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Little is known about young men who have sex with men's use of club drugs and the risk factors associated with such use. A structured survey was administered in 2005 to 496 young men who were 18-22 years old (40% were 18-19 years old); self-identified as with a same-sex sexuality (83%), bisexual (16%), and/or had had sex with a man (97%); Caucasian (35%), African American (24%), and Latino of Mexican descent (40%). Subjects were recruited from gay-identified venues in Los Angeles, California, using a venue-based probability sampling design. Descriptive statistics revealed a high prevalence of drug and club drug use. Regression analyses revealed risk factors associated with recent club drug use, including place of residence, religiosity, disclosure of sexuality to family, frequency of attendance at bars/clubs, and involvement in sexual exchange and street economy. Limitations and implications of this research are discussed. [ABSTRACT FROM AUTHOR]

Traumatic injury to the knee remains a diagnostic and therapeutic challenge. Magnetic resonance imaging (MRI) has been applied to musculoskeletal pathoa natomy and has been shown to be an effective tool for definition and characterization of knee pathology. A systematic approach is taken to establish anatomical and pathoanatomical correlations, as well as the role of MRI in the management of knee injuries.Imaging was performed at the UCLA Medical Center using a permanent magnet system and a combination of solenoidal surface coils and thin-section, high-reso lution scanning techniques. Images depict structural anatomical and spatial details of the knee that correlate well with corresponding cadaveric cryosections. To determine pathoanatomical correlations and the effi cacy of MRI, 105 patients with preoperative diagnoses of meniscal tears, anterior and posterior cruciate liga ment tears, tibial plateau fracture, and patella and quad riceps injuries were imaged.Results indicated that for the medial meniscus MRI demonstrated a 95.7% sensitivity, 81.8% specificity, 90% accuracy, 88.2% positive predictive value (PPV), and 93.1 % negative predictive value (NPV). Imaging of the lateral meniscus demonstrated a 75% sensitivity, 95% specificity, 91 % accuracy, 80% PPV, and 94% NPV. MRI of the ACL revealed 100% sensitivity, spec ificity, accuracy, positive and negative predictive values. MRI is a noninvasive tool which uses no ionizing radiation and can accurately define and characterize anatomy and pathoanatomy. This study indicates that MRI in conjunction with clinical evaluation can contrib ute to treatment decision-making processes and assist in preoperative planning. An algorithm demonstrating the potential clinical use of MRI is presented. [ABSTRACT FROM PUBLISHER]

Gene therapy for human immunodeficiency virus (HIV)-1 may be performed by introducing into hematopoietic stem cells genes that inhibit replication of HIV-1 using lentiviral vectors. However, production of lentiviral vectors derived from HIV-1 may be inhibited by the gene being carried to inhibit HIV-1 and these vectors could be mobilized by wild-type HIV-1 infecting transduced cells. This study investigates these problems for the delivery of a dominant-negative rev gene humanized revM10 (huM10) by a lentiviral vector. Although most packaging plasmids suffered inhibition of expression of HIV-1 virion proteins by vectors expressing huM10, the packaging plasmids that expressed the highest levels of HIV-1 virion proteins produced vectors at titers that would be sufficient for clinical applications. The vectors carrying huM10 were used to transduce primary human CD34+ hematopoietic progenitor cells and yielded high-level transduction without toxicity and conferred potent inhibition of HIV-1. The use of lentiviral vectors with deletion of the enhancers and promoter from the LTR (self-inactivating (SIN) vectors) decreased the frequency of vector mobilization by wild-type HIV-1; SIN vectors carrying huM10 were not mobilized detectably. These studies indicate that lentiviral vectors can be made effective for use in gene therapy for HIV-1.Molecular Therapy (2007) 15, 76–85. doi:10.1038/sj.mt.6300025 [ABSTRACT FROM AUTHOR]

