Depressive symptoms and HIV among a cohort of adolescent young men and transgender women who have sex with men, Bangkok and Nakhon Sawan, Thailand, 2017-2019.

Screening for depression may identify persons for HIV prevention services and to ensure linkage to care for ART and mental health. We assessed factors associated with depressive symptoms using multiple logistic regression among 15- to 29-year-old gay, bisexual or other men who have sex with men (MSM) and transgender women who have sex with men (TGW) attending HIV prevention clinics at Silom Community Clinic or Bangrak Hospital in Bangkok or Rainbow Clinic in Nakhon Sawan, Thailand. We defined depressive symptoms as a self-report of feelings of sadness that impacted daily life in the past one month. Among 192 MSM, 51 TGW, and 11 gender-questioning persons screened: 12.6% met the criteria for depression; 5.9% had new HIV diagnosis. Independently associated factors which increase the risk of depressive symptoms included: studying in a private school (AOR 7.17); experiencing any type of bullying (AOR 2.8); having a partner with HIV (AOR 4.1); and learning about the study from sources other than a friend (AOR 4.2). Given many youths had depressive symptoms, screening for depression and connection to mental health services would be beneficial in sexual health settings to meet the needs of HIV-vulnerable youth.

Susceptibility of North-American and European crickets to Acheta domesticus densovirus (AdDNV) and associated epizootics.

The European house cricket, Acheta domesticus L., is highly susceptible to A. domesticus densovirus (AdDNV). Commercial rearings of crickets in Europe are frequently decimated by this pathogen. Mortality was predominant in the last larval stage and young adults. Infected A. domesticus were smaller, less active, did not jump as high, and the adult females seldom lived more than 10-14 days. The most obvious pathological change was the completely empty digestive caecae. Infected tissues included adipose tissue, midgut, epidermis, and Malpighian tubules. Sudden AdDNV epizootics have decimated commercial mass rearings in widely separated parts of North America since the autumn of 2009. Facilities that are producing disease-free crickets have avoided the importation of crickets and other non-cricket species (or nonliving material). Five isolates from different areas in North America contained identical sequences as did AdDNV present in non-cricket species collected from these facilities. The North American AdDNVs differed slightly from sequences of European AdDNV isolates obtained in 1977, 2004, 2006, 2007 and 2009 and an American isolate from 1988. The substitution rate of the 1977 AdDNV 5kb genome was about two nucleotides per year, about half of the substitutions being synonymous. The American and European AdDNV strains are estimated to have diverged in 2006. The lepidopterans Spodoptera littoralis and Galleria mellonella could not be infected with AdDNV. The Jamaican cricket, Gryllus assimilis, and the European field cricket, Gryllus bimaculatus, were also found to be resistant to AdDNV.

Estrogen deficiency induces bone loss by enhancing T-cell production of TNF-alpha.

Estrogen deficiency induces bone loss by upregulating osteoclastogenesis by mechanisms not completely defined. We found that ovariectomy-enhanced T-cell production of TNF-alpha, which, acting through the TNF-alpha receptor p55, augments macrophage colony-stimulating factor-induced (M-CSF-induced) and RANKL-induced osteoclastogenesis. Ovariectomy failed to induce bone loss, stimulate bone resorption, or increase M-CSF- and RANKL-dependent osteoclastogenesis in T-cell deficient mice, establishing T cells as essential mediators of the bone-wasting effects of estrogen deficiency in vivo. These findings demonstrate that the ability of estrogen to target T cells, suppressing their production of TNF-alpha, is a key mechanism by which estrogen prevents osteoclastic bone resorption and bone loss.

Kiss and tell: what do we know about pre- and early adolescent females who report dating? A pilot study.

STUDY OBJECTIVE: To evaluate the implications of dating in pre- and early adolescent females. DESIGN: Cross-sectional survey. SETTING: Child psychiatry clinic; pediatric clinic; family clinic. PARTICIPANTS: Pre- and early adolescent females (n = 80) aged 11-14 and their parents. INTERVENTION: Pre- and early adolescent females aged 11-14 and a parent were recruited during a regular clinic visit. Pre- and early adolescent females completed a survey that included measures of dating; sensation seeking; lifetime individual and peer drug use; Attention Deficit Hyperactive Disorder, Oppositional Defiant Disorder and Conduct Disorder symptoms; and onset of menses. Parents were asked similar questions about their child's dating behaviors and peer relationships. MAIN OUTCOME MEASURE: Association of early dating with individual and peer drug use, sensation seeking, aggressive behavior, and onset of menses. RESULTS: In pre- and early adolescent females, dating regularly is associated with nicotine and alcohol use, sensation seeking, and aggressive behavior. Dating regularly is also associated with onset of menses and a younger age of onset of menses in those who had started menstruating. Parents under-report their child's dating practices and associated high-risk behaviors. CONCLUSION: Early dating is associated with nicotine and alcohol use, sensation seeking, aggressive behavior, and early onset of menses in adolescent females. Questions about early dating are a simple and efficient way to open inquiry of both parents and children about high-risk behaviors in the clinic setting.

