Regional anaesthesia for major orthopaedic trauma surgery in patients with conservatively managed pneumothoraces.

The anaesthetic management of multiple traumatic injuries poses numerous challenges. In this report, we present the cases of two patients with polytrauma including pneumothoraces and multiple rib fractures. The first patient, a 39-year-old man, presented with multiple left upper limb fractures, multiple bilateral rib fractures, bilateral pneumothoraces and fractures of multiple facial and cranial bones. The second patient, a 39-year-old woman, presented with right-sided radial and ulnar fractures, a right-sided pelvic fracture, and multiple right-sided rib fractures with an associated pneumothorax. We used ultrasound-guided superficial cervical plexus, interscalene and supraclavicular blocks in the first case and a combined spinal and epidural after ultrasound-guided fascia iliaca and supraclavicular blocks in the second case. In both cases, the use of multiple regional techniques allowed us to avoid the risks of general anaesthesia in patients with conservatively managed pneumothoraces.

The world-wide incidence of Kaposi's sarcoma in the HIV/AIDS era.

OBJECTIVES: Kaposi's sarcoma (KS) is a multicentric angioproliferative cancer of endothelial origin typically occurring in the context of immunosuppression or immunodeficiency. Consequently, KS is one of the most common cancers in HIV-infected individuals and frequently occurs among transplant recipients. Nevertheless, its incidence in different populations is not well understood. METHODS: We searched online databases for publications on KS incidence. A random-effect meta-analysis was performed to combine the KS incidences and incidence rate ratios (IRRs) for associated risk factors. RESULTS: Seventy-six eligible studies representing 71 time periods were included. For HIV-infected people, the overall KS incidence was 481.54 per 100 000 person-years with a 95% confidential interval (CI) of 342.36-677.32 per 100 000 person-years. HIV-infected men who have sex with men (MSM) had the highest incidence of KS (1397.11 per 100 000 person-years; 95% CI 870.55-2242.18 per 100 000 person-years). The incidence of KS was significantly lower in female than in male individuals (IRR 3.09; 95% CI 1.70-5.62). People receiving highly active antiretroviral therapy (HAART) had a lower incidence compared with people who had never received HAART (IRR 6.57; 95% CI 1.91-24.69). The incidence of KS was 68.59 (95% CI 31.39-149.86) per 100 000 person-years in transplant recipients, 52.94 (95% CI 39.90-70.20) per 100 000 person-years in children with HIV infection, and 1.53 (95% CI 0.33-7.08) per 100 000 person-years in the general population. CONCLUSIONS: Globally, a relatively high incidence of KS was found among HIV-seropositive people and, in particular, in HIV-infected MSM. The introduction of HAART has largely prevented the development of KS, but it has not entirely removed the challenge of KS. In Africa, in particular, KS imposes a very heavy disease burden, which can mainly be attributed to the high prevalence of KS-associated herpesvirus and poor access to HAART.

Ovarian function and pregnancy outcome in pony mares following immunocontraception with native and recombinant porcine zona pellucida vaccines.

REASONS FOR PERFORMING STUDY: Few studies have investigated ovarian function in the mare undergoing porcine zona pellucida (pZP) immunocontraception despite reported ovarian dysfunction in other species. OBJECTIVES: This study aimed to describe ovarian function and oestrous cyclicity in pony mares following treatment with either the conventional pZP vaccine or a novel recombinant form of the vaccine derived from porcine ZP3 and ZP4 (reZP). In addition, the contraceptive efficacy of pZP vs. reZP was assessed. STUDY DESIGN: Blinded, randomised, prospective clinical trial. METHODS: Mares (n = 21) were randomised into 3 groups of 7: Group I received the pZP vaccine, with a booster 5 weeks later; Group II received the reZP vaccine, with a booster 5 weeks later; and Group III (controls) received 2 treatments, 5 weeks apart, of saline and adjuvant alone. Mares underwent weekly monitoring via transrectal palpation and ultrasound examination of the reproductive tract, with daily monitoring during oestrus. Data were collected over a 24 week period coinciding with the physiological breeding season; treatments commenced in Week 4. Serum samples were obtained for antibody titres and ovarian steroid level analyses at 7 day intervals. Cycling mares were bred via fresh semen artificial inseminations over a maximum of 2 consecutive oestrous cycles, commencing 5 weeks post booster vaccination. RESULTS: Control mares cycled throughout the trial. After treatment, 6 of 7 pZP mares (86%) and one reZP mare (14%) had an extended anoestrus that correlated with basal serum oestradiol and progesterone levels. All mares resumed cyclicity by 10 months post treatment. Pregnancies were diagnosed in all controls, 4 reZP- (57%) and none of the pZP-immunised mares. CONCLUSIONS: The current study demonstrates the reversible suppression of ovarian function in pony mares following treatment with pZP. The effect of the reZP vaccine on pregnancy outcome requires further investigation.

