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BACKGROUND: The role of immunological disorders in the development of atopic dermatitis (AD) is currently beyond doubt. AIMS: Changes in the serum levels of IL-4, IL-10 and IL-13 in patients with atopic dermatitis (AD) after UV therapy combined with standard drug treatment have been studied. MATERIALS AND METHODS: The study included 80 patients with moderate to severe AD and 80 healthy volunteers. The patients with AD received a course of 311 nm UVB phototherapy combined with standard drug therapy. Serum IL-4, IL-10 and IL-13 levels were determined through enzyme-linked immunosorbent assay (ELISA). RESULTS: In the studied sample, patients with AD were found to have statistically significantly higher serum levels of IL-10 and IL-13 compared with healthy volunteers of the control group. Serum IL-10 level was 18.3 pg/ml in patients with AD and 13.2 pg/ml in those of the control group; the level of IL-13 was 15.8 pg/ml and 11.5 pg/ml, respectively; after the course of 311 nm UVB, serum IL-10 and IL-13 levels in patients with AD decreased (IL-10 by 27.8% and IL-13 by 12.5%). IL-4 values did not differ significantly in patients with AD and those in the control group, being 0.06 pg/ml and 0.05 pg/ml, respectively; after the course of phototherapy, serum IL-4 levels remained unchanged and were equal to 0.05 pg/ml. CONCLUSION: The results obtained confirm the assumptions about the significant role of IL-10 and IL-13 in the mechanisms of AD regulation and pathogenesis and demonstrate the anti-inflammatory efficacy of phototherapy (311 nm UVB) in patients with severe and moderate AD.

This article describes the clinical aspects and treatment of seborrheic keratosis. The authors report the highly effective use of destructive therapy, 1.5% zinc chloropropionate solution in 2-chloropropionic acid, in patients with seborrheic keratosis.

Skin cancer is the leading cancer type (12.6%) in both men and women in Russian Federation. Basal cell skin cancer is the most common non-melanoma, malignant epithelial skin tumor. The identification of skin tumors in the early stages is one of the priority purposes of modern medicine because it facilitates the radical treatment of these diseases. Notably, an examination by a dermatologist should be performed in conjunction with non-invasive diagnostic methods.

In chronic lymphocytic leukemia (CLL), the B cell receptor (BCR) plays a critical role in disease development and progression, as indicated by the therapeutic efficacy of drugs blocking BCR signaling. However, the mechanism(s) underlying BCR responsiveness are not completely defined. Selective engagement of membrane IgM or IgD on CLL cells, each coexpressed by more than 90% of cases, leads to distinct signaling events. Since both IgM and IgD carry the same antigen-binding domains, the divergent actions of the receptors are attributed to differences in immunoglobulin (Ig) structure or the outcome of signal transduction. We showed that IgM, not IgD, level and organization associated with CLL-cell birth rate and the type and consequences of BCR signaling in humans and mice. The latter IgM-driven effects were abrogated when BCR signaling was inhibited. Collectively, these studies demonstrated a critical, selective role for IgM in BCR signaling and B cell fate decisions, possibly opening new avenues for CLL therapy., publishedVersion

Numerous investigations implicate pronounced changes in the functioning of T-type Ca2+ channels localized on the somata of primary nociceptor units in the development and maintenance of painful diabetic neuropathy. This review highlights the role of T-type Ca2+ channels of nociceptive afferents in the processing of pain signals under diabetic conditions, as well as suggests a promising therapeutic strategy to treat painful diabetic neuropathy.

Objectives To better understand the disproportionate burdens from cancer, cardiovascular disease, diabetes mellitus, stroke, and other chronic conditions related to energy balance, we studied diet and physical activity patterns in younger and older adults in rural Appalachia by using a nonclinical, cross-sectional, community-based sampling approach. Methods A total of 651 younger (ages 18-59) and 254 older (ages ≥60) Appalachians were recruited from 43 churches or community organizations. Participants answered questions about fruit and vegetable intake and physical activity. Analyses were adjusted for clustering within churches. Results Compared with older Appalachians, younger Appalachians consumed significantly fewer fruits and vegetables (P = 0.01) and reported significantly more moderate-to-vigorous physical activity (P = 0.01). Regardless of age, engagement in healthy behaviors was suboptimal and well below national averages. Conclusions This community-based sample demonstrated elevated behavioral risk factors that likely contribute to some of the nation's highest rates of premature mortality. Despite suboptimal dietary intake and physical activity, results indicate some potential leverage points between the generations that may be used to improve health. For example, the older generation could benefit from engaging with their younger relatives in physical activities while advocating for a better-rounded diet. Given traditions of intergenerational connectedness, mutual aid, and self-reliance, transmission of healthier behaviors across the generations may be beneficial in the rural Appalachian context.

