Alcohol consumption patterns and HIV viral suppression among persons receiving HIV care in Florida: an observational study.

BACKGROUND: Alcohol consumption has been associated with poor antiretroviral therapy (ART) adherence but less is known about its relationship to HIV viral suppression, or whether certain drinking patterns have a stronger association than others. The objectives of this study were to determine the association of different patterns of alcohol consumption to HIV viral suppression and ART adherence, and to determine whether any associations of alcohol with HIV viral suppression were mediated by poor ART adherence. METHODS: This observational study used baseline data from 619 HIV+ participants, recruited across 8 clinical and community settings across Florida as part of the Florida Cohort from 2014 to 2016. Alcohol consumption was measured by self-report, and grouped into four categories: heavy drinking (>7/week for women or >14 drinks/week for men); binge, but not heavy drinking (≥4 or >5 drinks/occasion for women and men, respectively), low level drinking (neither heavy nor binge), and abstinence. Serum HIV RNA measurements were obtained from statewide HIV surveillance data, and durable viral suppression was defined as achieving HIV viral suppression (<200 copies/ml) at every assessment in the past 12 months. RESULTS: The majority of the 619 participants were male (63%) and aged 45 or greater (65%). The proportion of participants with heavy, binge, low-level drinking and abstinence was 9, 25, 37 and 30%, respectively. Optimal ART adherence (≥95%) was reported by 68%, and 60% achieved durable viral suppression. In multivariable analysis controlling for demographic factors, drug use, and homelessness, heavy drinking (compared to abstinence) was associated with increased odds of failing to achieve durable viral suppression (OR 2.16, 95% CI 1.08-4.32) whereas binge drinking alone was not significantly associated with this outcome (OR 1.04, 95% CI 0.64-1.70). Both heavy drinking and binge drinking were significantly associated with suboptimal ART adherence. Mediation analyses suggested that only a small proportion of the relationship between heavy drinking and suboptimal viral suppression was due to poor ART adherence. CONCLUSIONS: Exceeding weekly recommended levels of alcohol consumption (heavy drinking) was significantly associated with poor HIV viral suppression and ART non-adherence, while binge drinking was associated with suboptimal ART adherence in this sample. Clinicians should attempt to address heavy drinking in their patients with HIV.

La aplicación efectiva de la investigación usando métodos mixtos / The effective application of mixed-methods research / A aplicação efetiva da pesquisa usando métodos mistos

En respuesta a las cada vez mayores disparidades en salud alrededor del mundo, los científicos han identificado métodos de investigación alternativos que se establecen para mejorar la salud de las poblaciones sub-atendidas. Un acercamiento bien conocido es el de los métodos-mixtos, el cual implica la obtención y el análisis de datos tanto cuantitativos como cualitativos para entender un problema de investigación 1 . No obstante, que la investigación que usa métodos mixtos pudiera parecer fácil de implementar, los científicos necesitan considerar las siguientes cuestiones antes de desarrollar un estudio aplicando un diseño con métodos mixtos: 1) ¿Son las preguntas de investigación apropiadas para un estudio con métodos mixtos?, 2) ¿Cómo pueden los científicos diseñar estudios con métodos mixtos combinando métodos tanto cuantitativos como cualitativos para lograr los resultados más efectivos? y 3) ¿Cuáles son las mejores posiciones filosóficas y teóricas que los científicos pueden usar para enmarcar un estudio con métodos mixtos? Las respuestas a estas preguntas pueden ayudar a los científicos a desarrollar e implementar de forma rigurosa estudios con métodos mixto

Rainbow trout Oncorhynchus mykiss consume less energy when swimming near obstructions.

The effect of obstructions in steady flow on swimming by rainbow trout Oncorhynchus mykiss was examined in a respirometry swim tunnel to test the prediction that fish interacting with obstructions require less energy to hold station. When an obstruction was present, O. mykiss altered the kinematics of swimming and the rate of oxygen consumption was significantly reduced. The fish employed both entrainment and Kármán gait swimming strategies, permitting greater locomotor efficiency.

Live birth after sperm retrieval from a moribund man.

OBJECTIVE: To report a live birth with IVF-ET and intracytoplasmic sperm injection (ICSI) using sperm retrieved from a moribund man being maintained on life support systems. DESIGN: Case report. SETTING: Nonprofit private teaching hospitals. PATIENT(S): A 27-year-old man who was decorticate after an accident. INTERVENTION(S): Epididymal sperm retrieval and sperm cryopreservation, pastoral psychologic counseling, and subsequent IVF-ET with ICSI. MAIN OUTCOME MEASURE(S): Pregnancy and delivery. RESULT(S): Birth of a healthy child after IVF-ET with ICSI and single blastocyst transfer. CONCLUSION(S): First report in peer-reviewed medical literature of a live birth after sperm retrieval from a moribund man.

