Effectiveness of a Novel HIV Self-Testing Service with Online Real-Time Counseling Support (HIVST-Online) in Increasing HIV Testing Rate and Repeated HIV Testing among Men Who Have Sex with Men in Hong Kong: Results of a Pilot Implementation Project.

HIV self-testing (HIVST) with online real-time counseling (HIVST-online) is an evidence-based intervention to increase HIV testing coverage and to ensure linkage to care for men who have sex with men (MSM). A community-based organization (CBO) recruited 122 MSM who had ever used HIVST-online (ever-users) and another 228 new-users from multiple sources and promoted HIVST-online. A free oral fluid-based HIVST kit was sent to all the participants by mail. Experienced HIVST administrators implemented HIVST-online by providing real-time instruction, standard-of-care pre-test and post-test counseling via live-chat application. The number of HIVST-online sessions performed was documented by the administrators. The post-test evaluation was conducted 6 months after the pre-test survey. At month 6, 63.1% of ever-users and 40.4% of new-users received HIVST-online. Taking other types of HIV testing into account, 79.4% of ever-users and 58.6% of new-users being followed up at month 6 received any HIV testing during the project period. Ever-users were more likely to receive HIVST-online and any HIV testing as compared to new-users. Four HIVST-online users were screened to be HIV positive and linked to the treatment. The process evaluation of HIVST-online was positive. Implementation of HIVST-online was helpful to improve HIV testing coverage and repeated HIV testing among Chinese MSM. A larger scale implementation should be considered.

Blenderized Tube Feeding: A Survey of Dietitians' Perspectives, Education, and Perceived Competence.

Increasingly, patients and their caregivers desire blenderized tube feeding (BTF) as an alternative or adjunct to commercial enteral formula. Although dietitians are central in the care of tube fed patients, they do not necessarily have training or experience with BTF and may therefore find it challenging to manage the nutrition of patients who opt for this enteral nutrition approach. To describe dietitians' perspectives, perceived competence, and education on BTF, a cross-sectional survey was conducted by use of an original questionnaire. Dietitians with the authority to practice enteral nutrition in the province of British Columbia, Canada, were included in the study (n = 715). Of the 221 respondents (31% response rate), 28% reported being knowledgeable about BTF, and 24% reported confidence managing patients on BTF. Few agreed they had the expertise to design, administer, or teach administration of BTF (29%, 15%, and 24%, respectively). In regards to education, 27% of respondents did not have BTF education of any kind, and those with BTF education reported it to be primarily derived from informal sources such as self-directed study and learning from colleagues or patients. These results indicate that among dietitians, formal BTF education is uncommon, and there is limited perceived competence on BTF practice.

A dataset of clinically generated visual questions and answers about radiology images.

Radiology images are an essential part of clinical decision making and population screening, e.g., for cancer. Automated systems could help clinicians cope with large amounts of images by answering questions about the image contents. An emerging area of artificial intelligence, Visual Question Answering (VQA) in the medical domain explores approaches to this form of clinical decision support. Success of such machine learning tools hinges on availability and design of collections composed of medical images augmented with question-answer pairs directed at the content of the image. We introduce VQA-RAD, the first manually constructed dataset where clinicians asked naturally occurring questions about radiology images and provided reference answers. Manual categorization of images and questions provides insight into clinically relevant tasks and the natural language to phrase them. Evaluating with well-known algorithms, we demonstrate the rich quality of this dataset over other automatically constructed ones. We propose VQA-RAD to encourage the community to design VQA tools with the goals of improving patient care.

Comparison of oropharyngeal leak pressure between the Ambu® AuraGain™ and the LMA® Supreme™ supraglottic airways: a randomized-controlled trial.

PURPOSE: Studies comparing the recently introduced Ambu® AuraGain™ (Auragain) with the LMA® Supreme™ (Supreme) supraglottic airway (SGA) have reported conflicting results regarding differences in oropharyngeal leak pressure (OLP). This randomized-controlled trial investigated the OLP of the Auragain compared with the Supreme in patients undergoing ambulatory surgery. METHODS: Adult patients with a body mass index ≤ 40 kg·m-2 presenting for ambulatory surgery and requiring an SGA were randomized to receive either the Auragain or the Supreme. Anesthesia was induced with lidocaine (1 mg·kg-1), fentanyl (1-2 µg·kg-1), and propofol (2-3 mg·kg-1). The SGA was inserted using a standard technique with the cuff inflated to 60 cmH2O. The groups were compared for the primary outcome of OLP. RESULTS: One hundred sixty-five patients (n = 81, Auragain; n = 84, Supreme) completed the study. Demographics were similar between the groups. The mean (standard deviation [SD]) OLP was significantly higher in the Auragain than in the Supreme group [26.4 (2.8) cmH2O vs 21.6 (3.4) cmH2O, respectively; difference in means (MD), 4.8 cmH2O; 95% confidence interval (CI), 3.9 to 5.8; P < 0.001]. The mean (SD) insertion time was longer in the Auragain than in the Supreme group [13 (4) sec vs 11 (3) sec, respectively; MD, 2 sec; 95% CI, 1 to 3 sec; P < 0.001]. CONCLUSION: In patients undergoing ambulatory anesthesia, the OLP was higher but took longer to insert with the Auragain than with the Supreme. A higher OLP may allow for SGAs to be utilized in a wider range of patients and procedures. TRIAL REGISTRATION: www.clinicaltrials.gov (NCT02816463). Registered 28 June 2016.