The potential effects of radiographic criteria to exclude aortography in patients with blunt chest trauma. Results of a study of 32 patients with proved aortic or brachiocephalic arterial injury.

The purpose of this study was to test the effectiveness, in patients with known aortic or brachiocephalic arterial injury, of five previously published radiographic criteria for excluding aortography in patients with blunt chest trauma. These criteria were (1) normal findings on erect chest radiograph; (2) normal aortic arch and left subclavian artery; (3) normal aortic arch, descending aorta, aortopulmonary window, tracheal position, and left paraspinal interface; (4) normal right paratracheal stripe and nasogastric tube position, and (5) normal aortic arch and tracheal and nasogastric tube position. One or more of these criteria were met in 6% to 25% of patient with major thoracic arterial injury, depending on the criteria used. Interestingly, two (6%) patients had radiographs that showed no specific signs of mediastinal hemorrhage, which indicates that the chest radiograph is limited in its sensitivity to detect major thoracic arterial injury. Because of these results, we do not believe that attempts to limit aortography in patients with supine film evidence of mediastinal abnormality, based on the absence of certain signs of mediastinal hemorrhage, are warranted. Furthermore, an abnormal radiograph cannot be relied on as the sole criterion for aortography if the goal of care is to detect as close to 100% of vascular injuries as possible.

Pneumothorax ex vacuo.

Pneumothorax ex vacuo is a little-known complication of lobar collapse. In this condition, acute bronchial obstruction from mucous plugs, aspirated foreign bodies, or malpositioned endotracheal tubes causes acute lobar collapse and a marked increase in negative intrapleural pressure around the collapsed lobe. As a result, gas is drawn into the pleural space around the collapsed lobe while the seal between the visceral and parietal pleura of the adjacent lobe or lobes remains intact. The pneumothorax spontaneously resolves when the bronchial obstruction is relieved and the lobe reexpands. Recognition of pneumothorax ex vacuo is crucial in directing treatment to relieve the bronchial obstruction rather than inserting a chest tube into the pleural space.

Short report: Diapause, transovarial transmission, and filial infection rates in geographic strains of La Crosse virus-infected Aedes triseriatus.

La Crosse (LAC) virus is transmitted horizontally to vertebrates and vertically to progeny by Aedes triseriatus mosquitoes, and in northern midwestern states, this virus overwinters in diapausing eggs of the vector. In Florida, the vector remains active throughout the year and does not diapause. To determine if there is an association between diapause and vertical transmission efficiency of LAC virus, transovarial transmission (TOT), and filial infection (FI) rates were determined for geographic strains of Ae. triseriatus. The TOT rates were not significantly different for Ae. triseriatus originating from Florida (78%) and those from Wisconsin (85%). The FI rates did differ significantly between the two groups (33% and 45%, respectively, for the Florida and Wisconsin mosquitoes). Furthermore, a line of mosquitoes was selected from a Wisconsin colony that had a reduced diapause phenotype (the AD- strain). While this strain displayed TOT rates that were the same as the other Wisconsin mosquitoes (85%), the FI rates were significantly lower (34%), indicating a reduction in TOT efficiency. The role of vertical transmission capacity in LAC virus endemicity remains to be determined.

Radiographic manifestations of mediastinal hemorrhage from blunt chest trauma.

The diagnosis of rupture of the thoracic aorta or its major branches depends largely on the recognition of mediastinal hemorrhage from the initial chest radiograph and subsequent thoracic aortography. This review discusses the radiographic manifestations of mediastinal hemorrhage, including widening of the mediastinum; a ratio of mediastinal width to chest width greater than 0.25; abnormalities of aortic contour; opacification of the aortopulmonary window; depression of the left main bronchus; deviation of the trachea to the right; deviation of the nasogastric tube to the right; the apical cap sign; widening of the paraspinal lines; widening of the right paratracheal stripe; and left hemothorax. The relationship of these manifestations to major thoracic arterial injury is examined. Pitfalls in the radiographic evaluation of mediastinal abnormalities are considered, and indications for computed tomography of the thorax and thoracic aortography in the severely injured patient are reviewed.

