Phylogenetic evidence for underreporting of male-to-male sex among human immunodeficiency virus-infected donors in the Netherlands and Flanders.

BACKGROUND: Separate transmission networks for human immunodeficiency virus (HIV) coexist. Molecular typing of viral genomes can provide insight in HIV transmission routes in donors for whom risk behavior-based donor selection failed. STUDY DESIGN AND METHODS: This study includes all HIV-infected Dutch and Flemish donors in the period 2005 to 2014 (n = 55). Part of the HIV polymerase (pol) gene was amplified, sequenced, and compared with more than 10,000 HIV strains obtained from HIV-infected Dutch and Flemish patients. The most likely transmission route was determined based on HIV phylogeny and the donor's self-reported risk behavior during the exit interview. RESULTS: HIV-infected donors were predominantly male (69%), were repeat donors (73%), were born in the Netherlands or Belgium (95%), and harbored HIV Subtype B (68%). Seventy-five percent of HIV-infected male donors were part of robust phylogenetic clusters linked to male-to-male sex, while only 24% of HIV-infected male donors reported male-to-male sex during posttest counseling. Sex between men and women accounted for 13% of HIV infections in male donors and 93% of HIV infections in female donors based on phylogenetic analysis. Only 40% of HIV-infected female donors had HIV Subtype B; 65% of female donors reported a foreign partner and indeed HIV sequences interspersed with sequences from HIV-endemic areas abroad, in particular sub-Saharan Africa. CONCLUSION: HIV typing helps to understand HIV transmission routes in donor populations. We found substantial underreporting of male-to-male sex among HIV-infected male donors. Donor education on HIV risk factors and the danger of window-period donations and a donor environment that encourages frank disclosure of sexual behavior will contribute to a decrease of HIV-infected donors.

Hemoglobin screening in blood donors: a prospective study assessing the value of an invasive and a noninvasive point-of-care device for donor safety.

BACKGROUND: Low hemoglobin (Hb) levels are a common reason for whole blood donor deferral. As some of the deferred donors do not return to donate blood later, the development of accurate tools to reliably detect low Hb levels is therefore important for donor safety and retention. STUDY DESIGN AND METHODS: In a prospective study, 1483 whole blood donors were enrolled in three study arms. In each study arm the Hb results measured with a point-of-care testing device were compared with the venous Hb results obtained in our central laboratory. Both an invasive capillary Hb (Compolab) and a noninvasive spectroscopy Hb (Haemospect) were tested. For the latter, two different application methods for the positioning of the Digiclip were assessed. In a second phase the Compolab was tested in routine conditions. RESULTS: The Haemospect device failed to reliably identify donors with Hb levels below the European cutoffs (125 g/L for females and 135 g/L for males). In contrast, the Compolab identified 72.4% of first-time donors and 78.9% of regular donors with Hb levels below these cutoffs. In routine conditions, the Compolab identified the majority of donors with low Hb levels. CONCLUSION: Differences between Hb levels measured with invasive and noninvasive point-of-care devices and measured on venous samples exist. Implementing the Compolab at collection sites provides a high level of safety toward first-time donors.

Macroanatomic and radiologic characteristics of the superior genial spinal foramen and its bony canal.

PURPOSE: To determine the incidence, size, location, course, and content of the superior genial spinal foramen and its bony canal. MATERIALS AND METHODS: Three hundred eighty dry human cadaver mandibles were morphometrically analyzed by measuring the distance from the foramen to the mandibular base and the size of the foramen and bony canal. Radiologically, the course of the bony canal and its relation to the mandibular incisive canal were investigated after injecting contrast medium (Omnipaque) in the superior genial spinal foramen and the incisive canal at the level of the mental foramen or by inserting a thin metal wire into the bony canal. Dissection was performed on another 10 intact cadaver mandibles. RESULTS: A distinct foramen was present in 98% of all dry specimens studied. Its general form was round or flattened funnel-shaped. Upon microanatomic dissection, a distinct branch of the lingual artery and the lingual nerve entering the superior genial spinal foramen were found. CONCLUSIONS: The superior genial spinal foramen is present in most human mandibles and appears to be the entrance of a true lingual neurovascular bundle passing into the bone via a well-defined bony canal toward the buccal side. This implies that surgery and more specifically implant placement at the mandibular midline may carry some risk of neurovascular damage.

Accessory intraventricular prominence of the occipital horn of the lateral ventricle.

OBJECT: Knowledge of normal variations in ventricular morphological features is important in endoscopic neurosurgery. Classically, two elevations are described on the medial wall of the occipital horn of the lateral ventricle: an upper bulb and a lower calcar avis. Nevertheless, a third, as yet unreported elevation may be present at the junction of the medial wall and the floor of the occipital horn. The authors report the frequency with which this third elevation was found in a series of cadaveric brains. METHODS: The medial wall of the occipital horn of the lateral ventricle was studied in the three orthogonal planes in 45 formalin-fixed cadaveric hemispheres. The underlying structures responsible for the observed intraventricular prominences were exposed by microdissection. A third elevation was present, lying ventrorostral to the calcar avis, in seven (47%) of the 15 single hemispheres, and bilaterally in six (40%) of the 15 whole brains. After microdissection, a fiber bundle from the splenium of the corpus callosum was seen emerging in the occipital horn at the angle between the tail of the hippocampus and the bulb of the occipital horn. The most rostral fibers fanned out inferolaterally along the floor of the collateral trigone. The larger, posterior part protruded into the medial wall along the ventral border of the calcar avis as far as the tip of the occipital horn. CONCLUSIONS: Besides its importance as a variation of normal ventricular morphological features, the close relationship of this accessory intraventricular prominence to the tail of the hippocampus should be kept in mind when intervening neurosurgically so that damage to the underlying commissural fibers can be avoided.