Simple purification methods for an alphagalactose-specific antibody from chicken eggs.

For many applications avian antibody from egg yolk (IgY) offers advantages over the well-known mammalian antibodies. Different experimental techniques for the purification of IgY from chickens immunized with an alphagalactose-containing antigen (alphaGal-trisaccharide) were compared. These included ammonium sulfate precipitation, filtration with diatomaceous earth, treatment with deoxycholate, and thiophilic and affinity chromatography. Samples were tested for overall purity, protein and lipid content, and specific activity. Evaluated on the basis of these results and the simplicity of the process, the favored purification method is ammonium sulfate precipitation of diluted egg yolk directly followed by affinity chromatography. The high lipid content of IgY preparations is greatly reduced by either thiophilic or affinity chromatography. Affinity purification of ammonium sulfate precipitated material resulted in anti-alphaGal-trisaccharide IgY preparations with approximately 1% of the original protein content but approximately 100-fold higher specific activity for the alphaGal-trisaccharide epitope.

Serum müllerian-inhibiting substance levels during normal menstrual cycles.

OBJECTIVE: To measure serum levels of müllerian-inhibiting substance (MIS) during the normal menstrual cycle. DESIGN: Serum was collected from women during ovulation and the mid-luteal and early follicular phases of the menstrual cycles. It was stored frozen at -80 degrees C until assayed. SETTING: University of Louisville Departments of Obstetrics and Gynecology and Surgery. PATIENT(S): Twenty healthy women 22-35 years of age with normal menstrual cycles. INTERVENTION(S): Blood samples were collected on menstrual cycle day two or three and on the day of LH surge plus one and plus seven or eight. MAIN OUTCOME MEASURE(S): Serum MIS levels were measured by using an enzyme-linked immunosorbent assay. RESULT(S): Serum MIS levels ranged from a low of 1.4 +/- 0.9 ng/mL (mean [+/-SD]) in the early follicular phase, peaked mid-cycle at 1.7 +/- 1.1 ng/mL, and decreased to 1.4 +/- 0.9 ng/mL in the mid-luteal phase of the normal menstrual cycle. CONCLUSION(S): Fluctuations in serum MIS levels during the menstrual cycle suggest that MIS may have a regulatory role in folliculogenesis.

Oolemma rupture inside the intracytoplasmic sperm injection needle significantly improves the fertilization rate and reduces oocyte damage.

OBJECTIVE: To compare the effect on fertilization, oocyte damage, embryo freezing, and pregnancy rates of two different techniques for rupturing the oolemma during intracytoplasmic sperm injection (ICSI). DESIGN: Retrospective study. SETTING: Fertility Center, Alliant Health System Hospital. PATIENT(S): Seventy-nine consecutive IVF-ICSI cases. INTERVENTION(S): Patients in group I had ICSI performed by pushing the needle into the oocyte until the oolemma was observed to break outside the needle. In group II the oolemma was aspirated into the needle until it ruptured inside the needle. MAIN OUTCOME MEASURE(S): In group II ICSI resulted in significantly higher fertilization and lower oocyte damage rates (66% and 13%) than in group 1 (39% and 29%). There were no statistically significant differences in embryo cleavage rates or pregnancy rates per retrieval between the two groups. A greater number of cases had embryos cryopreserved in group II than in group I. RESULT(S): Rupturing the oolemma by aspirating it into the ICSI needle (group II) improved laboratory outcomes compared with the more traditional technique of breaking this membrane by the stabbing action of the needle (group I). This modification of the ICSI technique also increased the number of patients with cryopreserved embryos and therefore could increase the pregnancy rate per patient. CONCLUSION(S): The site and technique used to rupture the oolemma during ICSI has a significant effect on the fertilization and damage rates.

Improved clinical outcomes for in vitro fertilization with delay of embryo transfer from 48 to 72 hours after oocyte retrieval: use of glucose- and phosphate-free media.

