Proteomic approach used in the diagnosis of Riedel's thyroiditis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Riedel's thyroiditis, a rare thyroid disease, can be difficult to diagnose prior to surgical removal and can be confused with malignancy both clinically and cytologically.</p> <p>Case presentation</p> <p>We report the case of a 72-year-old Caucasian woman who presented with a goiter, which showed a rapid increase in size at ultrasound check, suggesting malignancy. Because of inconclusive cytology, a total thyroidectomy was performed. Fine-needle aspiration of the removed thyroid was processed by two-dimensional electrophoresis, and the proteome was compared with both anaplastic cancer and control samples. Significant differentially expressed protein spots were identified by Western blot analysis by using specific antibodies.</p> <p>Conclusions</p> <p>The protein pattern of Riedel's fine-needle aspiration revealed a superimposition with that of the control samples. The comparison of the protein pattern of Riedel's thyroiditis fine-needle aspiration with that of anaplastic cancer showed evidence of a different expression of ferritin heavy chains, ferritin light chains, and haptoglobins, as previously reported in thyroid cancers. Therefore, we performed Western blot analysis of these proteins and validated that their expression levels were low or absent in Riedel's thyroiditis and control samples despite the high concentrations present in fine-needle aspiration anaplastic samples. The concurrent absent or low expression levels of haptoglobin, ferritin light chain, and ferritin heavy chain in Riedel's thyroiditis fine-needle aspiration samples strongly indicate the benign nature of the thyroid lesion. These results suggest the potential applicability of fine-needle aspiration proteome analysis for Riedel's thyroiditis diagnosis.</p

Should young people be paid for getting tested? A national comparative study to evaluate patient financial incentives for chlamydia screening

<p>Abstract</p> <p>Background</p> <p>Patient financial incentives ("incentives") have been widely used to promote chlamydia screening uptake amongst 15-24 year olds in England, but there is scarce evidence of their effectiveness. The objectives of the study were to describe incentives used to promote chlamydia screening in Primary Care Trusts (PCTs) in England and to evaluate their impact on coverage and positivity rate.</p> <p>Methods</p> <p>PCTs that had used incentives between 1/1/2007 and 30/6/2009 (exposed) were matched by socio-demographic profile and initial screening coverage with PCTs that had not (unexposed). For each PCT, percentage point change in chlamydia screening coverage and positivity for the period before and during the incentive was calculated. Differences in average change of coverage and positivity rate between exposed and unexposed PCTs were compared using linear regression to adjust for matching and potential confounders.</p> <p>Results</p> <p>Incentives had a significant effect in increasing average coverage in exposed PCTs (0.43%, CI 0.04%-0.82%). The effect for voucher schemes (2.35%) was larger than for prize draws (0.16%). The difference was greater in females (0.73%) than males (0.14%). The effect on positivity rates was not significant (0.07%, CI -1.53% to 1.67%).</p> <p>Conclusions</p> <p>Vouchers, but not prize draws, led to a small absolute but large relative increase in chlamydia screening coverage. Incentives increased coverage more in females than males but had no impact on reported positivity rates. These findings support recommendations not to use prize draws to promote chlamydia screening and contribute to the evidence base of the operational effectiveness of using patient incentives in encouraging public health action.</p

Incentivizing HIV/STI Testing: A Systematic Review of the Literature

Suboptimal HIV/STI testing uptake has a profound impact on morbidity and mortality. Incentives have been effective in other areas of medicine and may improve HIV/STI testing uptake rates. This study reviewed the effects of incentives on HIV/STI testing uptake. A systematic search of seven databases was undertaken. Testing uptake was defined as test implementation and/or test result retrieval. Incentives were defined as monetary or non-monetary rewards or free-of-charge testing vouchers. Seven studies were included. All seven studies demonstrated higher rates of uptake in an incentivized group. Incentives offered at a nonclinical setting demonstrated more significant differences in uptake rates compared to incentives offered at a clinical setting. Incentivizing HIV/STI testing uptake, especially testing at a non-clinical setting, may be a useful tool to modify health behavior. Further research is needed to understand how incentives could be an effective component within a comprehensive HIV/STI control strategy

Mental Health and Substance Use in the Scale-Up of HIV Prevention

The past several years have witnessed dramatic advances in the potential for effective biomedical HIV prevention interventions. Recent landmark clinical trials, such as CAPRISA 004 and iPrEx, have shown that vaginal microbicides and oral preexposure prophylaxis (PrEP) can reduce the likelihood of HIV infection. Additionally, the results of HIV Prevention Trials Network (HPTN) 052 showed that early initiation of antiretroviral therapy (ART) could also function as a potential biomedical HIV prevention intervention. Nonetheless, many other trials of microbicides and PrEP failed to show a decrease in HIV incidence. Across these trials, it has been hypothesized that poor levels of treatment adherence accounted for the ineffectiveness of the interventions. It is well known that numerous mental health and substance use issues impact adherence to ART, and it is likely that adherence to PrEP and microbicides is similarly affected by these intertwined psychosocial problems. In this chapter, we discuss the impact of mental health and substance use on adherence, HIV transmission risk behavior, PrEP, microbicides, and ART as a secondary prevention strategy. Specifically, we examine how psychosocial syndemics, stigma, risk compensation, intimate partner violence, and the use of various substances (such as alcohol, cocaine, club drugs, methamphetamines) have been important factors in HIV treatment and prevention research to date, and then we present current research that applies these findings to biomedical prevention efforts. Finally, we discuss future research directions for addressing mental health and substance use issues in biomedical prevention interventions