Efforts to Find Heterosexual HIV in San Francisco, 2007-2013.

Nationally heterosexuals are an HIV prevention priority. In addition to case based HIV surveillance, behavioral surveillance surveys are conducted among heterosexuals living in high AIDS morbidity neighborhoods. We report on risk behaviors and HIV prevalence among "high-risk" heterosexuals in San Francisco. National HIV Behavioral Surveillance System is coordinated by the CDC and implemented in 21 health jurisdictions. The studies were conducted in 2006, 2010 and 2013 in San Francisco. Respondent driven sampling was used to sample participants. Eligible persons were 18-50 years old and had sex with at least one opposite gender partner in the past year. We obtained samples of 371, 421, 165 heterosexuals in 2007, 2010 and 2013, respectively. Some demographics varied across the 3 years. Residential neighborhoods changed, homelessness and healthcare coverage increased. Binge drinking, cocaine and heroin use increased while methamphetamine use declined. There were no changes in numbers of partners, unprotected vaginal intercourse or unprotected anal intercourse. Commercial sex work increased. Even with "fine tuning" of eligibility criteria to attempt to find heterosexual HIV cases, we estimate that HIV prevalence was 0.3, 0.2 and 2.4 % in 2007, 2010 and 2013 respectively. The increase was not statistically significant. For the present, effective prevention among persons in the populations most severely affected by HIV remains the priority, for their own benefit and to prevent transmission to other vulnerable populations to which they may be connected.

Trends in the HIV Epidemic Among African American Men Who Have Sex with Men, San Francisco, 2004-2011.

African American men who have sex with men have been disproportionately affected by the HIV epidemic in the United States and remain to this day one of the groups with highest HIV prevalence and incidence. Our goal was to clarify the current state of HIV risk, sexual behaviors, and structural/network-network level factors that affect black MSM's population risk of HIV, enabling the formulation of targeted and up-to-date public health messages/campaigns directed at this vulnerable population. Our approach maximized the use of local data through a process of synthesis and triangulation of multiple independent and overlapping sources of information that are sometimes separately published and often not examined side-by-side. Among African American MSM, we observed stable HIV incidence despite increases in reported individual risk behavior and STDs. An increasing proportion of African American MSM are reporting HIV testing in the past 6 months and seroadaptive behaviors, which may play a role in this observed decline in HIV among MSM in San Francisco, California. Our analysis suggests that currently the HIV epidemic is stable among African American MSM in San Francisco. However, we suggest that the observed stability is due to factors prohibiting expansion of new infections rather than decreasing risks for HIV infection among African American MSM.

Efficacy and safety of intraocular folding sutureless scleral fixating lens versus iris-claw intraocular lens implantation.

PURPOSE: To compare the refractive outcomes of sutureless scleral-fixated Carlevale® intraocular lenses versus Artisan® iris-claw-fixated lenses in terms of surgically induced astigmatism. SETTING: We included patients from the Quinze-Vingts National Ophthalmology Hospital, Paris, from August 2020 to December 2020. DESIGN: This was a single-center retrospective study. METHODS: Each patient included had undergone surgery with a sutureless scleral-fixated Carlevale® foldable intraocular lens or an Artisan® iris-claw lens in the context of secondary implantation. Exclusion criteria included a history of retinal detachment or any other retinal disease. We analyzed postoperative refractive data three months after surgery for the Carlevale group and three months after removal of all sutures for the Artisan group. RESULTS: A total of 25 eyes of 25 patients were included in the Carlevale group and 37 eyes of 36 patients in the Artisan group. At three months, the best-corrected visual acuity was not statistically different, at 0.33(±0.35) and 0.32(±0.33) LogMAR, respectively (P=0.99), and surgically induced astigmatism was significantly lower in the Carlevale group, at 0.538 (±0.560) and 2.30 (±3.97) Diopters, respectively (P<0.001). CONCLUSIONS: In this first comparative study, Carlevale® intraocular lenses appear to offer better refractive accuracy and less induced astigmatism than Artisan® iris-claw lenses, without increasing mean surgical time.

[Cyclic movement training versus conventional physiotherapy for rehabilitation of hemiparetic gait after stroke: a pilot study]. / Zyklisches apparatives Bewegungstraining versus konventionelles Gangtraining in der Rehabilitation des hemiparetischen Ganges nach Schlaganfall: Eine Pilotstudie.