OBJECTIVE: To evaluate clinical outcomes of day 2 versus day 3 ET using a culture media with no glucose or phosphate. DESIGN: Retrospective clinical study. SETTING: Hospital-based fertility clinic. PATIENT(S): One hundred seventy-six IVF-ET patients undergoing controlled ovarian supraovulation. INTERVENTION(S): IVF and delaying the ET by 1 day. MAIN OUTCOME MEASURE(S): Number of blastomeres per embryo, implantation and pregnancy rates. RESULT(S): Delaying the ET from day 2 to day 3 after oocyte retrieval significantly increased implantation rates (13% versus 24%) and ongoing/delivered pregnancy rates per retrieval (26% versus 44%). Day 3 embryos with > or = 8 blastomeres resulted in a significantly higher pregnancy rate (53%) than day 3 embryos with < 8 cells (23%) and day 2 embryos with > or = 4 cells (31%) or < 4 cells (11%). CONCLUSION(S): Day 3 ET was associated with a significant increase in implantation and pregnancy rates. Delaying the ET until day 3 may permit the selection of more viable embryos than on day 2. The absence of glucose and phosphate from the culture media is compatible with good IVF outcomes.

Smooth muscle cells isolated from the neointima after vascular injury exhibit altered responses to platelet-derived growth factor and other stimuli.

A variety of evidence suggests that vascular smooth muscle cells (SMC) exhibit a more immature phenotype when stimulated by injury to replicate in the adult. One growth characteristic common to immature (embryonic, fetal, and neonatal) SMC is a markedly reduced responsiveness to platelet-derived growth factor (PDGF) and other mitogenic stimuli. Here we demonstrate that SMC isolated from the 14-day neointima of experimentally injured carotid arteries exhibit a similar growth phenotype. The proliferative responses of neointimal cells to the BB homodimer of PDGF, which interacts with both forms of the PDGF receptor, were up to twenty-fold less (as assessed by BrdU immunocytochemistry) than that of adult control tunica media cells over a wide range of PDGF concentrations. Paradoxically, these cells expressed abundant mRNA for the alpha- and beta-subunits of the PDGF receptor (by RT-PCR) and expressed abundant PDGF receptor protein (by Western blotting). Addition of PDGF-BB to neointimal SMC induced significant autophosphorylation of the PDGF receptor, suggesting that the PDGF receptors were fully functional. The chemotactic responses of neointimal SMC to PDGF, in in vitro migration assays, were identical to that of control medial cells. The data further establish the existence of vascular SMC phenotypes characterized by a refractoriness to growth stimulation by specific mitogens, and provide further evidence for the reiteration of developmentally regulated programs following vascular injury in vivo.

Recurrent pregnancy loss.

This review of recurrent pregnancy loss examines our current understanding of the major etiologies of this unfortunate condition including genetic and endocrine abnormalities, anatomic variations, autoimmune conditions, alloimmune problems, systemic disease, and infection. Diagnostic protocols and treatment strategies are briefly presented. With a high rate of spontaneous normal pregnancy outcome, great care must be taken to do more good than harm.

A prospective study on the association between red hair color and endometriosis in infertile patients.

OBJECTIVE: To determine if red-haired infertile women have an increased prevalence of endometriosis. DESIGN: Prospective, nonblinded. SETTING: Large, metropolitan, private hospital, associated with a university. Subspeciality care provided by reproductive endocrinologists. PATIENTS: One hundred forty-three consecutive women undergoing laparoscopy or laparotomy for infertility. INTERVENTIONS: Laser ablation of any endometriosis present. MAIN OUTCOME MEASURE: Presence of endometriosis. RESULTS: Of 143 women entered into the study, 12 had natural red hair. The ages of these women ranged between 23 and 41 years. Ten of 12 (83%) of the red-haired women were found to have endometriosis compared with 55 of 131 (42%) of nonredheads. By statistical analysis, the 95% confidence intervals for the presence of endometriosis in redheads was 55% to 100% versus 34% to 51% for nonredheads. CONCLUSION: The results suggest an association between the occurrence of natural red hair and those factors that lead to the development of endometriosis.

Endometriosis after neosalpingostomy.

A patient seen for infertility developed severe endometriosis within 2 years of neosalpingostomy for bilateral fallopian tube obstruction. A retrospective review of infertility surgeries revealed none of 20 patients with obstructed tubes to have endometriosis, compared with 66 of 125 (52.8%) with at least one patent fallopian tube (p < 0.001, 95% confidence interval 0% to 17% vs 44% to 62%.

Developmentally timed expression of an embryonic growth phenotype in vascular smooth muscle cells.