PURPOSE The Centers for Disease Control and Prevention identified rural mothers as a priority population for targeted breastfeeding promotion programs. In Georgia, breastfeeding rates lag behind the national ones. This study examines rural-urban differences and trends over time in breastfeeding initiation and continuation (breastfeeding for at least 8 weeks) among women with a live birth from 2004 to 2013 in Georgia. METHODS This observational study is based on the Pregnancy Risk Assessment Monitoring System data. The National Center for Health Statistics urban-rural continuum codes were used to operationalize mother's county of residence. Prevalence of breastfeeding was estimated from the logistic regression models, unadjusted and adjusted for sociodemographic and health-related characteristics. FINDINGS In both unadjusted and adjusted analyses, significantly fewer rural (60.2%, 95% CI: 57.5-62.9 and 64.5%, 95% CI: 61.3-67.6, respectively) than urban (74.9%, 95% CI: 73.4-76.4 and 72.9%, 95% CI: 71.1-74.6, respectively) mothers initiated breastfeeding (P

Tobacco use delivers nicotine, tobacco-specific nitrosamines (TSNAs), volatile organic compounds (VOCs), and polycyclic aromatic hydrocarbons (PAHs), which are metabolized and excreted in urine offering useful biomarkers of exposure. Previous studies compared individual toxicants across tobacco users. Based on a group of biomarkers, cluster analysis was used to define tobacco toxicant exposure profiles. Clusters with distinct exposure profiles, were determined and described, based on levels of urinary biomarkers of exposure to nicotine, TSNAs, VOCs, and PAHs among a national sample of current, established, adult tobacco users, and examine the association of use behavior and cluster membership. The PATH Biomarker Wave 1 data were analyzed. Current established tobacco users with complete urinary biomarker data were included (N = 6724). User groups included cigarette smokers, users of electronic cigarette (ECIG), smokeless tobacco (SLT), and dual and poly tobacco users. Cluster analysis, pairwise comparisons, and multinomial logistic regression were conducted. Cigarette smokers were primarily in clusters with high biomarker concentrations across all groups, but actual concentrations were associated with smoking quantity. A cluster with high TSNAs but low levels of PAHs and VOCs was heavily populated by SLT users. Exclusive ECIG users, depending on use frequency, were predominantly in clusters with low biomarker concentrations, except for one cluster that had relatively high TSNAs. Clusters heavily populated by dual and poly tobacco users were the same as those heavily populated by cigarette smokers. Ten exposure profiles (clusters) were determined and linked to tobacco use behavior. Findings could inform future research and policy initiatives.

While earlier studies on men having sex with men (MSM) tended to examine infection-related cancers, an increasing number of studies have been focusing on effects of sexual orientation on other cancers and social and cultural causes for cancer disparities. As a type of tertiary research, this umbrella review (UR) aims to synthesize findings from existing review studies on the effects of sexual orientation on cancer. Relevant peer-reviewed systematic reviews (SRs) will be identified without date or language restrictions using MEDLINE, Cochrane Database of Systematic Reviews, and the International Prospective Register for Systematic Reviews, among others. The research team members will prepare the data extraction forms. Two reviewers will independently assess extracted SRs using the Assessment of Methodological Quality of Systematic Reviews. A third reviewer will weigh in to resolve discrepancies. The reviewers will be blinded to publisher, journal, and authors, making their judgements on the title, year, and abstract. The Preferred Reporting Items for Systematic Reviews and Meta-analysis checklist will guide data synthesis. By collating evidence from multiple reviews into one accessible and usable document, our first UR on global epidemiology of malignancies among MSM would serve as an evidence-based decision-making tool for the public health community.

