Social Determinants of Health Among Persons Living with HIV Impact Important Health Outcomes in Michigan.

Addressing social determinants of health (SDOH) is a national priority for improving quality of life and addressing obstacles to accessing care for people living with HIV (PLWH). Utilizing the Oregon Social Determinants of HIV Health Index and CDC's Medical Monitoring Project, we examined the association between social determinants of health and various HIV clinical outcomes and quality of life indicators, including stigma and mental health, for people living with HIV in Michigan. We calculated estimates of SDOHs, clinical outcomes, stigma, and mental health using weighted percentages and prevalence ratios with predicted marginal means, adjusting for age, race/ethnicity, and gender/sexual orientation. Compared with PLWH reporting 0-1 SDOH challenges, those reporting ≥ 4 SDOH challenges were more likely to miss ≥ 1 HIV care appointment (aPR: 2.57, 95% CI 1.70-3.88), have symptoms of depression (aPR: 4.03, 95% CI 2.68-6.05) and anxiety (aPR: 3.55, 95% CI 2.25-5.61), and less likely to have 100% antiretroviral therapy (ART) adherence (aPR: 0.62, 95% CI 0.50-0.78) and sustained viral suppression (aPR: 0.77, 95% CI 0.65-0.90). Stigma scores were highest for those reporting ≥ 4 SDOH challenges. Our findings indicate significant associations between SDOH and adverse HIV health and quality of life outcomes which can inform and direct federal, state, and local strategies aimed at improving these outcomes. Linking PLWH to social support services and providing mental health screening and care services could benefit their mental and emotional well-being, leading to better healthcare outcomes.

Benefit of an implanted solid barrier for the feasibility of a sequence of three different hepato-biliary operations in a small animal model.

BACKGROUND: Current liver surgery includes complex multi-stage procedures such as portal vein ligation (PVL) followed by extended liver resection, especially in patients with Klatskin tumours. The risk for severe adhesions increases with every procedure. Finally, this complex sequence could fail because of malignant adhesions. Therefore, we proved the hypothesis of reducing malignant adhesions and increasing feasibility of a sequence with three hepato-biliary operations by implantation of a solid barrier. MATERIALS AND METHODS: We operated in male rats (n=40). Our sequence included as 1st operation bile duct ligation mimicking Klatskin III° or IV°, the 2nd operation was a selective portal vein ligation (sPVL) and 3rd procedure was a 70% liver resection. The mechanical barrier (part of a sterile glove) was implanted at the end of the first operation between the upper (median lobe+left lateral lobe [ML+LLL]) and lower (right lobe+caudate lobe [RL+CL]) rat liver lobes. We assessed the degree of adhesions and the feasibility of the 2nd and 3rd operation by using an established adhesion score (Zühlke) and a feasibility score. The severity of the adhesions and the pro-inflammatory cellular response were further evaluated by morphometry of thickness (HE) of the adhesion layer and quantification of infiltrating neutrophils (ASDCL) in the adhesion layer on the liver surface. RESULTS: The planned liver resection as the third procedure was only feasible when a mechanical barrier was placed. Extent of cholestasis or time interval between the operations had no significant impact on adhesions score or feasibility of the whole sequence. CONCLUSION: A sequence of three hepato-biliary operations in a small animal model (rat) is feasible. It should be considered to implant a mechanical barrier in a sequence of more than two surgical interventions in an experimental model in order to assure the feasibility of the final operation.

[Video-based self-control in surgical teaching. A new tool in a new concept]. / Videounterstützte Selbstkontrolle in der chirurgischen Lehre. Ein neues Tool in einem neuen Konzept.

BACKGROUND: Image and video-based results and process control are essential tools of a new teaching concept for conveying surgical skills. The new teaching concept integrates approved teaching principles and new media. METHOD: Every performance of exercises is videotaped and the result photographically recorded. The quality of the process and result becomes accessible for an analysis by the teacher and the student/learner. The learner is instructed to perform a criteria-based self-analysis of the video and image material by themselves. RESULTS: The new learning concept has so far been successfully applied in seven rounds within the newly designed modular class "Intensivkurs Chirurgische Techniken" (Intensive training of surgical techniques). Result documentation and analysis via digital picture was completed by almost every student. The quality of the results was high. Interestingly the result quality did not correlate with the time needed for the exercise. The training success had a lasting effect. CONCLUSION: The new and elaborate concept improves the quality of teaching. In the long run resources for patient care should be saved when training students according to this concept prior to performing tasks in the operating theater. These resources should be allocated for further refining innovative teaching concepts.

Hairy pinnae after orchiectomy and chemotherapy for testicular cancer: acquired localized hypertrichosis of the ears.

Acquired localized hypertrichosis has rarely been reported. Here, we describe a patient with localized hypertrichosis of the pinnae that occurred 4 months after orchiectomy and chemotherapy for a testicular carcinoma. To our knowledge, this is the first case of an acquired hypertrichosis of the pinnae after cancer therapy. We propose that in our patient either hypogonadism or the hormonal imbalance caused by the cancer therapy led to the development of the hairy pinnae, perhaps alongside a genetic predisposition for hairy ears.

Ear reconstruction following severe complications of otoplasty.

