted, stepping exercise has potential value as a nursing intervention to correct alterations in physical mobility in selected populations. Stepping is proposed as an alternative exercise strategy; one which adds variety to exercise routines and may enhance long-term exercise adherence.

Evaluation of a commercial accelerometer (Tritrac-R3 D) to measure energy expenditure during ambulation

This study evaluated the ability of a commercially available accelerometer (Tritrac-R3 D) to measure energy expenditure in 16 subjects at rest (pre- and post-exercise) and during three different intensities of steady-state exercise (40-70% of peak oxygen consumption [VO2peak]) while ambulating on a treadmill (no grade). Oxygen consumption and the respiratory exchange ratio from indirect calorimetry and the vector magnitude of triaxial accelerations were used to estimate energy expenditure using the manufacturers' equations. There was a significant relationship between indirect calorimetry-derived energy expenditure and the energy expenditure derived from the accelerometer (r=0.96). Using analysis of variance, there was no difference in the energy expenditure derived by the two methods at rest before exercise and during the three different intensities of ambulatory exercise. There was a significant difference between energy expenditure derived via indirect calorimetry and with the accelerometer during rest after exercise, probably due to the failure of the accelerometer to accurately estimate the energy expenditure associated with the progressive decline in post-exercise oxygen consumption. Thus, this commercially available accelerometer appears to provide statistically acceptable estimates of energy expenditure at rest and during zero-grade treadmill ambulation up to about 70% VO2peak. This may indicate its acceptable utility for large-scale population studies of physical activity involving this mode of movement. The failure of the accelerometer to accurately estimate energy expenditure during recovery from exercise may contribute to an underestimation of energy expenditure in some physically active individuals.

The problem drinker's lived experience of suffering: an exploration using hermeneutic phenomenology

Research in the area of problem drinking has traditionally relied on quantitative methodologies which view the problem from the researcher's perspective. The purpose of this hermeneutic-phenomenological study was to describe and understand the problem drinker's lived experience of suffering using a philosophy and research approach which preserves the uniqueness of the experience from the sufferer's point of view. The method involved conducting in-depth interviews with a sample of six problem drinkers. Interviews were analysed using an interpretive process, which aimed at generating a deeper understanding of the topic by facilitating a fusion of the world views of both participant and researcher. A reflexive journal recorded the involvement of the self of the researcher throughout the research process. Suffering was viewed as a spiralling vicious circle of physical, psychological, social and spiritual distress. Symptoms of physical dependence, shame and guilt emerged strongly as being both sequelae of heavy drinking and cues to further drinking bouts. Evoking memories of previous suffering through telling one's story was found to be an empowering and motivating force. The results have relevance to specialist and generic workers, who are urged to pay greater attention to the social, psychological and spiritual care of problem drinkers.

Analysis of mutations in the K-ras and p53 genes of lung tumors and in the hprt gene of 6-thioguanine-resistant T-lymphocytes from rats treated with 1,6-dinitropyrene

Direct pulmonary instillation of 1,6-dinitropyrene (DNP) into male Fischer 344 rats results in a dose-dependent induction of lung tumors and 6-thioguanine-resistant (TGr) T-lymphocytes. The treatment also results in DNP binding to dG in the lung and in T-lymphocytes. In the present study, we have examined the types of mutations associated with these responses to DNP. Sequencing of DNA amplification products from 20 DNP-induced lung tumors identified 5 mutations in K-ras codon 12, 4 GGT-->TGT transversions and one GGT-->GAT transition. No mutations were found in K-ras codons 13 or 61. Single-strand conformation polymorphism analysis of p53 exons 5-8 revealed mobility shifts indicative of mutation in 9 of the 20 tumor samples. Eight of the mutations were substitutions at G:C base pairs, and one was a deletion of a single G:C base pair. DNA from 161 TGr lymphocyte colonies cultured from DNP-treated rats was examined for point mutations by amplification of hprt exons 2, 3, and 8, and screening the products for mutant: wild-type heteroduplex formation by denaturing gradient-gel electrophoresis. Only three mutations were found, a G-->T transversion in exon 3, a G-->A transition in exon 8, and a complex mutation consisting of a tandem G-->T transversion and a one base deletion in exon 3. The mutations identified in the DNP-induced lung tumors and TGr T-lymphocytes are consistent with the formation of dG-DNA adducts by DNP. The extremely low recovery of point mutations from TGr lymphocytes suggests that DNP induces a substantial number of mutations by other mechanisms.