Introduction: Engagement in leisure-time physical activity (PA) levels recommended by the American Heart Association (AHA) is inversely associated with both ischemic and hemorrhagic stroke risk. PA levels fluctuate over the lifecourse, but the association between changes in PA from mid- to late-life and stroke risk is unknown. Hypothesis: Participants who maintained ideal levels of PA or increased their PA across 6 years will have lower ischemic and hemorrhagic stroke risk relative to those who had persistently poor PA. Methods: We included 11,658 participants of the Atherosclerosis Risk in Communities study without a history of CHD or stroke at visit 3 (1993-1995). Leisure-time PA was assessed using the modified Baecke questionnaire at visits 1 and 3 and categorized according to the AHA guidelines for PA (ideal, intermediate, or poor). All adjudicated definite and probable incident ischemic and hemorrhagic strokes between visit 3 and end of year 2013 were included. Cox proportional hazards regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for ischemic and hemorrhagic stroke by categories of PA at visits 1 and 3. Those with poor PA at both visits were the referent group. We adjusted for age, sex, race/center, smoking, alcohol consumption, hypertension, diabetes mellitus, LDL, HDL, triglycerides, and body mass index. Results: During a median of 18.7 years of follow-up, 640 incident ischemic strokes and 76 hemorrhagic strokes occurred. In adjusted analyses, participants with ideal PA at both visits had a significantly lower ischemic stroke risk (HR=0.75 (0.59, 0.96)) but not significantly lower hemorrhagic stroke risk (HR=1.27 (0.65, 2.48)). Those whose PA levels increased from poor to ideal also had lower ischemic stroke risk (HR=0.74 (0.54, 1.03)) but not hemorrhagic stroke risk (HR=0.74 (0.28, 2.02)). Conclusion: Increasing PA between visit 1 and visit 3 was associated with lower ischemic stroke risk. Increasing PA may be an important component of stroke prevention.

Objective In individuals with mitochondrial disease, respiratory viral infection can result in metabolic decompensation with mitochondrial hepatopathy. Here, we used a mouse model of liver-specific Complex IV deficiency to study hepatic allostasis during respiratory viral infection. Methods Mice with hepatic cytochrome c oxidase deficiency (LivCox10−/−) were infected with aerosolized influenza, A/PR/8 (PR8), and euthanized on day five after infection following three days of symptoms. This time course is marked by a peak in inflammatory cytokines and mimics the timing of a common clinical scenario in which caregivers may first attempt to manage the illness at home before seeking medical attention. Metabolic decompensation and mitochondrial hepatopathy in mice were characterized by serum hepatic testing, histology, electron microscopy, biochemistry, metabolomics, and bioenergetic profiling. Results Following influenza infection, LivCox10−/− mice displayed marked liver disease including hepatitis, enlarged mitochondria with cristae loss, and hepatic steatosis. This pathophysiology was associated with viremia. Primary hepatocytes from LivCox10−/− mice cocultured with WT Kupffer cells in the presence of PR8 showed enhanced lipid accumulation. Treatment of hepatocytes with recombinant TNFα implicated Kupffer cell-derived TNFα as a precipitant of steatosis in LivCox10−/− mice. Eliminating Kupffer cells or blocking TNFα in vivo during influenza infection mitigated the steatosis and mitochondrial morphologic changes. Conclusions Taken together, our data shift the narrative of metabolic decompensation in mitochondrial hepatopathy beyond the bioenergetic costs of infection to include an underlying susceptibility to immune-mediated damage. Moreover, our work suggests that immune modulation during metabolic decompensation in mitochondrial disease represents a future viable treatment strategy needing further exploration., HIGHLIGHTS • Influenza infection leads to worsening mitochondrial function and steatohepatitis in a model of mitochondrial hepatopathy. • Kupffer cells may mediate this damage by the uptake of influenza virus and the secretion of TNFa. • Hepatocytes affected by mitochondrial disease have a lower threshold for immune mediated toxicity by TNFa. • Modulating the immune response leads to an improvement in the phenotype.