BACKGROUND: Correction of prominent ears is one of the most common operations performed in congenital deformity. Many appropriate corrective techniques have been described. While rare, severe complications destroying ear contours can occur and their correction should follow the established principles of ear reconstruction. METHODS: A retrospective review of the notes of all patients who presented to Clinique George Bizet (1981-2007) in Paris, for correction of complications after undergoing prominent ear surgery at another facility, was performed. Each patient's age, gender, diagnosis, number of previous operations and final outcome were noted as available. Patients were included in this study if they had undergone one or more operations for prominent ears, leading to severe destructive complications, prior to consultation with the senior author and then underwent surgical repair with either an auricular (conchal) cartilage graft or with autogenous costal cartilage. RESULTS: A total of 49 (25 female, 24 male) patients met the inclusion criteria. The mean age at presentation was 23 years (range of 10-59 years of age). The mean number of previous attempts to correct the ear deformity was 1.3 (1-12) times. Eight patients underwent reconstruction with a conchal cartilage graft and 41 with costal cartilage. CONCLUSIONS: While more minor contour deformities are correctable with a contralateral conchal cartilage graft, when more than a quarter of the ear or more than two planes of its complex folds are deformed, costal cartilage is recommended for surgical repair. The principles of ear reconstruction should be well understood prior to attempting a repair of severe complications after otoplasty.

Adverse effects of MVA-T7 on the transport of Marburg virus glycoprotein.

Expression of glycoproteins has been carried out successfully using recombinant vaccinia virus vectors. Especially attractive is the use of recombinant vaccinia viruses which express the DNA-dependent RNA polymerase of the phage T7 (T7-polymerase). The T7-polynerase drives the transcription of plasmid-based genes under the control of the T7 RNA polymerase promoter transfected into the infected cell. Comparison of two different recombinant vaccinia viruses, vTF7-3 and MVA-T7, revealed that post-translational processing of Marburg virus surface glycoprotein (GP) is impaired in the MVA-T7 but not in the vTF7-3 system. Influenza virus hemagglutinin, however, was transported and processed like the authentic protein in both systems. It is shown that transport of GP in the MVA-T7 system is not completely blocked, but the vast majority of molecules remained Endo H-sensitive. Only trace amounts evaded the endoplasmatic reticulum and reached the plasma membrane. Thus, the adverse effects of MVA-T7 on the processing of recombinant glycoproteins cannot be predicted, and correct processing has to be investigated for every expressed glycoprotein.

Sorting of Marburg virus surface protein and virus release take place at opposite surfaces of infected polarized epithelial cells.

Marburg virus, a filovirus, causes severe hemorrhagic fever with hitherto poorly understood molecular pathogenesis. We have investigated here the vectorial transport of the surface protein GP of Marburg virus in polarized epithelial cells. To this end, we established an MDCKII cell line that was able to express GP permanently (MDCK-GP). The functional integrity of GP expressed in these cells was analyzed using vesicular stomatitis virus pseudotypes. Further experiments revealed that GP is transported in MDCK-GP cells mainly to the apical membrane and is released exclusively into the culture medium facing the apical membrane. When MDCKII cells were infected with Marburg virus, the majority of GP was also transported to the apical membrane, suggesting that the protein contains an autonomous apical transport signal. Release of infectious progeny virions, however, took place exclusively at the basolateral membrane of the cells. Thus, vectorial budding of Marburg virus is presumably determined by factors other than the surface protein.

Statutory emancipation of minors: use and impact.

Interviews with 18 adolescents who petitioned for emancipation under a California statute revealed that the decision to seek emancipation was often based on the concerns of adult family members, and that those adults sometimes facilitated the actual legal process. The study also revealed that the statute's prerequisites for emancipation were frequently not fulfilled.

A comparison of the psychological effects of breast-saving procedures with the modified radical mastectomy.

Twenty women who underwent conservative surgical treatment of their breast cancer were compared with 20 women who underwent modified radical mastectomies on several indices of body image and psychological adjustment. The women were matched by pairs in terms of age and time postsurgery, and were group matched with respect to marital status. Women who underwent conservative surgical procedures showed significantly greater intactness of their external body boundaries, and significantly less change and weighted change in overall body satisfaction than women in the modified radical group. There were no significant differences between the groups with respect to body anxiety, general psychological adjustment, or marital satisfaction. The results with respect to body boundary and body satisfaction were interpreted to be the result of the less intrusive surgical procedures used to treat the breast cancer. Since body anxiety did not appear to be affected differentially by the two procedures, it may be that women in both groups were highly concerned about their bodies as a result of having had cancer. It was suggested that there was no difference in the psychological adjustment of the two groups because the women in the modified radical group were representative of that population which adjusts well to surgery. Finally, it was concluded that marital satisfaction is stable regardless of the surgical procedure undergone to treat the breast cancer.

Properties of a cell line from human adenocarcinoma of the rectum.

A new, highly differentiated line of cells derived from adenocarcinoma of the rectum (HT55) is described. This line is noteworthy for the following features: 1. The role played in its development by the use of UV-inactivated Sendai virus to attach tumour cell clumps to plastic bottles. 2. Evidence that it produces RNA-containing material of density 1-5--1-16 g/ml. 3. Induction of bone formation in the stroma when grown in athymic mice. 4. Stimulation of primary CBA mouse embryo fibroblasts to form a transient nodule when mixed with them and injected into adult CBA mice. The karyotype and growth-cycle characteristics of the line are described.

Population: the Singapore experience.

PIP: The effects of population policies in Singapore are described. To deal with the problem of overpopulation, the government of Singapore not only developed programs to provide family planning services, but in 1967, the government also instituted 5 tough social disincentives to having large families. As a result, the population growth rate dropped to 1.7% in 1971 from 2.5% in 1966. The rate then rose a little, but by 1974, it was down again, to 1.6%. A 1973 survey, however, indicated that a continuing preference for sons among many women encouraged them to keep getting pregnant until a boy was born. A campaign was begun to counter this attitude and to spread the idea of the 2-child family. It is suggested that these measures for population control are effective up to a point, but that a broader and more human approach is needed to motivate greater numbers of people to accept family planning.^ieng