Men in the Dark

The John Peter Zenger Award, 1959 / Men in the Dark, An Address by Herbert Brucker, Editor, Hartford CourantIncludes foreword by Richard A. Harvill, The University of Arizona.This title from the Zenger Awards collection is made available by the University of Arizona School of Journalism and the University of Arizona Libraries. For more information about the Zenger Awards, visit http://journalism.arizona.edu/zenger

Detection of Human Papillomavirus Infection in Patients with Vaginal Intraepithelial Neoplasia

<div><p>Introduction</p><p>Vaginal intraepithelial neoplasia (VAIN) is a pre-malignant lesion, potentially leading to vaginal cancer. It is a rare disease, representing less than 1% of all intraepithelial neoplasia of the female genital tract. Similar to cervical intraepithelial neoplasia (CIN), there are three different grades of VAIN. VAIN 1 is also known as a low-grade squamous intraepithelial lesion (LSIL), whereas VAIN 2 and VAIN 3 both represent high-grade squamous intraepithelial lesions (HSIL). Risk factors for the development of VAIN are similar to those for cervical neoplasia, i.e. promiscuity, starting sexual activity at an early age, tobacco consumption and infection with human papillomavirus (HPV). However, compared to other intraepithelial neoplasia such as CIN or VIN (vulvar intraepithelial neoplasia), there still is little understanding about the natural course of VAIN and its capacity for pro- or regression. Furthermore, there is controversial data about the HPV detection rate in VAIN lesions.</p><p>Patients and Methods</p><p>67 patients with histologically confirmed VAIN, who were diagnosed between 2003 and 2011 at the University Women´s Hospital of Heidelberg Germany, were included in this study. The biopsies of all participating patients were subjected to HPV genotyping. GP-E6/E7 Nested Multiplex PCR (NMPCR) was used to identify and genotype HPV. Eighteen pairs of type-specific nested PCR primers were assessed to detect the following "high-risk" HPV genotypes: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68, as well as the "low-risk" genotypes 6/11, 42, 43 and 44. The data was analyzed with the software SAS (Statistical Analysis System).</p><p>Results</p><p>All 67 cases were eligible for DNA analysis. The median age was 53 years. The largest group with 53% (n = 36) was formed by women, who were first diagnosed with VAIN between the age of 41 to 60 years. 50% (n = 37) of the patients presented a VAIN in the upper 1/3 of the vagina. 58 (87%) were diagnosed with HSIL (VAIN). The median age in patients with LSIL (VAIN) was 53 years and in patients with HSIL (VAIN) 53.5 years. 12 women (18%) had an immunosuppression. HPV positivity was confirmed in 37 patients (55%). Except for a single patient, who had a triple infection with HPV types 6/11, 16 and 68, only infections with one single HPV genotype were detected. An infection with the HPV genotypes 31, 39, 45, 51, 58, 59, 66, 42, 43 and 44 couldn’t be found in any of the patients. In 28 patients with diagnosed VAIN, an infection with HPV 16 could be shown, 24 (86%) of them were diagnosed with a HSIL (VAIN). 16 (24%) women presented condylomata and 13 of them (81%) had a positive HPV status. However, only 47% of the women without condylomata presented a positive HPV status, resulting in a significant correlation (p = 0.0164) between condylomata and HPV infection. In 28 of all 67 patients (42%), recurrence of the neoplasia occurred.</p><p>Conclusion</p><p>HPV 16 is the main virus-type to be associated with the development of a VAIN. Also, HPV 16 infection, VIN or condylomata acuminata in the past medical history seemed to be significant factors for early relapse.</p></div

Calcific uremic arteriolopathy - The argument for hyperbaric oxygen and sodium thiosulfate

Calcific uremic arteriolopathy (CUA) is a rare event primarily in patients with end-stage kidney disease which is characterized by small vessel media calcification, panniculitis, dermal necrosis producing exquisitely painful difficult to heal wounds. Mortality rates may be as high as 80%, predominantly due to intervening sepsis. This clinical phenomenon is being increasingly reported and treated with a widening number of agents. Recent case reports highlight the benefit of two modalities that have been employed as adjuvant therapy with significant success in the treatment of CUA. Hyperbaric oxygen (HBO) is capable of enhancing oxygen delivery to the ulcerating lesions that characterize CUA. Chronic hypoxia can be reversed using HBO to facilitate growth factor production, neoangiogenesis, fibroblast proliferation, and collagen synthesis that may facilitate all aspects of wound healing. Sodium thiosulfate appears to chelate and solubilize calcium ions, reducing the calcium vascular load that appears to participate in the obliterative small vessel disease. There is a rapid analgesic effect and slower regression of cutaneous calcific nodules. The authors advocate for aggressive treatment of CUA, using all available therapies.Natasha M. Rogers and P. Toby H. Coate

HPV type distribution.

<p>HPV type distribution.</p

Patient characteristics.

<p>Patient characteristics.</p

The effect of heat applied with stretch to increase range of motion: A systematic review

Application of heat to muscle is commonly advocated to enhance the efficacy of stretching. However, the effect of this combined therapy using different methods of heating, applied to different muscles, and after one or multiple treatments, is not known. To perform a systematic review to address the question: Does stretching augmented by heat application result in greater gains in range of motion (ROM) compared to stretch alone?The following databases were searched for original articles that evaluated our question: MEDLINE, EMBASE, CINAHL, the Cochrane Central Register of Controlled Trials, SPORTDiscus and PEDro databases. After title and abstract screening followed by full-text screening, the quality of included articles was assessed and their data was abstracted. Screening, data abstraction and quality assessment was performed and consensus was achieved by two reviewers. Range of motion (ROM) data were synthesized by meta-analyses for overall effect and subgroup analysis according to muscle group, method of heat application, single or multiple treatments, and reported tightness of muscle. Twelve studies were included and reported the effects of stretch with or without heat on ROM of 352 participants. Heat applications included ultrasound, shortwave diathermy and hot packs. Meta-analyses and subgroup analyses demonstrated greater increases in ROM after heat and stretch (H + S) than heat alone. Subgroup analysis of muscle groups and the method of heat application showed some trends, but no significant differences. Multiple treatments (more so than single treatments) showed consistent treatment effects of H + S versus stretch alone amongst subgroups. Muscles described as tight did not show a greater treatment effect in response to H + S compared to muscles not reported as tight. Heating provides an added benefit on stretch related gains of ROM in healthy people