Despite judicious monitoring and care, patients with fatty acid oxidation disorders may experience metabolic decompensation due to infection which may result in rhabdomyolysis, cardiomyopathy, hypoglycemia and liver dysfunction and failure. Since clinical studies on metabolic decompensation are dangerous, we employed a preclinical model of metabolic decompensation due to infection. By infecting mice with mouse adapted influenza and using a pair-feeding strategy in a mouse model of long-chain fatty acid oxidation (Acadvl(−/−)), our goals were to isolate the effects of infection on tissue acylcarnitines and determine how they relate to their plasma counterparts. Applying statistical data reduction techniques (Partial Least Squares-Discriminant Analysis, PLS-DA), we were able to identify critical acylcarnitines that were driving differentiation of our experimental groups for all the tissues studied. While plasma displayed increases in metabolites directly related to mouse VLCAD deficiency (e.g. C16 and C18), organs like the heart, muscle and liver also showed involvement of alternative pathways (e.g. medium chain FAO and ketogenesis), suggesting adaptive measures. Matched correlation analyses showed strong correlations (r > 0.7) between plasma and tissue levels for a small number of metabolites. Overall, our results demonstrate that infection as a stress produces perturbations in metabolism in Acadvl(−/−) that differ greatly from WT infected and Acadvl(−/−) pair-fed controls. This model system will be useful for studying the effects of infection on tissue metabolism as well as evaluating interventions aimed at modulating the effects of metabolic decompensation.

Purpose The purpose of this study was to examine the importance of rural location in the likelihood of adolescent drunk driving and riding in a vehicle with a driver under the influence while controlling for a variety of student-, school-, and county-level factors. Methods Data from the 2013 Georgia Student Health Survey (GSHS) II (a statewide assessment of student health in public school students in Georgia) were analyzed using multilevel binary regressions to examine rural-urban differences in prevalence of driving under the influence (11th and 12th graders only; n = 114,907) and riding with a driver under the influence (9th -12th graders; n = 258,610), controlling for school-level race, gender, and income, in addition to county-level education level, unemployment, alcohol use, and smoking. Findings Across geographies, students were twice as likely to report riding with a driver under the influence (10.32%) as driving under the influence (4.16%). While both outcomes were more likely among rural adolescents in unadjusted analyses, in adjusted analyses, rural adolescents were not significantly more likely to drive under the influence (ORadj = 1.19; P = .055), but they were significantly more likely to ride with a driver under the influence (ORadj = 1.18; P = .002). Conclusions Our findings suggest that riding with a driver under the influence rather than driving under the influence may be a more pressing public health issue for adolescents in rural areas. Future research focused on the formative work necessary to build novel, culturally tailored interventions should be conducted to minimize the associated substantial burden of motor vehicle deaths within rural adolescents.

This study examined the association between adherence to American College of Sports Medicine and American Cancer Society guidelines on aerobic and muscle-strengthening activities and mortality risks among 3+ year cancer survivors in the U.S.The observational study was based on 1999-2009 National Health Interview Survey Linked Mortality Files with follow-up through 2011. After applying exclusion criteria, there were 13,997 observations. The hazard ratios (HRs) for meeting recommendations on muscle-strengthening activities only, on aerobic activities only, and on both types of physical activity (i.e., adhering to complete guidelines) were calculated using a reference group of cancer survivors engaging in neither. Unadjusted and adjusted HRs of all-cause, cancer-specific, and cardiovascular disease-specific mortalities were estimated using Cox proportional hazards models.In all models, compared to the reference group, cancer survivors adhering to complete guidelines had significantly decreased all-cause, cancer-specific, and cardiovascular disease-specific mortalities (HRs ranged from 0.37 to 0.64, p's 0.05). There were no statistically significant differences between hazard rates of cancer survivors engaging in recommended levels of muscle-strengthening activities only and the reference group (HRs ranged from 0.76 to 0.94, p's 0.05). Wald test statistics suggested a significant dose-response relationship between levels of adherence to complete guidelines and cancer-specific mortality.While muscle-strengthening activities by themselves do not appear to reduce mortality risks, such activities may provide added cancer-specific survival benefits to 3+ year cancer survivors who are already aerobically active.