Upper rib fractures following median sternotomy.

First and second rib fractures occurred in 11 (16%) of 69 patients undergoing median sternotomy. Although 6 patients had no symptoms related to the rib fractures, 5 patients had postoperative chest, shoulder, and arm pain suggestive of angina pectoris or postpericardiotomy syndrome. The correct diagnosis of pain related to postoperative upper rib fracture may be made by direct visualization of the fracture on supine anteroposterior radiographs, elicitation of pain by palpation of the rib or motion of the upper extremity, lack of response to nitroglycerin, and negative electrocardiogram and cardiac enzyme levels. Upper rib fractures following median sternotomy are usually radiographically detectable within the first three postoperative days. Placement of the Ankeney sternal retractor with the upper blade in a lower position (fourth intercostal space) may reduce the incidence of this postoperative complication.

Unstable Jefferson variant atlas fractures: an unrecognized cervical injury.

We retrospectively reviewed the plain films and CT scans of 11 unstable atlas fractures from a series of 72 atlas fractures to better characterize these injuries and to determine if the correct diagnosis could have been made. These 11 atlas fractures were unstable because either the anterior bony ring was disrupted (six cases), the posterior longitudinal ligament was torn (one case), or both the anterior bony ring and the posterior longitudinal ligament were disrupted (four cases), allowing C1-C2 subluxation to occur. Although all the fractures were potentially unstable, only eight demonstrated subluxation on the lateral radiography. Despite the abnormal open mouth view in all cases, the plain films showed minimal abnormalities, requiring CT for definitive diagnosis. Less than half (five of 11) of the patients had other levels of spine injury or associated transverse ligament tear. Three of the 11 patients were quadriplegic, and two died as a result of their spinal cord injury. These unstable atlas fractures were similar to the classical Jefferson fracture in appearance and mechanism, except that they had fewer than four breaks in the atlas ring and were associated with severe neurologic injury and lower level spine injuries. The pattern of bilateral anterior arch fractures was associated more often with neurologic injury. Because of these differences, we chose to refer to them as Jefferson variant fractures to distinguish them from the classical Jefferson fracture and to emphasize the seriousness of this injury.

Fractures of the craniovertebral junction associated with other fractures of the spine: overlooked entity?

In a review of 155 craniovertebral fractures (occiput-C1-C2), 40 of these had associated fractures and/or dislocations or subluxations elsewhere in the spine. This rather common occurrence, one of four, has not been emphasized in the recent literature, indicating that the radiologic examination should not stop after the craniovertebral fracture is identified. Furthermore, in 13 patients, neurologic deficits were encountered that in all instances were from associated lower-level fracture. From this experience it was believed that a minimum of anteroposterior and lateral views of the entire spine should be obtained in patients in whom a craniovertebral fracture is found, especially if neurologic deficits are present. The other sites of injury were in the lower cervical spine in 17 patients, in the thoracic spine in five, in the lumbar spine in two, and in the sacrococcygeal spine in two patients. Eight patients had three or more levels of fracture.

Evaluation of traumatic atlantooccipital dislocations.

The diagnosis of traumatic atlantooccipital dislocation (AOD) from the cross-table lateral radiograph is difficult because of problems in demonstrating the complex anatomy of this area and the intricate radiographic methods used to diagnose AOD. Although CT or polytomography seem to be the most accurate diagnostic methods, it is often the lateral radiograph from which the diagnosis and further decisions are made. To determine both the best radiographic method for diagnosing AOD from the lateral radiograph and the role of CT and tomography in the diagnosis of AOD, the literature was reviewed concerning how the diagnosis of AOD has been obtained. In addition, the Wholey dens-basion line, the Powers ratio, the Dublin method of diagnosing AOD, and measurement of the atlantooccipital joint width were applied to 12 cases of traumatic AOD; and the Wholey dens-basion line and the Powers ratio were determined in 100 normal adults and 50 normal children. An alternative plain radiographic method for diagnosing AOD was developed, called the X-line method. This was the most accurate of the methods tested, correctly diagnosing AOD in 75% of cases. The Wholey dens-basion line and direct measurement of the atlantooccipital joint width were each correct in 50% of cases, the Powers ratio in 33% of cases, and the Dublin method in only 25% of cases. Ultimately, either CT or polytomography should provide the definitive diagnosis. In this regard high-resolution CT with reformatted coronal and sagittal images generated from 2-mm thin axial slices appeared to have the most promise as the first study of choice.