BACKGROUND: Recovery of impaired motor functions following stroke is commonly incomplete in spite of intensive rehabilitation programmes. At 6 months following a stroke up to 60 % of affected individuals still suffer from permanent motor deficits, in particular hemiparetic gait, that are relevant for daily life. Novel innovative therapeutic strategies are needed to enhance the recovery of impaired gait function following stroke. METHOD: This pilot study has investigated the effectiveness of conventional physiotherapy in comparison to an apparative cyclic movement training over a period of 4 weeks to improve (i) power during a submaximal cyclic movement training of the lower limbs, (ii) cardiac fitness, (iii) balance and gait ability, and (iv) quality of life in stroke patients. RESULTS: In comparison to physiotherapy apparative cyclic movement training improved power, balance, cardiac fitness and quality of life to a greater extent. However, there was a statistically significant difference between both intervention groups only for balance but not for the other parameters assessed. CONCLUSION: The present pilot study should inspire future research with larger patient cohorts to allow appropriate judgement on the effectiveness of apparative cyclic movement training in stroke rehabilitation.

HIV is hyperendemic among men who have sex with men in San Francisco: 10-year trends in HIV incidence, HIV prevalence, sexually transmitted infections and sexual risk behaviour.

OBJECTIVES: To evaluate trends in the HIV epidemic among men who have sex with men (MSM) in San Francisco and the implications for HIV prevention. METHODS: An ecological approach assessed temporal trends in sexual risk behaviour, sexually transmitted infections (STI), HIV incidence and prevalence from multiple data sources between 1998 and 2007. RESULTS: By 2007, there were over 13 000 HIV-infected MSM living in San Francisco. No consistent upward or downward temporal trends were found in HIV incidence, newly reported HIV cases, AIDS deaths, proportion of AIDS cases using antiretroviral therapy, rectal gonorrhoea or primary and secondary syphilis cases among MSM during the study period. Trends in indicators of sexual risk behaviour among MSM were mixed. Overall, unprotected anal intercourse (UAI) increased in community-based surveys. Among HIV-positive MSM, no significant trends were noted for UAI. Among HIV-negative MSM, UAI with unknown serostatus partners decreased but increased with potentially discordant serostatus partners. Among MSM seeking HIV testing, increases were noted in insertive UAI at anonymous testing sites and at the STI clinic, in receptive UAI at anonymous test sites and in receptive UAI with a known HIV-positive partner at the STI clinic. CONCLUSIONS: Temporal trends in multiple biological and behavioural indicators over the past decade describe a hyperendemic state of HIV infection among MSM in San Francisco, whereby prevalence has stabilised at a very high level. In the absence of new, effective prevention strategies this state will persist.

Educating youth swine exhibitors on influenza A virus transmission at agricultural fairs.

Influenza A virus (IAV) is a major zoonotic pathogen that threatens global public health. Novel strains of influenza A viruses pose a significant risk to public health due to their pandemic potential, and transmission of influenza A viruses from animals to humans is an important mechanism in the generation and introduction of IAVs that threaten human health. The purpose of this descriptive correlational study was to develop real-life training scenarios to better inform swine exhibitors of the risks they may encounter when influenza A viruses are present in swine. Educational activities were implemented in five Ohio counties where exhibition swine had historically been shedding influenza A viruses during the county fair. A total of 146 youth swine exhibitors participated in the educational programme, and an increase in the knowledge base of these youth was documented. It is expected that educating youth exhibitors about exposure to influenza A virus infections in the swine they are exhibiting will result in altered behaviours and animal husbandry practices that will improve both human and animal health.

The transcriptional repressor HIC1 regulates intestinal immune homeostasis.