Background Over the past half century the proportion of Hispanics in the US population has been steadily increasing, and groups of Hispanic origin have diversified. Despite notable racial and ethnic disparities in ovarian cancer (OC) mortality, population-based studies on OC among Hispanic females are lacking. Objectives To examine sub-ethnic disparities in OC mortality and survival trends using the Surveillance, Epidemiology, and End Results Program (SEER) 18 data on Hispanic women diagnosed with epithelial OC during 1992–2013. Methods The disparities in OC 5 year survival and mortality were examined using log-rank tests and Cox proportional hazards models, adjusted for sociodemographic and pathological characteristics, time of diagnosis, receipt of resection surgery and county socioeconomic status. Trends in 5-year survival rates were examined using joinpoint regression models. Results The 5-year survival was lowest in Puerto Ricans (median survival: 33 months; survival rate: 31.07%) and was highest in the “Other” Hispanic subgroup (median survival: 59 months; survival rate: 49.14%) (log-rank test: P Conclusions OC mortality in Hispanic patients varied by sub-ethnicity. This heterogeneity should be considered in future cancer data collection, reports and research.

Authors observed 18 patients with cutaneous B-cell lymphomas (B-CLS): primary cutaneous follicle center lymphoma (PCFCL) (44,45%), primary diffuse large B-cell lymphoma (B-CLL) (44,45%), cutaneous marginal zone B-cell lymphoma (CMZL) (11,1%). Features of cutaneous marginal zone B-cell lymphoma are: appearance of multiple spots; identification of diagnosis in stages T2aN0M0; treatment - excision or laser destruction; frequent recurrence do not affect prognosis. Features of primary cutaneous follicle center lymphoma are: appearance of single node; identification of diagnosis in stages T1aN0M0 and T2aN0M0; treatment - excision, can be also combined with radiotherapy. Features of primary diffuse B-CLL are: appearance of multiple spots; identification of diagnosis in stages T3bN0M0, T1aN1M0 and T2bN2M0; disease is aggressive; treatment is a local radiotherapy, interferon alpha intralesional, chemotherapy according to schemes CHOP, COP and R-CHOP, photodynamic therapy is possible.

Introduction: The study hypothesized that sociocultural factors would be associated with breast cancer screening within the past 2 years among Latina immigrant women. Method: This study employed a survey design and included 82 Latina immigrant female participants 40 to 64 years of age for the analysis. Two multivariable binary logistic regression models were estimated, one for the sociocultural deterrents and the other for the symptomatic deterrents from the Cultural Cancer Screening Scale. Results: The results indicated two constructs of the Cultural Cancer Screening Scale, sociocultural deterrents (odds ratio = 2.00; 95% confidence interval = 1.04-3.86) and symptomatic deterrents (odds ratio = 1.65; 95% confidence interval = 1.08-2.54), were associated with screening in the past 2 years, when adjusting for sociodemographic and health-related characteristics. Conclusion: These findings provide evidence for the importance of sociocultural factors in Latina immigrant women’s timely mammography screening.

We studied the adjuvant properties of micelles from nonionogenic detergents, liposome, and selenium nanoparticles containing extracellular and intracellular vaccine antigens of a weakly virulent α-hemolytic Escherichia coli B-5 strain used for the immunization of experimental animals. Triton X-100 was used as a nonionogenic detergent for micelle preparation. The liposomes were obtained on the basis of lecithin from a chicken egg and E. coli B-5 membrane lipids. Native lipoproteins of E. coli B-5 cells and peptides for the proteolytic hydrolysis of toxin-containing culture liquid were used as antigens for micelles and liposomes. The obtained data suggested that micelles, liposomes, and selenium nanoparticles can be used for immunization with cellular and extracellular E. coli antigens.

Physical activity guidelines for cancer survivors issued by the American Cancer Society and the American College of Sports Medicine emphasize the essential role of a health care provider (HCP) in counseling cancer survivors to achieve healthier lifestyles. However, research has not established whether HCP's recommendations to engage in physical activity are associated with increased physical activity levels of cancer survivors. The study examines this potential association using the 2005 and 2010 National Health Interview Survey data. The final analytic sample consisted of 3320 cancer survivors and 38,955 adults without cancer who reported seeing or talking to a HCP and if or not they had received a physical activity recommendation in the prior year. Consistent with the aforementioned guidelines, physical activity levels were categorized as inactive, insufficiently active, and sufficiently active (i.e., meeting guidelines). Average adjusted predictions and marginal effects were estimated from generalized ordered logit models. Multivariable regressions controlled for socio-demographic and health-related characteristics and survey year. On average, receipt of a HCP's physical activity recommendation was associated with a lower adjusted prevalence of inactivity by 8.3 percentage points and a higher adjusted prevalence of insufficient and sufficient activity by 4.6 and 3.7 percentage points, respectively, regardless of cancer diagnosis (P's