Little is known about the phenotypic changes that occur in vascular smooth muscle cells (SMCs) as the developing aorta undergoes the transition from a loosely organized, highly replicative tissue to a morphologically mature, quiescent tissue. In the present study, we have characterized the in vivo pattern of SMC replication during intrauterine and neonatal aortic development in the rat and have cultured and assessed the in vitro growth properties of embryonic, fetal, and neonatal vascular SMCs. Embryonic SMCs, which exhibited a very high in vivo replication rate (75% to 80% per day), demonstrated a significant potential for self-driven replication, as assessed by the ability to proliferate under serum-deprived conditions. Several lines of evidence suggest that the autonomous growth of SMCs in the "embryonic growth phenotype" may be driven by a unique mechanism independent of known adult SMC mitogens: embryonic SMC replication was not associated with the detectable secretion of mitogenic activity capable of stimulating adult SMCs, and embryonic SMCs were mitogenically unresponsive to a variety of known adult SMC growth factors. The capacity for self-driven growth was lost by embryonic day 20, suggesting that important changes in gene expression and phenotype occur in developing SMCs between embryonic days 18 and 20. Taken together, the data describe a unique embryonic growth phenotype of vascular SMCs and suggest that the replication of aortic SMCs during intrauterine development is self driven, self regulated, and controlled by a developmental timing mechanism. The conversion of SMCs from the embryonic to the late fetal/adult growth phenotype will likely be found to be an important component of a developmental system controlling vascular morphogenesis.

Substance P in peritoneal fluid.

Substance P is a neuropeptide that has been identified in the ovary, fallopian tube, uterus, and vagina and in the hypothalamic-pituitary axis in both an animal model and human ovaries. We sought to determine if substance P is present in peritoneal fluid and, if so, whether it correlated with the cause of infertility. Its presence was determined by radioimmunoassay in the peritoneal fluid of 66 patients undergoing diagnostic laparoscopy for clinical indications related to infertility. Total volume of peritoneal fluid and cycle day were recorded; patients were evaluated in groups according to diagnosis: endometriosis (n = 24), pelvic adhesions (n = 18), and normal controls (n = 24). The level of substance P (mean +/- SEM) was 122 +/- 19 pg/ml for endometriosis and 130 +/- 19 pg/ml for pelvic adhesions. These values were not significantly different from the normal controls (130 +/- 25 pg/ml). There was no significant difference in levels between follicular and luteal phase of the menstrual cycle. We conclude that substance P is present normally in peritoneal fluid and that its levels are not affected by pelvic endometriosis or adhesions.

Light and electron microscope immunocytochemical localization of 5- and 12-lipoxygenases and cyclooxygenase enzymes in human granulosa cells from preovulatory follicles.

Cellular and subcellular distribution of 5- and 12-lipoxygenases and cyclooxygenase enzymes were investigated in human granulosa cells from preovulatory follicles using light and electron microscope immunocytochemistry. The results demonstrated that all three enzymes are present in granulosa cells but not in minor contaminating red blood cells. While the distribution of cyclooxygenase and 12-lipoxygenase was relatively uniform among the granulosa cells, 5-lipoxygenase was not uniformly distributed among these cells. All three enzymes are present in microvillus plasma membranes, rough endoplasmic reticulum, cytoplasm, nuclear membranes and chromatin. In summary, 5- and 12-lipoxygenases and cyclooxygenase enzymes, which catalyze the transformation of arachidonic acid into different eicosanoids, are present in several subcellular organelles including nuclei of granulosa cells from preovulatory follicles.

Alteration of 5-HT uptake by plasma fractions in the premenstrual syndrome.

The effects of plasma and an aqueous plasma fraction from patients with premenstrual syndrome (PMS) and control subjects on the uptake of 5-hydroxytryptamine (5-HT) in washed human platelets and rat forebrain synaptosomes were studied. Pre- and postmenstrual samples of unextracted plasma from the control group significantly enhanced platelet uptake of 5-HT. In contrast, an aqueous fraction following extraction of the plasma with organic solvents caused a dose-dependent decrease of 5-HT uptake. Plasma obtained from patients with PMS caused less stimulation of 5-HT uptake compared to plasma from the control group. The aqueous fraction of premenstrual plasma from patients tended to inhibit 5-HT uptake to a greater extent than a similar plasma fraction from controls. The inhibition of 5-HT uptake was associated with an increase in Km. Aqueous plasma fractions from both groups also inhibited 5-HT uptake in brain synaptosomes. However, there were no significant differences between groups. The results of the platelet study suggest that there may be quantitative differences in the plasma concentration of endogenous factors that affect 5-HT uptake between patients with PMS and control subjects and that such differences may explain the previously reported alteration of platelet 5-HT uptake and content associated with PMS symptoms.