The intestine is a unique immune environment that must respond to infectious organisms but remain tolerant to commensal microbes and food antigens. However, the molecular mechanisms that regulate immune cell function in the intestine remain unclear. Here we identify the POK/ZBTB family transcription factor hypermethylated in cancer 1 (HIC1, ZBTB29) as a central component of immunity and inflammation in the intestine. HIC1 is specifically expressed in immune cells in the intestinal lamina propria (LP) in the steady state and mice with a T-cell-specific deletion of HIC1 have reduced numbers of T cells in the LP. HIC1 expression is regulated by the Vitamin A metabolite retinoic acid, as mice raised on a Vitamin A-deficient diet lack HIC1-positive cells in the intestine. HIC1-deficient T cells overproduce IL-17A in vitro and in vivo, and fail to induce intestinal inflammation, identifying a critical role for HIC1 in the regulation of T-cell function in the intestinal microenvironment under both homeostatic and inflammatory conditions.

Examining the Quality of Life of Farmers with Disabilities: The Ohio AgrAbility Study.

Quality of life is a broad concept that presents a challenge to measure as a scientific category. Quality of life encompasses a broad range of variables based on an individual's expression of life satisfaction, perceptions, values, feelings of subjective well-being, and happiness. This study identified and examined factors that influenced the quality of life of Ohio farmers with disabilities who were enrolled in the Ohio AgrAbility Program (OAP) (n = 55) and participated in this study (60% response rate). A 34-item questionnaire was created. The sample of OAP farmers reported stress many days a week, had a negative outlook on life, and were less satisfied with their overall quality of life because of their health. The OAP participants reported external factors, such as cost of equipment, financial pressures, and input costs, as having a negative effect on their quality of life. The participants also reported that they were not satisfied with the amount of vacation time (60.6%), managing farm work and family life (54.6%), overall health (55%), and quality of life (27%). The results showed a significant difference between the OAP participants' overall quality of life and the following variables: gender, net cash income, outlook on life, health, stress, farm work, managing farm and family, social activities, and emotional support for farmers with disabilities. The findings of this exploratory study allowed farmers to identify factors that they perceived as important to their quality of life. Moreover, the results may be helpful for stakeholders to better understand the needs of farmers with disabilities and provide appropriate educational and other services to enhance their quality of life.

The results of successful penetrating keratoplasty using donor organ-cultured corneal tissue.

BACKGROUND: The aim of this study was identification of predictive factors for postoperative visual acuity in patients with a clear organ-cultured graft and to analyze the change in visual acuity between 12 and 24 months after transplantation. METHODS: The study design was a prospective cohort study. A total of 342 consecutive penetrating keratoplasties using donor organ-cultured grafts, performed in 324 patients, were included. Visual acuity, graft thickness, and graft endothelial cell density were recorded in patients with clear transplants. RESULTS: At 24 months postoperatively, 25 (18.7%) of 134 patients had 20/200 or worse visual acuity and 66 (49.3%) had 20/40 or better visual acuity. Graft thickness took 1 month to decrease to normal values. A temporary graft thinning occurred at 6 months postoperatively, followed by recovery of normal graft thickness by 18 months. The average postoperative endothelial cell density was 1,533+/-598 cells/mm2 during the second year. The 24-month LogMAR (logarithm of minimal angle of resolution) visual acuity correlated with preoperative LogMAR visual acuity (beta=0.26, P=0.005), postoperative lens status (beta=-0.34, P=0.008), preoperative intraocular pressure (beta=0.50, P=0.020), and postoperative astigmatism (beta=0.17, P=0.040). Visual acuity (P=0.022) significantly improved between 12 and 24 months. Preoperative diagnosis (P < 0.0001) and postoperative lens status (P < 0.0001) significantly influenced the change in LogMAR visual acuity between 12 and 24 months. CONCLUSIONS: Donor variables do not influence the visual acuity results of penetrating keratoplasty using organ-cultured donor tissue, whereas they have a strong influence on graft survival and graft endothelial cell density. Visual acuity improves during the first 2 years after transplantation. After keratoplasty, organ-cultured corneal grafts undergo dramatic modifications of their thickness and probably of their transparency.

Regulation of human corneal epithelial cell proliferation and apoptosis by dexamethasone.

