Faculty Bibliography

BACKGROUND:The association between human papillomavirus (HPV) infection and the risk of human immunodeficiency virus (HIV) seroconversion is unclear, and the genital cellular immunology has not been evaluated. METHODS:A case-control analysis nested within a male circumcision trial was conducted. Cases consisted of 44 male HIV seroconverters, and controls were 787 males who were persistently negative for HIV. The Roche HPV Linear Array Genotype Test detected high-risk HPV (HR-HPV) and low-risk HPV (LR-HPV) genotypes. Generalized estimating equations logistic regression was used to estimate adjusted odds ratios (aORs) of HIV seroconversion. In addition, densities of CD1a(+) dendritic cells, CD4(+) T cells, and CD8(+) T cells were measured using immunohistochemistry analysis in foreskins of 79 males randomly selected from participants in the circumcision trial. RESULTS:HR-HPV or LR-HPV acquisition was not significantly associated with HIV seroconversion, after adjustment for sexual behaviors. However, HR-HPV and LR-HPV clearance was significantly associated with HIV seroconversion (aOR, 3.25 [95% confidence interval {CI}, 1.11-9.55] and 3.18 [95% CI, 1.14-8.90], respectively). The odds of HIV seroconversion increased with increasing number of HPV genotypes cleared (P < .001, by the test for trend). The median CD1a(+) dendritic cell density in the foreskin epidermis was significantly higher among males who cleared HPV (72.0 cells/mm(2) [interquartile range {IQR}, 29.4-138.3 cells/mm(2)]), compared with males who were persistently negative for HPV (32.1 cells/mm(2) [IQR, 3.1-96.2 cells/mm(2)]; P = .047), and increased progressively with the number of HPV genotypes cleared (P = .05). CONCLUSIONS:HPV clearance was associated with subsequent HIV seroconversion and also with increased epidermal dendritic cell density, which potentially mediates HIV seroconversion.

Background The risk of tuberculosis (TB), infection and lymphoma is a major concern for anti-tumor necrosis factor (anti-TNF) therapies. However, limited comparative data about the rates in Asia and Taiwan Objectives To assess the incidence of TB, serious bacterial infection and lymphoma in rheumatoid arthritis patients who received anti-TNF therapy and non-biologic treatment in Taiwan. Methods The National Health Insurance Research Database (NHIRD) 1999-2009 data were analyzed. NHIRD comprises longitudinal patient-level data which covers long-term disease tracking on almost 99.9% of population in Taiwan. Adult patients (age >18) have at least twice diagnosis of RA (ICD-9 "714.0x") and hold catastrophic illness card who received traditional disease-modified anti-rheumatic drug (TDMARDs) or BDMARDs (including etanercept, adalimumab or rituximab were included in the analysis. Patients with prior TB, serious infections or lymphoma were excluded. Patients who received TDMARDs were matched with BDMARDs cohort with 2:1 ratio using propensity score method to adjust age, gender, disease severity, and co-morbidities. Incidence rates of TB, serious infection and lymphoma were defined as number of events divided by total patient exposure years. Incidence rate ratios (IRRs) were calculated between patients on TDMARDs vs. BDMARDs, and among different BDMARDs. Results Of total patients in between 1999 and 2009, 35,589 met the inclusion criteria, and were included in the analysis. The average duration of RA was 8.2 years; 79.1% was female, and the average age was 60.6 years. Patients on BDMARDs group had higher incidences of TB, serious infections and lymphoma compared with patients who received TDMARDs only (Table 1). Within BDMARDs group, 3,335 patients (75.8%) and 1,029 patients (23.2%) and had ever received first line treatment of etanercept and adalimumab respectively. Patients on etanercept group had lower incidences of TB, serious infections and lymphoma compared with patients on adalimumab group. All !

Transgender patients have particular needs with respect to demographic information and health records; specifically, transgender patients may have a chosen name and gender identity that differs from their current legally designated name and sex. Additionally, sex-specific health information, for example, a man with a cervix or a woman with a prostate, requires special attention in electronic health record (EHR) systems. The World Professional Association for Transgender Health (WPATH) is an international multidisciplinary professional association that publishes recognized standards for the care of transgender and gender variant persons. In September 2011, the WPATH Executive Committee convened an Electronic Medical Records Working Group comprised of both expert clinicians and medical information technology specialists, to make recommendations for developers, vendors, and users of EHR systems with respect to transgender patients. These recommendations and supporting rationale are presented here.

OBJECTIVE:To determine trends in the consumption of sugar-sweetened beverages (SSBs) and 100% fruit juice by California children ages 2 to 11 years from 2003 to 2009. METHODS:This analysis used serial cross-sectional data from the California Health Interview Survey, a telephone survey of households in California. Parents were asked how many servings of SSBs and 100% fruit juice the child consumed the day before. A test of trend was used to evaluate changes in consumption over time. Multivariate logistic regression was used to determine the independent effects of race/ethnicity, parental education, and household income on beverage consumption. RESULTS:The percentage of children consuming an SSB on the prior day declined from 40% in 2003 to 16% in 2009 (P < .001) among children ages 2 to 5 and from 54% in 2003 to 33% in 2009 (P < .001) among children ages 6 to 11. The percentage of children consuming any SSB decreased for all racial/ethnic groups, although there were disparities with higher consumption among Latinos. Among children ages 2 to 5, consumption of 2 or more servings of 100% fruit juice per day decreased among white children and increased among Latinos. For children ages 6 to 11, consumption of 2 or more servings of 100% fruit juice per day remained stable for white children and increased among Latinos and African Americans. CONCLUSIONS:The decrease in SSB consumption by California children from 2003 to 2009 is a promising trend. The increase in 100% fruit juice consumption among minority children during this period may be an unintended consequence of efforts to reduce SSB consumption.

