Faculty Bibliography

Carcinoma arising in the apocrine sweat glands is rare and there are few reports describing the cytological features of this neoplasm. We describe the cytological features of a histologically confirmed apocrine carcinoma occurring in a 55-year-old man who presented with an ulcerated mass in the right axilla. Fine-needle aspiration cytology revealed features of a signet ring adenocarcinoma. The significance of this infrequently encountered neoplasm lies in its potential for diagnostic confusion with more common lesions containing signet ring cells. In an axillary mass lesion, cytological features along with clinical correlation are essential to distinguish primary apocrine carcinoma from mammary neoplasms with signet ring cells and other metastatic adenocarcinomas.

Plasmacytoid DCs (pDCs) have been implicated as crucial cells in antiviral immune responses. On recognizing HIV, they become activated, secreting large amounts of IFN-alpha and inflammatory cytokines, thereby potentiating innate and adaptive antiviral immune responses. Here, we have shown that HIV-stimulated human pDCs can also induce the differentiation of naive CD4+ T cells into Tregs with suppressive function. This differentiation was independent of pDC production of IFN-alpha and primarily dependent on pDC expression of indoleamine 2,3-dioxygenase, which was induced through the TLR/MyD88 pathway, following binding of HIV to CD4 and triggering of TLR7 by HIV genomic RNA. Functionally, the Tregs induced by pDCs were shown to inhibit the maturation of bystander conventional DCs. This study therefore reveals what we believe to be a novel mechanism by which pDC may regulate and potentially limit anti-HIV immune responses

Approved by the FDA in 2005, Byetta effectively treats diabetes by mimicking the effects of incretin. Still, since its approval, close to a million patients have used it. The risk of life-threatening pancreatitis is only 1 in 10,000 patients, a very low number. But recent deaths from pancreatitis in patients that had been taking the drug lead the FDA to consider adding stern black-box warnings to the drug label. These warnings could severely limit the usefulness of a very effective drug

INTRODUCTION: The Patient Assessment of Chronic Illness Care (PACIC) survey is a patient-centered instrument for evaluating the quality and patient-centeredness of chronic illness care received according to the Chronic Care Model paradigm. This study validates the Spanish translation of the PACIC in an urban, Spanish-speaking population. METHODS: One hundred Spanish-speaking patients with diabetes completed the translated PACIC and sociodemographic and cultural questionnaires. Test-retest reliability was assessed in a subset of 20 patients who completed the questionnaire 2 to 4 months later. Internal consistency was evaluated with Cronbach alpha. PACIC score and subscale associations with sociodemographic characteristics were examined. RESULTS: Test-retest reliability for the overall translated PACIC scale was 0.77. Scores were not associated with patient sociodemographic characteristics, including age, country of birth, years living in the United States, or education level (P >.05). CONCLUSION: The Spanish translation of the PACIC survey demonstrated high reliability, internal consistency, and test-retest reliability. Scores showed no association with sociodemographic or cultural characteristics. The Spanish version can reliably be used to assess care delivered according to the Chronic Care Model in a heterogeneous Spanish-speaking population

Arab immigrants living in the United States total between 1.5 million and 3.5 million, and have been growing in number each decade. New York's Arab population, at 405,000, ranks third in the U.S. after California and Michigan. Despite the large numbers, little health research has focused on this population. Data about the cancer incidence, mortality, and screening practices of Arab Americans is overwhelmingly lacking. To better understand the health care and cancer knowledge, attitudes, and beliefs of Arab American immigrants, five single-gender focus groups were convened with Arab men and women in New York City. Attention was given to factors that act as barriers to utilization of general health care services, and of cancer prevention, treatment, and support services. The data revealed the importance of providing culturally and linguistically appropriate health interventions in partnership with trusted community leaders, and the need for follow-up research of this understudied immigrant population