PURPOSE: To investigate whether human corneal epithelial cells express the glucocorticoid receptor (GR) and to assess the influence of dexamethasone (DEX) on these cells. METHODS: Human corneal epithelial cells were cultured in medium supplemented with various concentrations of DEX (ranging from 10(-10) to 10(-4) M). Cell proliferation was analyzed by 3-(4, 5-dimethylthiazol-2-yl)-5-(3-carboxy-methoxyphenyl)-2-(4-sulfop henyl) -2H-tetrazolium inner salt (MTS) assay at 2, 4, and 6 days of culture. Apoptosis was studied by nucleus labeling using a fluorescent dye and immunostaining by APO 2.7 at 6 days of culture. GR mRNA was detected in corneal epithelium and cultured corneal epithelial cells by means of reverse transcription-polymerase chain reaction (RT-PCR). Immunocytochemical staining of the epithelial cells was performed with a monoclonal anti-human GR. RESULTS: RT-PCR and immunocytochemistry showed the expression of GR (mRNA and protein) in corneal epithelial cells. DEX significantly increased corneal epithelial cell proliferation with concentrations ranging from 10(-10) to 10(-6) M, with a maximum effect at 10(-7) M (P < 0.005). However, DEX also induced apoptosis of cultured corneal epithelial cells at any concentration used. CONCLUSIONS: These results indicate that human corneal epithelial cells express the GR and proliferate in response to DEX stimulation which also induces corneal epithelial cell apoptosis.

A selective synthesis of 4-aminobiphenyl-N2-deoxyguanosine adducts.

A selective synthesis of N2-deoxyguanosine adducts derived from 4-aminobiphenyl (ABP) is described. The reactions of O2-trifluoromethylsulfonyl-O6-allyl-3',5'-O-bis(tert-butyldimethyl silyl)-2'- deoxyxanthosine with 3-amino-4-acetaminobiphenyl and 4-hydrazinobiphenyl, respectively, are the key steps. Successive removal of the protecting groups from the protected adducts leads to the free adducts 3-(deoxyguanosine-N2-yl)-acetyl-ABP and N-(deoxyguanosyl-N2-yl)-ABP, respectively.

Tissue crossmatch before corneal transplantation.

AIM: To investigate the influence of anticorneal antibodies on the outcome of transplantation in recipients before penetrating keratoplasty. METHODS: 100 consecutive penetrating keratoplasties performed between July 1995 and June 1996 were included in this study. Donor corneoscleral rim cryosections were incubated with recipient serum. Fixation of recipient IgM on donor corneas was revealed with a polyclonal anti-human mu-chain antibody. The mean follow up time was 61 months. Five years after transplantation, 63% of patients were available for follow up. During the follow up period, 15% of keratoplasties failed because of irreversible rejection. RESULTS: Anti-donor stromal lamellae IgM were found in 14 recipients. Anti-donor keratocyte IgM were present in 28 recipients. Dilution of recipient serum (up to 1/800) did not modify the results of positive crossmatch assays. Crossmatch assays performed with positive recipient sera and negative donor corneoscleral rims were negative. No significant influence of IgM crossmatch results on graft survival and rejection-free graft survival was found. CONCLUSION: Donor specific anticorneal stroma IgM were found in 28% of recipients before transplantation. This pre-immunisation was not associated with a higher risk of transplantation rejection.

Screening human donor corneas during organ culture for the presence of guttae.

AIMS: To detect the presence of guttae by means of light microscopy during organ culture and to evaluate the influence of the presence of guttae in the donor tissue on transplantation outcome. METHODS: Donor corneas were investigated for the presence of guttae by means of light microscopy at the end of organ culture. Recipient corneal buttons from patients with severe Fuchs' dystrophy and donor corneas with advanced guttae were first studied by light microscopy and subsequently by transmission electron microscopy. Lastly, 168 consecutive donor corneas were evaluated for the presence of guttae and issued for transplantation. RESULTS: Corneal specimens with Fuchs' dystrophy displayed numerous round highly reflecting guttae at the level of the corneal endothelium. Donor corneas with advanced guttae showed less numerous guttae. Among 168 organ cultured donor corneas issued for transplantation, low density guttae were found in 43 (25.6%) corneas. The endothelial cell density and figure coefficient were significantly lower and organ culture time was significantly higher in the cornea guttata group than in the control group. The presence of grouped guttae significantly decreased the adjusted graft survival. The incidence of postoperative stage 3 cornea guttata was significantly higher when grouped guttae were found (5/6) than when no guttae or scattered guttae were found (8/101). CONCLUSION: Cornea guttata can be detected during organ culture by means of light microscopy. It is associated with a decrease in endothelial cell figure coefficient and cell density. The presence of grouped guttae is associated with poorer graft survival and more frequent stage 3 cornea guttata in the graft after transplantation.