Unusual radiographic manifestations of lung cancer.

The majority of lung cancers present as either a solitary parenchymal nodule or mass or as a hilar mass that demonstrates progressive growth with time. Unusual parenchymal manifestations of lung cancer include a nodule or mass that may decrease in size without therapy; intrinsic calcification; thin-walled cavitation; a meniscus sign; unifocal or multifocal alveolar infiltrates; satellite nodules; and multiple well-defined pulmonary nodules or masses. Unusual bronchial manifestations of lung cancer include widely separated areas of segmental or lobar atelectasis, mucoid impaction of bronchi, and obstructive hyperinflation. In the pleural space, bronchogenic carcinoma may occasionally be manifested as spontaneous pneumothorax, diffuse nodular tumor spread, and isolated effusion. Unusual mediastinal manifestations of lung cancer include primary mediastinal bronchogenic carcinoma, "downhill" esophageal varices, pulmonary artery invasion and infarction, pericardial and cardiac invasion, and esophageal obstruction. In addition, lung cancer may arise as a complication of bullous lung disease and a number of conditions that cause focal or diffuse lung scarring. Through increased familiarity with these varied manifestations of lung cancer, and a high index of suspicion, it is hoped that the radiographic detection of lung cancer will be improved.

The clinical and imaging spectrum of findings in patients with congenital lobar emphysema.

Congenital lobar emphysema (CLE) is an important cause of infantile respiratory distress that may require surgical intervention. We retrospectively reviewed the clinical and imaging findings in eight infants with CLE. In our series, CLE was more common in females, predominantly involved the right lung, often presented with an opaque lobe from retained fetal lung fluid, and frequently involved the lower lobes, multiple segments or lobes, and both lungs. Most patients with CLE were diagnosed and managed on the basis of clinical and plain radiographic findings alone. Computed tomography, and occasionally ventilation/perfusion scintigraphy, were helpful in confirming the diagnosis and in guiding management decisions in several cases; bronchoscopy showed that stenosis of the right mainstem bronchus was the cause of CLE in one case. Three patients experienced progressive worsening of respiratory distress and required surgical resection of the affected lobe for cure; the remaining five patients were managed medically with eventual remission of symptoms.

Utility of portable chest radiographs as a predictor of endotracheal tube cuff pressure.

Increased endotracheal tube cuff pressure causes mucosal ischemia that can lead to necrosis, infection, and, eventually, tracheomalacia or tracheal stenosis. Endotracheally intubated patients frequently undergo portable chest radiography. In this study we explored the relationship of endotracheal tube cuff pressure and the appearance on the tracheal air columns on the portable chest radiograph. We measured the endotracheal tube cuff pressure of intensive care unit patients 124 times immediately before portable chest radiography. On 64 of these radiographs we measured the width of the tracheal air column below the tip of the endotracheal tube and at the maximal diameter of the endotracheal tube balloon. We then analyzed the relationship of cuff pressure to tracheal dilation. The results of ANOVA of tracheal dilation for three groups (safe, borderline, and unsafe cuff pressures) were significant. Large overlapping ranges existed in each group. Regression analysis confirmed a linear relationship between cuff pressure and tracheal dilation (r = 0.435, p < 0.001). Predicted tracheal expansion at 20 mm Hg was a poor screen for endotracheal tube cuff inflation safety; the sensitivity was only 56% and specificity only 71%. The differences in the capacity for tracheal distension between patients make these findings not unexpected. The portable chest radiograph is a poor screening tool for unsafe endotracheal tube cuff pressure.

Occipital condyle fracture associated with cervical spine injury.

Fracture of the occipital condyle is a rare sequela of craniocervical trauma; it has been reported in only 8 patients since 1816. In one-third of the cases, the fracture was associated with dislocation of the atlantooccipital junction, a uniformly fatal injury. We report a case of fracture of the occipital condyle associated with fractures of C6 and C7, a combination of injuries not previously reported to the best of our knowledge.

Right hilar pseudomass due to partial right lower lobe atelectasis.