OBJECTIVES: To test the feasibility, acceptability, and effect of a senior center-based behavioral counseling lifestyle intervention on systolic blood pressure (BP). DESIGN: A pre-post design pilot trial of behavioral counseling for therapeutic lifestyle changes in minority elderly people with hypertension. Participants completed baseline visit, Visit 1 (approximately 6 weeks postbaseline), and a final study Visit 2 (approximately 14 weeks postbaseline) within 4 months. SETTING: The study took place in six community-based senior centers in New York City with 65 seniors (mean age 72.29+/-6.92; 53.8% female; 84.6% African American). PARTICIPANTS: Sixty-five minority elderly people. INTERVENTION: Six weekly and two monthly 'booster' group sessions on lifestyle changes to improve BP (e.g., diet, exercise, adherence to prescribed antihypertensive medications). MEASUREMENTS: Primary outcome was systolic BP (SBP) measured using an automated BP monitor. Secondary outcomes were diastolic BP (DBP), physical activity, diet, and adherence to prescribed antihypertensive medications. RESULTS: There was a significant reduction in average SBP of 13.0+/-21.1 mmHg for the intervention group (t(25)=3.14, P=.004) and a nonsignificant reduction in mean SBP of 10.6+/-30.0 mmHg for the waitlist control group (t(29)=1.95, P=.06). For the intervention group, adherence improved 26% (t(23)=2.31, P=.03), and vegetable intake improved 23% (t(25)=2.29, P=.03). CONCLUSION: This senior center-based lifestyle intervention was associated with a significant reduction in SBP and adherence to prescribed antihypertensive medications and diet in the intervention group. Participant retention and group attendance rates suggest that implementing a group-counseling intervention in senior centers is feasible

Online support groups (OSGs) may be a particularly promising option for immigrants. They can be a cost-effective method that easily addresses geographic isolation and immigrants' needs for privacy This article examines the viability of OSGs for Hispanic immigrants with breast cancer and the effectiveness of OSGs for the participants. The authors hypothesized that OSGs are a feasible mechanism for delivering support to Latina women with breast cancer, as immigrant Latinas with breast cancer in OSGs showed significant improvement compared to a control group on depression, in coping with pain, in quality of life, and personal growth. Of 85 potential participants approached, 68 Spanish-dominant speaking immigrant women with breast cancer were recruited into the Virtual Community for Immigrants with Cancer (VCIC). Forty-eight were randomly assigned to OSGs and 20 were assigned to a usual care control group. VCIC participants were grouped into OSGs with eight participants in each. Each group met for 90 minutes once a week for 30 weeks. The groups were facilitated by trained bilingual facilitators and issues of interest to the group were discussed, such as managing symptoms and side effects from medications, family concerns, and alienation. The dropout rate from the groups was 13%. The VCIC experiences suggest that OSGs are acceptable to and feasible for immigrant minorities, including those with limited English proficiency. While none of the outcome measures showed statistically significant change pre-post compared to the control group, statistical trends were noted suggesting beneficial impact on outcomes. When compared to the controls, the experimental had increases in seeing new possibilities (F = 2.81, P = .09) and increased feelings of strength (F = 3.59, P = .06).

Molecular biology has revolutionized the field of tuberculosis (TB) research. Comparative genomics and molecular epidemiology are providing revelations about the evolutionary origins of MYCOBACTERIUM TUBERCULOSIS and phylogenetic relationships between different strains and strain families. Accumulating evidence indicates that distinct strains of M. TUBERCULOSIS (genotype) may be associated with differential transmissibility, virulence, and/or clinical manifestations (phenotype). As advances in our understanding of the relationships between genotype and phenotype progress, this knowledge will have important ramifications for TB control and the development of novel vaccines and improved diagnostics. Some of the greatest advantages of molecular epidemiological methods include our abilities to follow transmission of particular strains within communities, track epidemics, and recognize the presence of historic outbreaks. Moreover, there are critical questions about TB that are essentially unanswerable in the absence of molecular techniques. These include our capacity to distinguish exogenous reinfection from endogenous reactivation in recurrent TB cases and to recognize primary transmission of drug resistant strains versus the acquisition of drug resistance via de novo mutations. Finally, an elucidation of the phylogenetic structure and evolutionary history of M. TUBERCULOSIS provides a necessary background for understanding the underlying mechanisms responsible for the continued success of this deadly pathogen