Donor organ cultured corneal tissue selection before penetrating keratoplasty.

AIMS: Donor organ cultured corneal tissue selection before penetrating keratoplasty is carried out by taking into account different variables. The objective was to identify preoperative variables which are significantly and independently associated with transplant outcome and should effectively be taken into account before transplantation. METHODS: 231 consecutive penetrating keratoplasties were prospectively studied using organ cultured tissue. Morphometric analysis of the donor corneal endothelium was performed before transplantation. Graft survival and endothelial cell density, during the second year following transplantation, were studied both at a univariate and multivariate level. RESULTS: Recipient age, recipient rejection status, and preoperative diagnosis significantly influenced graft survival. Graft survival was higher when using corneal tissue from donors older than 80 years. Postoperative endothelial density decreased with preservation time and coefficient of variation after preservation. It increased with endothelial cell density after preservation and deswelling time, and correlated with preoperative diagnosis. CONCLUSION: Organ cultured corneas with endothelial cell density after preservation < 2000 cells/mm2, and high coefficient of variation, may be discarded before transplantation. Corneas should be preserved for less than 3 weeks, and allowed to deswell before transplantation for 2 or 3 days rather than 1 day.

Effects of penetrating keratoplasty suture removal on corneal topography and refraction.

PURPOSE: To study the refractive and topographic modifications induced by penetrating keratoplasty suture removal. METHODS: We retrospectively studied 50 corneas from 50 patients who had undergone penetrating keratoplasty. All of the eyes were examined before and after all sutures were removed at 10.8+/-4.7 months and 20.3+/-7.9 months after keratoplasty. Subjective refraction, best spectacle-corrected visual acuity (LogMAR units), and corneal topography (EyeSys 2000R device) were recorded. RESULTS: Suture removal decreased the subjective cylinder by an average of 0.91+/-2.32 D (p = 0.004) and modified the corneal topographic pattern (p = 0.03) and shape (p < 0.001) distribution. The change in subjective cylinder correlated with the variation of the steepest meridian power (r(s) = 0.46; p < 0.001). It correlated with the change in topographic pattern (r(s) = 0.59; p < 0.001). The subjective spherical equivalent increased (hyperopization) by an average of 0.61+/-2.24 D (p = 0.01). After suture removal, the prolate shape was less frequent, and the oblate shape was more frequent than before suture removal. Best spectacle-corrected visual acuity increased by an average of 0.8+/-2.0 lines (p = 0.004). The change in subjective cylinder correlated with the change in visual acuity (r(s) = 0.36; p = 0.006). CONCLUSION: Suture removal modifies the corneal topographic pattern and shape. It decreases the subjective cylinder and induces an hyperopization. Visual-acuity improvement after suture removal mainly is explained by the decrease in astigmatism. Suture removal seems particularly helpful in corneas with a bow-tie pattern.

An analysis of substance use among adolescents from smaller places.

This study examined trends in substance use among 12th grade students who live in smaller places. Subjects from smaller places were defined as those residing in nonmetropolitan and metropolitan counties who reported growing up on a farm, in the country (i.e., living in an unincorporated rural area but not on a farm) or in a small town (i.e., living in a place with fewer than 50,000 residents that is not a suburb or located next to a larger place). Six types of smaller places were created from a cross-tabulation of nonmetropolitan-metropolitan status and where subjects reported growing up. Substance-use rates among 12th graders residing in these six types of smaller places from 1976 to 1997 at three-year intervals were compared, based on data available from the Monitoring the Future study. For past-year alcohol use, some differences were found by place, with farm youth showing the lowest rates. Large differences were exhibited for past-year marijuana use, both across nonmetropolitan-metropolitan status and across youth from farm, country and small-town locations within nonmetropolitan counties. Rates of past-year illicit drug use were essentially the same regardless of location. Overall, when significant differences were found, most revealed less use for the more rural location.

Adolescents becoming adults: attributes for adulthood.