Chymopapain-induced reduction of proinflammatory phospholipase A2 activity and amelioration of neuropathic behavioral changes in an in vivo model of acute sciatica

The mechanism of action underlying chymopapain (Chymodiactin) chemonucleolysis remains obscure. Radiographic studies suggest that chymopapain does not alter disc fragment size acutely; nonetheless, patients often report symptom resolution within a few days, even hours, of treatment. The authors postulate that, in addition to its chemonucleolytic action, chymopapain may possess antiinflammatory properties. To test this hypothesis, the authors assessed the ability of chymopapain to modulate the activity of the proinflammatory enzyme phospholipase A2 (PLA2) and to ameliorate behavioral changes associated with inflammatory neuropathy in an in vivo model of sciatica. Thirty-nine male Fischer rats were randomly assigned to one of three treatment groups: 1) saline, 2) betamethasone, or 3) chymopapain. All of the rats underwent unilateral sciatic nerve ligation with loose chromic gut suture to induce inflammatory mononeuropathy. The animals were tested for thermal and mechanical hyperalgesia on Days 0 (preoperation), 7 (pretreatment), and 14 (prior to death). Three animals were killed on Day 0 to determine the baseline PLA2 activity within unmanipulated rat sciatic nerves. On Day 7, three animals from each group were killed to assess PLA2 activity prior to treatment. The remainder were given a single infusion of saline, betamethasone (0.3 mg/kg), or chymopapain (100 pKat U) around the inflamed nerve. On Day 14, the remaining animals were killed and their sciatic nerves were removed. The tissue was homogenized and the PLA2 activity was determined using [14C]arachidonate-labeled Escherichia coli phospholipid membrane as a substrate. Lipids were extracted and separated by thin-layer chromatography. All animals developed behavioral changes consistent with inflammatory mononeuropathy 24 to 72 hours postoperatively; these included gait disturbance, flexion deformity, and hyperalgesia of the involved hindlimb. The degree of mechanical and thermal hyperalgesia was comparable between groups at Day 7. By Day 14, the thermal hyperalgesia had resolved; the mechanical hyperalgesia was less evident in the betamethasone- and chymopapain-treated groups than in the saline-treated controls (p = 0.003; saline- vs. chymopapain-treated groups p = 0.004; saline- vs. betamethasone-treated groups p = 0.008). The mean PLA2 activity at baseline (Day 0) was 11.6 +/- 4.9 nmol phospholipid hydrolyzed per minute per milligram of protein. The PLA2 activity at Day 7 was 74.4 +/- 18.2 (ligated side) and 21.2 +/- 11.7 (nonligated side). At Day 14, PLA2 activity was reduced in the chymopapain- (47.8 +/- 12.3) and betamethasone- (39.7 +/- 9.5) treated groups compared with the saline control group (62.3 +/- 11.2), (saline- vs. chymopapain-treated groups p < 0.05; saline- vs. betamethasone-treated groups p < 0.01). The PLA2 activity in nonligated specimens was 18.6 +/- 10.1. These data indicate that chymopapain exhibits antiinflammatory properties in vivo, reducing PLA2 activity and ameliorating mechanical hyperalgesia in this model of inflammatory sciatic neuropathy.

Follicular dendritic cells (FDC) in retroviral infection: host/pathogen perspectives

Follicular dendritic cells (FDC) are found in the follicles of virtually all secondary lymphoid tissues. In health, these cells trap and retain antigens (Ag) in the form of immune complexes and preserve them for months in their native conformation. FDC thus serve as a long-term repository of extracellular Ag important for induction and maintenance of memory responses. In retroviral infection, FDC trap and retain large numbers of retroviral particles with profound effects on FDC. FDC-trapped retrovirus induces follicular hyperplasia, and conventional Ag trapped prior to infection are lost and new Ag cannot be trapped. Concomitantly, antibody-forming cells (AFC) specific for Ag lost from FDC decrease followed by loss of specific serum antibody (Ab). Eventually, FDC die and follicular lysis occurs. From the pathogen perspective, binding to FDC is remarkably beneficial, bringing together virus and activated target cells that are highly susceptible to infection. Furthermore, FDC permit HIV to infect surrounding cells even in the presence of a vast excess of neutralizing Ab. Preliminary data suggest that FDC maintain virus infectivity-even when the virus cannot replicate. Thus retrovirus infection monopolizes FDC networks, thereby transforming the FDC Ag repository into a highly infectious retroviral reservoir.