High prevalence of early childhood infection by Kaposi's sarcoma-associated herpesvirus in a minority population in China.

In China, KSHV seroprevalence varies considerably among different regions and ethnicities. But in Xinjiang province, located in the northwestern China, there is a very high seroprevalence of KSHV in adults of Kazak and Ughur ethnicities. However, KSHV prevalence in children and the risk factors associated with the acquisition of infection are currently not known. The aim of this study was to investigate the prevalence of KSHV infection and identify associated socioeconomic or behavioural risk factors and the humoral immune response among children in this population. This is a cross-sectional study (N = 178) to screen children and their caregivers from Xinjiang for total KSHV antibodies, KSHV neutralizing antibodies and HIV infection. Structured questionnaires were utilized to investigate risk factors associated with KSHV prevalence. KSHV seroprevalence in children and caregivers in Xinjiang was 48.3% and 64.7%, respectively. Neutralizing antibody was detected in most seropositive caregivers (93.8%) but was detected in only 5.8% of the infected children. A significant association was observed between child KSHV seroprevalence and sharing of food among family members. These results suggest that similar to other endemic areas in Africa, KSHV infection in the minority populations of Xinjiang is likely to be occurring during early childhood, probably via horizontal transmission through saliva, and results in high seroprevalence in the adult population.

Prevalence and correlates of Kaposi's sarcoma-associated herpesvirus infection in a sample of men who have sex with men in Eastern China.

This study aimed to determine the seroprevalence of Kaposi's sarcoma-associated herpesvirus(KSHV) and related factors in men who have sex with men (MSM) in China. A total of 208 subjects were recruited from eastern China from 2008 to 2009. Plasma samples were collected and screened for KSHV, HIV and syphilis. Overall, KSHV seroprevalence was 32.7% in the subjects. About 92.7% of subjects reported having ever had anal sex with a man, of whom 67.8% had receptive anal sex and 77.9% had insertive anal sex. About 93.1% of the study participants reported having had oral sex with a man, of whom 76.0% had receptive oral sex and 56.7% had insertive oral sex. KSHV seropositivity was independently associated with receptive anal sex[odds ratio (OR) 2.68, 95% confidence interval (CI) 1.15­6.23], syphilis (OR 3.25, 95% CI1.56­6.76) and HSV-2 infection (OR 2.40, 95% CI 1.09­5.26). KSHV infection is highly prevalent and is probably sexually transmitted among MSM in eastern China.

Prevalence of human herpesvirus 8 and hepatitis C virus in a rural community with a high risk for blood-borne infections in central China.

Illegal blood donation in the past decade has caused human immunodeficiency virus (HIV) outbreaks in some rural areas in China. Other HIV-associated virus infections, such as those caused by human herpesvirus 8 (HHV8), in such areas are still not well defined. In order to explore HHV8 and hepatitis C virus (HCV) seroprevalence and potential risk factors in such areas, a cross-sectional study with 305 HIV-positive and 315 HIV-negative subjects recruited from a rural county in Shanxi province was conducted, in which illegal blood collection was reported. Interview questionnaires and serum testing were carried out with these participants. HCV and HHV8 seroprevalence were found to be higher in the HIV-positive than in the HIV-negative group (76.4% vs. 2.5% and 15.4% vs. 4.8%, respectively), whereas the difference in HBV seroprevalence was not significant. Co-infection with HCV and HHV8 was also more prevalent in the HIV-positive group. HIV status (OR 2.71; 95% CI 1.16-6.30) and HBV status (OR 2.56; 95% CI 1.14-5.75) were independently associated with HHV8 infection. HIV status (OR 23.03; 95% CI 9.95-53.27) and blood/plasma selling history (OR 14.57; 95% CI 7.49-28.23) were strongly associated with HCV infection. These findings demonstrate that both HHV8 and HCV infections are prevalent in this community. HIV infection is an important risk factor for both HHV8 and HCV infection. HBV infection is associated with HHV8 infection but not with HCV infection. It is possible that HHV8 and hepatitis B virus, but not HCV, have similar modes of transmission in this population.