Objective: The objective of our study was to determine the clinical and MRI characteristics of clinically significant prostate cancer (PCA) (Gleason score ≥ 3 + 4) in men with Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) category 3 transition zone (TZ) lesions., Materials and Methods: From 2014 to 2016, 865 men underwent prostate MRI and MRI/ultrasound (US) fusion biopsy (FB). A subset of 90 FB-naïve men with 96 PI-RADSv2 category 3 TZ lesions was identified. Patients were imaged at 3 T using a body coil. Images were assigned a PI-RADSv2 category by an experienced radiologist. Using clinical data and imaging features, we performed univariate and multivariate analyses to identify predictors of clinically significant PCA., Results: The mean patient age was 66 years, and the mean prostate-specific antigen density (PSAD) was 0.13 ng/mL 2 . PCA was detected in 34 of 96 (35%) lesions, 14 of which (15%) harbored clinically significant PCA. In univariate analysis, DWI score, prostate volume, and PSAD were significant predictors (p < 0.05) of clinically significant PCA with a suggested significance for apparent diffusion coefficient (ADC) and prostate-specific antigen value (p < 0.10). On multivariate analysis, PSAD and lesion ADC were the most important covariates. The combination of both PSAD of 0.15 ng/mL 2 or greater and an ADC value of less than 1000 mm 2 /s yielded an AUC of 0.91 for clinically significant PCA (p < 0.001). If FB had been restricted to these criteria, only 10 of 90 men would have undergone biopsy, resulting in diagnosis of clinically significant PCA in 60% with eight men (9%) misdiagnosed (false-negative)., Conclusion: The yield of FB in men with PI-RADSv2 category 3 TZ lesions for clinically significant PCA is 15% but significantly improves to 60% (AUC > 0.9) among men with PSAD of 0.15 ng/mL 2 or greater and lesion ADC value of less than 1000 mm 2 /s.

Objective: The goal of this study was to assess the effectiveness of the different types of healthcare worker training in pediatric disaster medicine knowledge over time and to analyze the effects of training type on healthcare workers' attitude toward pediatric disaster medicine., Design: Prospective randomized controlled longitudinal study., Setting: Large, urban, tertiary academic children's hospital., Subjects: Physicians and nurses employed at Children's Hospital Los Angeles randomly selected from a global hospital e-mail server over a 3-week time frame were invited to participate and receive an incentive on completion. Forty-three controls and 42 intervention subjects (22 lecture + tabletop exercise, 20 lecture only) completed the study. Subjects with disaster training in the prior 6 months were excluded., Interventions: Subjects underwent a didactic lecture or a combination of didactic lecture and tabletop exercise. Preintervention and postintervention testing took place using a 37-question multiple-choice test on pediatric disaster medical topics. Posttesting took place immediately after intervention and then 1, 3, and 6 months after the intervention. Subjects also were surveyed before and after intervention regarding their attitudes toward pediatric disaster medicine., Main Outcome Measures: (1) Scores on a 37-question knowledge test and (2) Likert scores on self-perceptions of knowledge, comfort, and interest in pediatric disaster medicine., Results: Regardless of intervention type, participant scores on a postintervention pediatric disaster medicine tests over a 6-month period increased and remained well above pretest means for intervention and control pretest scores. There were no differences in scores comparing type of intervention. However, subjects who underwent the tabletop simulation had a better sense of knowledge and comfort with the topics compared with those who only underwent a didactic lecture., Conclusions: Didactic lecture and tabletop exercises both increase healthcare worker's knowledge of pediatric disaster medical topics. This knowledge seems to be retained for at least 6 months postintervention. The addition of the tabletop exercise to a standard didactic lecture may increase a learner's sense of knowledge and comfort with disaster topics, which may in turn lead to increased staff participation in the event of an actual disaster.