OBJECTIVE:The widespread application of abdominal computerized tomography (CT) imaging has revealed that 0.98-4.0% of individuals harbour adrenal lesions (incidentalomas). There is, however, paucity of information regarding the prevalence of adrenal lesions in patients with gastroenteropancreatic neuroendocrine tumours (GEP-NETS). Purpose of this study was to estimate the prevalence of adrenal lesions in patients with GEP-NETS and identify their radiological features and clinical significance. DESIGN/METHODS:The prevalence of adrenal lesions was estimated retrospectively in 438 patients with GEP-NETS who underwent abdominal imaging. Secretory status and changes in size were documented during subsequent follow-up. MEN-1 patients and ectopic ACTH-secreting tumours were excluded. RESULTS:Adrenal lesions were detected in 32 (8.4%) of 383 patients included. The majority (22 patients - 69%) were located at the left adrenal gland and the mean size was 23.6 mm. In two patients, one with a well and another with a poorly differentiated tumour, clinicopathological features suggested adrenal metastases. During a mean follow-up period of 69.5 months, no subsequent growth of any adrenal lesion was observed. Endocrine evaluation documented subclinical glucocorticoid hypersecretion in 4 cases (14%). The presence of adrenal lesions did not correlate to distant metastases, however, they were observed more frequently in patients with G3 tumours. CONCLUSION/CONCLUSIONS:The prevalence of adrenal lesions in patients with GEP-NETs was found to be higher than the general population and mostly represent benign adrenal adenomas (except patients with G3 tumours). Nevertheless, individualized assessment of imaging characteristics should be still considered.

Compared to white women, premenopausal Chinese-American women have more plate-like trabecular (Tb) bone. It is unclear whether these findings are relevant to postmenopausal women and if there are racial differences in the deterioration of bone microarchitecture with aging. We applied individual trabecula segmentation and finite element analysis to high-resolution peripheral quantitative computed tomography images in premenopausal and postmenopausal Chinese-American and white women to quantify within-race age-related differences in Tb plate-versus-rod microarchitecture and bone stiffness. Race-menopause status interactions were assessed. Comparisons between races within menopause status were adjusted for age, height and weight. Comparisons between premenopausal and postmenopausal women were adjusted for height and weight. Adjusted analyses at the radius indicated that premenopausal Chinese-Americans had a higher plate bone volume fraction (pBV/TV), Tb plate-to-rod ratio (P-R ratio), and greater plate-plate junction densities (P-P Junc.D) versus white women (all p < 0.01), resulting in 27% higher Tb stiffness (p < 0.05). Greater cortical thickness and density (Ct.Th and Dcort) and more Tb plates led to 19% greater whole bone stiffness (p < 0.05). Postmenopausal Chinese-Americans had similar pBV/TV and P-P Junc.D, yet a higher P-R ratio versus white women. Postmenopausal Chinese-American versus white women had greater Ct.Th, Dcort, and relatively intact Tb plates, resulting in similar Tb stiffness but 12% greater whole bone stiffness (p < 0.05). In both races, Ct.Th and Dcort were lower in postmenopausal versus premenopausal women and there were no differences between races. Tb plate parameters were also lower in postmenopausal versus premenopausal women, but age-related differences in pBV/TV, P-R ratio, and P-P Junc D were greater (p < 0.05) in Chinese-Americans versus white women. There are advantages in cortical and Tb bone in premenopausal Chinese-American women. Within-race cross-sectional differences between premenopausal and postmenopausal women suggest greater loss of plate-like Tb bone with aging in Chinese-Americans, though thicker cortices and more plate-like Tb bone persists.

Cushing's disease (CD) is a rare endocrine disorder that is caused by an adrenocorticotropin (ACTH)-producing pituitary adenoma that chronically stimulates adrenocortical cortisol production. CD is primarily treated by transsphenoidal surgery, resulting in long-term biochemical remission in approximately 60-90% of the patients. Patients who are ineligible for surgery or have undergone unsuccessful surgery are candidates for drug therapy. Medical treatment can aim to inhibit the excess ACTH production at the level of the pituitary adenoma, to decrease adrenocortical steroidogenesis or to antagonize the effects of cortisol at the level of its receptor. In recent years, a number of studies have been published that evaluated the efficacy of medical therapy, either as monotherapy or combination therapy, in patients with CD. In particular, the effects of the somatostatin analog pasireotide and the glucocorticoid receptor antagonist mifepristone have been investigated in two large clinical trials. Moreover, the first clinical experiences with the novel steroidogenesis inhibitor LCI699 and the pituitary-directing retinoic acid have become available. Finally, an in vitro study with gefitinib, an epidermal growth factor receptor-antagonist, showed promising results that warrant further exploration. In this review, the efficacy and limitations of drugs that have been used in the treatment of CD will be discussed as well as recent developments with respect to new pituitary- and adrenal-targeting compounds.