Active surveillance is suitable for intermediate term follow-up of renal oncocytoma diagnosed by percutaneous core biopsy.

OBJECTIVES: To evaluate the intermediate outcome of conservative management in patients with biopsy-proven oncocytoma. PATIENTS AND METHODS: Patients with oncocytoma diagnosed on percutaneous core biopsy between January 2000 to December 2014 were identified from the renal biopsy database of a large specialist urologic pathology laboratory. After review of patient clinical records, the study cohort comprised only of patients enrolled in active surveillance. Clinicopathological and follow-up details were reviewed for each case, in particular: type and interval of surveillance imaging, tumour growth, definitive intervention and reason for intervention. Where possible, correlation was made between the final surgical and the initial biopsy specimens. RESULTS: Fifty three patients diagnosed with oncocytoma on core biopsy were initially placed on active surveillance with median follow-up of 34 months (range 6-109). The median age at diagnosis was 65 years (range 20-85) and median tumour size was 30 mm (range 13-87). Mean average tumour growth was 1.4 mm per annum (median 0 mm/year) with the majority (36 of 53, 68%) exhibiting minimal growth (less than 2 mm per annum) or partial regression. Forty seven of the 53 patients remained on active surveillance with no significant progression. Six patients elected to undergo definitive intervention (five surgical excision, one ablation). Renal oncocytoma was confirmed in all five patients who underwent surgical excision of their lesions. CONCLUSIONS: The majority of oncocytomas in this study showed minimal growth rate or regression. Patients with biopsy proven oncocytoma can be conservatively managed with active surveillance.

Scapular spine stress fractures: To fix or not to fix, our experience in a patient with bilateral fractures and review of the literature.

We report a case of bilateral scapular spine stress fracture, treated conservatively on one side and operatively on the other side. Besides, we performed a literature review to establish management options. A 61-year-old right-handed gentleman came to our clinic with acute on chronic deterioration of shoulder pain and loss of arm function. Clinical assessment and investigations revealed long-standing bilateral rotator cuff tear and scapular spine stress fractures. The fracture on the right side united with conservative management for 2 months. However, his left side remained symptomatic with pain, abnormal mobility and no radiological evidence of union. The fracture progressed to union after fixation and bone grafting. At the final follow-up at 2 years, the patient was asymptomatic with regards to the fractures with Oxford Shoulder Score (OSS)-30 and Disabilities of the Arm, Shoulder and Hand (DASH)-30.8. Fracture union either by conservative or operative treatment is associated with good functional outcome and is supported by our review.

Retrospective evaluation of weekly paclitaxel hypersensitivity reactions reported utilizing an electronic medical record system at a tertiary cancer center.

OBJECTIVES: This is a retrospective observational study evaluating hypersensitivity reactions captured by an electronic medical record (EMR) system for weekly paclitaxel infusions. MATERIALS AND METHODS: The study evaluates the demographics, co-morbidities, premedications, chemotherapy agents, and postmedications of patients reporting a hypersensitivity reaction to weekly infusions of paclitaxel at a major cancer center, from June 2006 to December 2007. Data were analyzed using descriptive statistics and logistic regression. P values <0.05 were considered significant. RESULTS: There were 51 hypersensitivity reactions in 36 patients during this time period that were documented in the allergy section of the EMR. Reactions occurred in patients with an average age of 55 years (SD = 10.77); 47 (92%) of the reactions occurred in females, and 42 (82%) of the reactions occurred with orders on the breast medical/surgical service. Thirty-two (63%) reactions occurred with either the first or second dose of weekly paclitaxel infusion. The most common premedication was dexamethasone (50 infusions), followed by diphenhydramine (18 infusions), and cimetidine (14 infusions). Thirty-three (65%) infusions had only one premedication. Postreaction, 41 (80%) cases had diphenhydramine and 30 (59%) cases had hydrocortisone administered prior to restarting the infusion. Logistic regression analysis did not indicate any relationship between history of previous allergies, hypertension, coronary disease, or chronic obstructive pulmonary disease and the number of premedications. CONCLUSIONS: The results indicate that there is substantial variability in the type and number of premedications utilized in the management of paclitaxel hypersensitivity reactions. Interventions are needed to decrease the rate of hypersensitivity reactions from weekly paclitaxel infusions.