Introduction: Contemporary events in the United States (eg, September 2001, school shootings), Europe (eg, Madrid train bombings), and the Middle East have raised awareness of mass casualty events and the need for a capable disaster response. Recent natural disasters have highlighted the poor preparation and infrastructure in place to respond to mass casualty events. In response, public health policy makers and emergency planners developed plans and prepared emergency response systems. Emergency response providers include first responders, a subset of emergency professionals, including firemen, law enforcement, paramedics, who respond to the incident scene and first receivers, a set of healthcare workers who receive the disaster victims at hospital facilities. The role of pediatric surgeons in mass casualty emergency response plans remains undefined. The authors hypothesize that pediatric surgeons' training and experience will predict their willingness and ability to be activated first receivers. The objective of our study was to determine the baseline experience, preparedness, willingness, and availability of pediatric surgeons to participate as activated first receivers., Methods: After institutional review board approval, the authors conducted an anonymous online survey of members of the American Pediatric Surgical Association in 2007. The authors explored four domains in this survey: (1) demographics, (2) disaster experience and perceived preparedness, (3) attitudes regarding responsibility and willingness to participate in a disaster response, and (4) availability to participate in a disaster response. The authors performed univariate and bivariate analyses to determine significance. Finally, the authors conducted a logistic regression to determine whether experience or preparedness factors affected the respondent's availability or willingness to respond to a disaster as a first receiver, Results: The authors sent 725 invitations and received 265 (36.6 percent) completed surveys. Overall, the authors found that 77 percent of the respondents felt "definitely" responsible for helping out during a disaster but only 24 percent of respondents felt "definitely"prepared to respond to a disaster. Most felt they needed additional training, with 74 percent stating that they definitely or probably needed to do more training. Among experiential factors, the authors found that attendance at a national conference was associated with the highest sense of preparedness. The authors determined that subjects with actual disaster experience were about four times more likely to feel prepared than those with no disaster experience (p < 0.001). The authors also demonstrated that individuals with a defined leadership position in a disaster response plan are twice as likely to feel prepared (p = 0.002) and nearly five times more willing to respond to a disaster than those without a leadership role. The authors found other factors that predicted willingness including the following: a contractual agreement to respond (OR 2.3); combat experience (OR 2.1); and prior disaster experience (OR 2.0). Finally, the authors found that no experiential variables or training types were associated with an increased availability to respond to a disaster., Conclusions: A minority of pediatric surgeons feel prepared, and most feel they require more training. Current training methods may be ineffectual in building a prepared and willing pool of first receivers. Disaster planners must plan for healthcare worker related issues, such as transportation and communication. Further work and emphasis is needed to bolster participation in disaster preparedness training.

Purpose: Many molecular pathways, including cell cycle control, angiogenesis, and drug resistance, mediate tumor growth and survival. Vascular endothelial growth factor-A (VEGF-A) serum levels <40 and >100 pg/mL have been associated with good and poor prognoses, respectively., Experimental Design: The hypothesis was that serum VEGF-A levels in standard-risk acute lymphoblastic leukemia pediatric patients at induction are predictive of event-free survival (EFS). One hundred seventeen patients were entered in CCG-1962 study and randomized into the native and polyethylene glycolated asparaginase arms. VEGF-A levels were quantified by an ELISA assay., Results: All patients had a decrease in VEGF-A levels by day 14 of induction, but they later dichotomized; EFS group levels remained low and event group levels increased. A correlation exists between high VEGF-A levels at entry to induction and time to event. Moreover, 6-year EFS patients have lower end of induction VEGF-A levels (28 +/- 6 pg/mL) than event patients (>100 pg/mL; P < 0.01). Kaplan-Meier curves using various VEGF-A values were produced; with < or =30 at entry into induction (day 0) and < or =60 pg/mL at the end of induction (day 28), patients with low VEGF-A levels had superior EFS (P < 1e-4). Furthermore, patients who had an increase in VEGF-A during induction (DeltaVEGF-positive, days 0-28) were more likely to have an event (P < 1e-4). Bifurcation by asparaginase treatment arm did not alter these results., Conclusions: These observations strongly support that high VEGF-A levels in induction are an asparaginase treatment-independent predictive marker for EFS. Hence, an anti-VEGF-A therapy should be tested in acute lymphoblastic leukemia.

The purpose of this study was to determine whether there is a significant association between function and well-being in children with cerebral palsy. To determine this, the authors used validated measures of function (Gillette Functional Assessment Questionnaire, Gross Motor Function Classification System, Gross Motor Function Measure, and walking speed) and correlated them to health-related quality of life (HRQOL) measures (Pediatric Outcomes Data Collection Instrument, Pediatric Quality of Life instrument). In a cross-sectional study of ambulatory children with mild to moderate cerebral palsy aged 10.2 +/- 3.2 years, mild to moderate decreases in function were found when compared with normative data. As the assessment of HRQOL comprises both functional well-being and psychosocial well-being, the authors decided to specify the aspect of well-being to which they were referring. It was found that the child's function was not correlated to psychosocial well-being. The children with mild cerebral palsy had greater effects on their psychosocial well-being than would be predicted by their functional disability. Functional measures were good at predicting the functional well-being but were weak at predicting the psychosocial arm of well-being.