Family responsibilities and social expectations often prompt conflict in caregivers' decision-making processes. Janis and Mann's (1977) conflict model describes vigilance as high-quality decision-making resulting in optimal outcomes. The purpose of our research was threefold: (1) to describe decision styles in a population of family caregivers of persons with dementia; (2) to examine the socio-economic characteristics associated with caregivers who are more likely to be vigilant decision-makers; and (3) to assess differences in caregiving experiences between vigilant and non-vigilant caregivers.Our analysis was based on 639 survey respondents recruited from a university-affiliated memory disorders clinic.Our typical caregiver was Caucasian non-Hispanic, was currently married, and had two children. Approximately half of our sample used a 'pure vigilant' decision style. Vigilance was associated with more positive and fewer negative caregiving outcomes.Supporting caregivers to become vigilant decision-makers is a functionally viable intervention that could significantly improve the caregiving experience.

Introduction: Engagement in leisure-time physical activity (PA) levels recommended by the American Heart Association (AHA) is inversely associated with ischemic stroke risk. PA level can fluctuate over time but the association between PA fluctuations and ischemic stroke risk is unknown. The extent that ischemic stroke risk could be attenuated by increasing PA among those who are inactive could inform stroke prevention. Hypothesis: We hypothesize that participants who remained active or increased their PA levels will have lower ischemic stroke risk relative to those who were persistently inactive. Methods: We included 12,611participants of the Atherosclerosis Risk in Communities (ARIC) cohort study ages 45-64 at visit 1 (1987-1989) who did not have a history of stroke at visit 3 (1993-1995). Leisure-time PA was assessed using the modified Baecke questionnaire at visits 1 and 3 and categorized according to the AHA guidelines for PA (ideal, intermediate, or poor). All adjudicated definite and probable incident ischemic strokes between visit 3 and end of year 2013 were included. Cox-proportional hazards regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for ischemic stroke by cross-categories of PA at visits 1 and 3 using those with poor PA at both visits as the referent group. We adjusted for age, sex, race/center, smoking status, and alcohol intake at visit 3. Results: During a median of 18.6 years of follow-up, 777 incident ischemic stroke events occurred. Compared with those with poor PA at visits 1 and 3, participants with ideal PA at both visits had the lowest ischemic stroke risk (HR=0.64, 0.51, 0.80). Those whose PA increased from poor to ideal also had significantly lower ischemic stroke risk (HR = 0.70, 0.53, 0.94). Conclusion: Sustained ideal PA was associated with the lowest ischemic stroke risk. Increasing PA between visit 1 and visit 3 was also associated with significantly lower ischemic stroke risk. Increasing PA may be an important component of stroke prevention.

Clinical case of patient with rashes on mucous membrane of oral cavity with severe pain, edema, redness, deformation of eyelids on both eyes and decreased visual acuity is presented. After examination by several specialists (dentist, ophthalmologist and dermatologist) cicatricial pemphigoid with primary lesion of eyes was diagnosed. Authors point out doctors on danger of serious complications of this disease, which demand active involvement of doctors of other specialties.

Clinical case of skleroderma, associated with borrelia infection is presented. 64 year old patient complained about lesions on the skin of the trunk, in the form of consolidation with change of colour and shine. 5 years ago on a skin in the left calcaneal area stuck tick that has been independently removed, was found. First occurrences of dark stains on a trunk was noticed a year ago. On the basis of the anamnesis, clinical picture and histologic research the diagnosis of localized skleroderma was established. Successful treatment was performed.

Cases of pyogenic granulema on hand and face of child which have arisen after small traumas are presented. Patients complained about tumor formations easily bleeding at an insignificant trauma. In one case histologic examination confirmed the diagnosis. Electrocoagulation of the tumor was performed. No complications were detected. Disease recurrence was observed. Dermatologists should carry out differential diagnostics with tumor formations (nodular melanoma, sarcoma of Kaposhi and others).