Luminescent cyclometalated iridium(III) polypyridine indole complexes--synthesis, photophysics, electrochemistry, protein-binding properties, cytotoxicity, and cellular uptake.

A series of luminescent cyclometalated iridium(III) polypyridine indole complexes, [Ir(N--C)(2)(N--N)](PF(6)) (HN--C = 2-phenylpyridine (Hppy), N--N = 4-((2-(indol-3-yl)ethyl)aminocarbonyl)-4'-methyl-2,2'-bipyridine (bpy-ind) (1a), N--N = 4-((5-((2-(indol-3-yl)ethyl)aminocarbonyl)pentyl)aminocarbonyl)-4'-methyl-2,2'-bipyridine (bpy-C6-ind) (1b); HN--C = 7,8-benzoquinoline (Hbzq), N--N = bpy-ind (2a), N--N = bpy-C6-ind (2b); and HN--C = 2-phenylquinoline (Hpq), N--N = bpy-ind (3a), N--N = bpy-C6-ind (3b)), have been synthesized, characterized, and their photophysical and electrochemical properties and lipophilicity investigated. Photoexcitation of the complexes in fluid solutions at 298 K and in alcohol glass at 77 K resulted in intense and long-lived luminescence (lambda(em) = 540-616 nm, tau(o) = 0.13-5.15 mus). The emission of the complexes has been assigned to a triplet metal-to-ligand charge-transfer ((3)MLCT) (dpi(Ir) --> pi*(N--N)) excited state, probably with some mixing of triplet intraligand ((3)IL) (pi --> pi*) (pq) character for complexes 3a,b. Electrochemical measurements revealed that all the complexes showed an irreversible indole oxidation wave at ca. +1.1 V versus SCE, a quasi-reversible iridium(IV/III) couple at ca. +1.3 V, and a reversible diimine reduction couple at ca. -1.3 V. The interactions of these complexes with an indole-binding protein, bovine serum albumin (BSA), have been studied by emission titrations, and the K(a) values are on the order of 10(4) M(-1). Additionally, the cytotoxicity of the complexes toward human cervix epithelioid carcinoma (HeLa) cells has been examined by the 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyltetrazolium bromide (MTT) assay. The IC(50) values of the complexes ranged from 1.1 to 6.3 microM, which are significantly smaller than that of cisplatin (30.7 microM) under the same experimental conditions. Furthermore, the cellular uptake of the complexes has been investigated by flow cytometry and laser-scanning confocal microscopy. The microscopy images indicated that complex 3a was localized in the perinuclear region upon interiorization. Temperature-dependence experiments suggested that the internalization of the complex was an energy-requiring process such as endocytosis. This has been confirmed by cellular-uptake experiments involving the luminescent conjugates Ir-BSA and Ir-TF (TF = holo-transferrin), which were prepared by conjugation of the proteins with the complex [Ir(pq)(2)(phen-NCS)](PF(6)) (phen-NCS = 5-isothiocyanato-1,10-phenanthroline).

Rhenium(I) polypyridine biotin isothiocyanate complexes as the first luminescent biotinylation reagents: synthesis, photophysical properties, biological labeling, cytotoxicity, and imaging studies.