In cases of right lower lobe atelectasis, in which the lobe remains partially aerated, rotation of the right hilum into an anteroposterior plane can result in the formation of a "pseudomass" in the right hilar region on the frontal radiograph. Failure to recognize this variant appearance of right lower lobe atelectasis can result in a false diagnosis of a hilar mass and result in an unnecessary workup for lung cancer. Familiarity with this variant appearance of right lower lobe atelectasis, coupled with careful comparison with recent normal chest radiographs, should allow a correct diagnosis of a "pseudomass" in most cases. Computed tomography of the thorax can reliably exclude a hilar mass in cases in which recent normal chest radiographs are unavailable for comparison.

Computed tomography distinction of central thoracic masses.

In an analysis of 36 central lung, 54 mediastinal, and 10 central pleural masses, features were sought that would allow accurate localization of the mass by CT. The mass-lung interface was the most useful feature; with few exceptions a mass with a spiculated, nodular, or irregular edge was in the lung, and a mass with a smooth edge was in the mediastinum. In the superior mediastinal, supraazygos, and supraaortic regions lung masses were lateral to the great vessels, and mediastinal masses were medial to the great vessels. Anterior mediastinal masses were typically positioned between the sternum and great vessels; some were more laterally positioned, however, and could only be distinguished from lung masses by the mass-lung interface. In the infraazygos, infraaortic, and paraspinal areas, lung and mediastinal masses were best differentiated by the mass-lung interface. The angles formed between the mass and lung were occasionally helpful in localizing the mass. Central pleural masses were characterized by a lack of intimate mediastinal effect, obtuse angles between the mass and lung, a smooth mass-lung interface, and characteristic association with other similar areas of involvement in the pleural space. These criteria were used for the correct localization of 99 of 100 masses; therefore, they can simplify and focus the work-up of most central thoracic masses.

Types and mechanisms of pulmonary atelectasis.

Atelectasis is one of the most commonly encountered abnormalities in chest radiology and remains a daily diagnostic challenge. At times atelectasis can be overlooked, particularly when pulmonary opacification is minimal or absent, and at other times it might be interpreted as being some other form of intrathoracic pathology, particularly pneumonia. The direct signs of atelectasis are crowded pulmonary vessels, crowded air bronchograms, and displacement of the interlobar fissures. Indirect signs of atelectasis are pulmonary opacification; elevation of the diaphragm; shift of the trachea, heart, and mediastinum; displacement of the hilus; compensatory hyperexpansion of the surrounding lung; approximation of the ribs; and shifting granulomas. For descriptive purposes, atelectasis can be divided into the following types: segmental, lobar, or whole lung; subsegmental; platelike, linear, or discoid; round; and generalized or diffuse. Resorption atelectasis is caused by resorption of alveolar air distal to obstructing lesions of the airways; adhesive atelectasis stems from surfactant deficiency; passive atelectasis is caused by simple pneumothorax, diaphragmatic dysfunction, or hypoventilation; compressive atelectasis is due to tension pneumothorax, space-occupying intrathoracic lesions, or abdominal distention; cicatrization atelectasis stems from pulmonary fibrosis; and gravity-dependent atelectasis is the result of gravity-dependent alterations in alveolar volume. Whenever signs of volume loss are present on a chest radiograph, the radiograph should be interpreted as showing atelectasis. By understanding the various mechanisms leading to atelectasis, and by considering the underlying conditions, the radiologist should be able to develop an appropriate list of the possible causes of atelectasis. The diagnosis of atelectatic pneumonia should be based upon the presence of clinical signs and symptoms of pneumonia coupled with the identification of pathogenic bacteria in sputum, tracheal aspirates, or protected bronchoalveolar lavage or bronchial brush specimens rather than on the radiographic identification of atelectasis alone.

Radiographic manifestations of lobar atelectasis.

In this article we review the plain radiographic and computed tomographic manifestations of lobar atelectasis. The progression of lobar atelectasis from mild to marked volume loss is emphasized. Common combinations of lobar and whole lung atelectasis are also discussed. Radiographic features that help distinguish lobar atelectasis from pleural thickening, pleural effusion, and mediastinal masses are outlined. Where appropriate, selected examples of segmental atelectasis are also presented. The recognition of lobar atelectasis is important, particularly in cases stemming from obstructing endobronchial tumors. Since all signs of volume loss are not present in any given case, knowing as many signs of lobar atelectasis as possible is useful. Careful analysis of the chest radiograph and subtle alterations in the fissures and hilar vascularity aids in differentiating lobar atelectasis from other intrathoracic processes.