The research literature identifying the end of adolescence and the onset of adulthood has focused on event-related factors (e.g., marriage, occupation), while ignoring cognitive-related factors (e.g., responsibility for one's self and making decisions). This study addresses both realms. Adolescents (N = 113, M age = 16.5 years) were surveyed to determine what they believed were the most important attributes for becoming adults, and at what age their adulthood began. The sample perceived that adult status occurred at a mean age of 17.4 years (SD = 2.55) with 78.8% of the youth reporting that they were "adults." The majority of the sample identified cognitive factors as indicators of adulthood. Further analyses indicated that respondents who perceived that adulthood occurred at younger ages had higher levels of self-esteem. Implications of the consequences of adulthood attributes and beliefs for current and later life adjustment are discussed.

[Immunosuppression in corneal transplantation]. / L'immunosuppression dans la greffe de cornée.

Rejection is the leading cause of corneal graft failure, induced by loss of the so-called eye immune privilege. Prevention of graft rejection with immunosuppressive therapy is then necessary. Topical corticosteroids are currently the gold standard, and steroids are the only treatment for acute rejection episodes. Steroids are nonspecific immunosuppressive agents, and they can induce glaucoma, cataract, infections, and epithelial defects. Cyclosporin has a specific effect, because it inhibits interleukin-2 transcription and, consequently, the specific activation of T lymphocytes. When cyclosporin is given orally, it effectively prevents graft rejection in high-risk recipients, but it may induce severe side effects (i.e., systemic hypertension, kidney deficiency, and malignant tumor induction). When cyclosporin is given topically, it can effectively replace steroids in case of dexamethasone-induced glaucoma and graft infection, but it can also induce serious corneal epithelial defects. Cyclosporin is not a treatment for acute rejection episodes. Mycophenolate mofetil and FK 506 are promising drugs, but currently they cannot be used routinely to prevent corneal graft rejection.

[Effect of sodium hyaluronate administered at the end of penetrating keratoplasty on reepithelialization of the graft]. / Effet du hyaluronate de sodium appliqué en fin de kératoplastie transfixiante sur la réépithélialisation du greffon.

PURPOSE: To investigate the effect of sodium hyaluronate on reepithelialization time after penetrating keratoplaty. METHODS: We prospectly studied 56 consecutive penetrating keratoplasties. One group of patients (n = 22) received dexamethasone ointment at the end of surgery. The second group (n = 34) received sodium hyaluronate and topical dexamethasone. Postoperative reepithelialization time and graft central thickness were recorded. RESULTS: There was no statistical difference between both groups for epithelialization (4.6 + 3.2 days in the hyaluronate group and 4.4 + 2.3 days in the dexamathasone group) and for graft thickness at day one (710 + 85 microns for the former group and 713 + 84 microns for the latter group) and at day of reepithelialization (663 + 80 microns for the former group and 703 + 99 microns for the latter group). The epithelium aspect was different at the first postoperative day between both groups. CONCLUSION: The use of sodium hyaluronate at the end of penetrating keratoplasty improves the graft epithelium aspect at the first postoperative day, but it does not influence reepithelialization time. Further studies are needed to investigate the mechanism of sodium hyaluronate effect on corneal epithelium.

[The relationship between keratoconus and axial myopia]. / Relation entre le kératocône et la myopie axile.

PURPOSE: To study the relationship between keratoconus and axial myopia. METHODS: We prospectively studied refraction and ocular biometry in 100 consecutive keratoconus eyes, and 100 emmetropic eyes. Biometric data (including posterior segment length) were obtained by A-scan ultrasound, Orbscan, and ultrasonic pachymetry. Biometric measurements were compared in both groups. RESULTS: Anterior chamber depth, posterior segment length and axial length were significantly different between the two groups (p<0.001). Axial length was significantly greater in the keratoconus group than in the emmetropic group (23.97 mm versus 23.21 mm, p<0.001). Posterior segment length was significantly greater in the keratoconus group than in the emmetropic group (16.54 mm versus 15.99 mm, p<0.001). In the keratoconus group, the posterior segment length and the subjective spherical equivalent were significantly correlated (rs=-0.45, p<0.001). CONCLUSION: The increase in posterior segment length in the keratoconus group and the correlation between posterior segment length and spherical equivalent in the keratoconus group suggest a statistical relationship between keratoconus and axial myopia.