We report here the design of the first class of luminescent biotinylation reagents derived from rhenium(I) polypyridine complexes. These complexes [Re(N-N)(CO)(3)(py-biotin-NCS)](PF(6)) (py-biotin-NCS = 3-isothiocyanato-5-(N-((2-biotinamido)ethyl)aminocarbonyl)pyridine; N-N = 1,10-phenanthroline (phen) (1a), 3,4,7,8-tetramethyl-1,10-phenanthroline (Me(4)-phen) (2a), 4,7-diphenyl-1,10-phenanthroline (Ph(2)-phen) (3a)), containing a biotin unit and an isothiocyanate moiety, have been synthesized from the precursor amine complexes [Re(N-N)(CO)(3)(py-biotin-NH(2))](PF(6)) (py-biotin-NH(2) = 3-amino-5-(N-((2-biotinamido)ethyl)aminocarbonyl)pyridine; N-N = phen (1c), Me(4)-phen (2c), Ph(2)-phen (3c)). To investigate the amine-specific reactivity of the isothiocyanate complexes 1a-3a, they have been reacted with a model substrate ethylamine, resulting in the formation of the thiourea complexes [Re(N-N)(CO)(3)(py-biotin-TU-Et)](PF(6)) (py-biotin-TU-Et = 3-ethylthioureidyl-5-(N-((2-biotinamido)ethyl)aminocarbonyl)pyridine; N-N = phen (1b), Me(4)-phen (2b), Ph(2)-phen (3b)). All the rhenium(I) complexes have been characterized, and their photophysical properties have been studied. The avidin-binding properties of the thiourea complexes 1b-3b have been examined by the 4'-hydroxyazobenzene-2-carboxylic acid (HABA) assay. Titration results indicated that the complexes exhibited emission enhancement by ca. 1.4-1.5-fold upon binding to avidin, and the lifetimes were elongated to ca. 0.8-2.0 micros. Additionally, we have biotinylated bovine serum albumin (BSA) with the isothiocyanate complexes. All the resultant rhenium-BSA bioconjugates displayed intense and long-lived orange-yellow to greenish-yellow emission upon irradiation in aqueous buffer under ambient conditions. The avidin-binding properties of the bioconjugates have been investigated using the HABA assay. Furthermore, the cytotoxicity of the thiourea complexes 1b-3b toward the HeLa cells has been examined by the 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyltetrazolium bromide (MTT) assay. The IC50 values were determined to be ca. 17.5-28.5 microM, which are comparable to that of cisplatin (26.7 microM) under the same conditions. The cellular uptake of complex 3b has been investigated by fluorescence microscopy, and the results showed that the complex was localized in the perinuclear region after interiorization.

Luminescent biological probes derived from ruthenium(II) estradiol polypyridine complexes.

Four luminescent ruthenium(II) polypyridine estradiol complexes [Ru(NwedgeN)2(bpy-estradiol)](PF6)2 (NwedgeN = 2,2'-bipyridine (bpy), 4,7-diphenyl-1,10-phenanthroline (Ph2-phen); bpy-estradiol = 5-(4-(17alpha-ethynylestradiolyl)phenyl)-2,2'-bipyridine (bpy-ph-est), 4-(N-(6-(4-(17alpha-ethynylestradiolyl)benzoylamino)hexyl)aminomethyl)-4'-methyl-2,2'-bipyridine (mbpy-C6-est)) have been designed as new luminescent biological probes. The lipophilicity and photophysical and electrochemical properties of these complexes have been investigated. Upon photoexcitation, all the complexes exhibited intense and long-lived triplet metal-to-ligand charge-transfer (3MLCT) (dpi(Ru) --> pi*(diimine)) emission in fluid solutions at 298 K and in low-temperature glass. The binding of the complexes to estrogen receptor-alpha (ERalpha) has been studied by emission titrations. The Ph2-phen complexes showed emission enhancement and increased lifetimes upon binding to the protein. Additionally, the cytotoxicity of the complexes toward the HeLa cell line has been examined by the 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyltetrazolium bromide (MTT) assay and the IC50 values ranged from 83.1 to 166.6 microM (cisplatin showed an IC50 value of 34.3 microM under the same experimental conditions). Furthermore, the cellular uptake of the complexes has been investigated by flow cytometry and laser-scanning confocal microscopy.

Oncogenic viruses in AIDS: mechanisms of disease and intrathoracic manifestations.

OBJECTIVE: The objective of this article is to introduce the reader to the thoracic manifestations of neoplasms that are related to common oncogenic viruses in HIV-infected patients. We review the pathologic basis of the infections and illustrate the imaging features of their thoracic manifestations. CONCLUSION: The intrathoracic manifestations of oncogenic viral infection in AIDS patients are protean. Understanding their epidemiologic, pathologic, and imaging features is crucial to diagnosing and managing these often-treatable conditions.

Tissue-specific and imprinted epigenetic modifications of the human NDN gene.

Allele-specific DNA methylation, histone acetylation and histone methylation are recognized as epigenetic characteristics of imprinted genes and imprinting centers (ICs). These epigenetic modifications are also used to regulate tissue-specific gene expression. Epigenetic differences between alleles can be significant either in the function of the IC or in the cis-acting effect of the IC on 'target' genes responding to it. We have now examined the epigenetic characteristics of NDN, a target gene of the chromosome 15q11-q13 Prader-Willi Syndrome IC, using sodium bisulfite sequencing to analyze DNA methylation and chromatin immunoprecipitation to analyze histone modifications. We observed a bias towards maternal allele-specific DNA hypermethylation of the promoter CpG island of NDN, independent of tissue-specific transcriptional activity. We also found that NDN lies in a domain of paternal allele-specific histone hyperacetylation that correlates with transcriptional state, and a domain of differential histone H3 lysine 4 di- and tri-methylation that persists independent of transcription. These results suggest that DNA methylation and histone H3 lysine 4 methylation are persistent markers of imprinted gene regulation while histone acetylation participates in tissue-specific activity and silencing in somatic cells.