Following the latest update of cervical cancer screening guidelines in 2012, we estimate the prevalence of guideline adherent cervical cancer screening and examine its associated factors among a nationally representative sample of US women aged 21–65 years. Our study was based on cross-sectional data from Cycles 3 (2013) and 4 (2014) of the Health Information National Trends Survey. The final analytic sample consisted of 2822 women. Guideline adherent cervical cancer screening was defined as having a Pap test within the last 3 years. Correlates of guideline adherent cervical cancer screening included socio-demographic and health-related characteristics and HPV/cervical cancer-related beliefs and knowledge items. Multivariable logistic regression analyses were used to estimate prevalence of guideline adherent screening. An estimated 81.3% of women aged 21–65 years reported being screened for cervical cancer within the last 3 years. Controlling for sociodemographic and health-related characteristics and survey year, women aged 46–65 years were less likely to be guideline adherent than those aged 21–30 years (aPR = 0.89; 95% CI 0.82–0.97). The adjusted prevalence of adherence was significantly higher among married/partnered than among not married women (aPR = 1.13; 95% CI 1.05–1.22), and those with one to three medical visits (aPR = 1.30; 95% CI 1.14–1.48), and four or more visits in the past year (aPR = 1.26; 95% CI 1.09–1.45) compared to those with no medical visits. Differences in unadjusted prevalence of guideline adherent screening depending on women’s beliefs and knowledge about HPV and cervical cancer were not significant in adjusted analyses. Lack of interaction with a healthcare provider, being not married/partnered and increasing age continue to be risk factors of foregoing guideline adherent cervical cancer screening.

In response to infection, patients with inborn errors of metabolism may develop a functional deterioration termed metabolic decompensation. The biochemical hallmarks of this disruption of metabolic homeostasis are disease specific and may include acidosis, hyperammonemia or hypoglycemia. In a model system previously published by our group, we noted that during influenza infection, mice displayed a depression in hepatic mitochondrial enzymes involved in nitrogen metabolism. Based on these findings, we hypothesized that this normal adaptation may extend to other metabolic pathways, and as such, may impact various inborn errors of metabolism. Since the liver is a critical organ in inborn errors of metabolism, we carried out untargeted metabolomic profiling of livers using mass spectrometry in C57Bl/6 mice infected with influenza to characterize metabolic adaptation. Pathway analysis of metabolomic data revealed reductions in CoA synthesis, and long chain fatty acyl CoA and carnitine species. These metabolic adaptations coincided with a depression in hepatic long chain β-oxidation mRNA and protein. To our surprise, the metabolic changes observed occurred in conjunction with a hepatic innate immune response, as demonstrated by transcriptional profiling and flow cytometry. By employing an immunomodulation strategy to deplete Kupffer cells, we were able to improve the expression of multiple genes involved in β-oxidation. Based on these findings, we are the first to suggest that the role of the liver as an immunologic organ is central in the pathophysiology of hepatic metabolic decompensation in inborn errors of metabolism due to respiratory viral infection.

Introduction As obesity prevalence has increased, adolescents' self-perceived body weight might have shifted accordingly. This study aims to investigate the generational shift in adolescents' perception of their body weight. Methods We used data from adolescents aged 12–16 years who participated in the National Health and Nutrition Examination Survey in 1988–1994 (early, n =1,720) or 2007–2012 (recent, n =2,518). Self-perceived weight status was assessed by face-to-face interviews, and BMI z -scores were calculated using directly measured weight and height with the 2000 CDC Growth Charts as the reference. The analysis was conducted in 2013. Results The median BMI z -score of self-perceived overweight adolescents increased from 1.32 (95% CI=1.18, 1.46) among adolescents interviewed early to 1.82 (1.74, 1.90) among adolescents interviewed recently. After adjusting for age, race/ethnicity, sex, and family income, the probability of self-perceiving as "overweight" declined by 29% for overweight/obese adolescents interviewed recently (probability ratio [PR]=0.71 [0.62, 0.82]) compared with adolescents with the same z -scores but interviewed early. The declining tendency of accurately self-perceiving as overweight was most pronounced among whites (PR=0.64 [0.48, 0.85]), and least among blacks (PR=0.76 [0.58, 0.99]). Both boys and girls interviewed recently were significantly less likely to accurately self-perceive as overweight (PR=0.70 [0.56, 0.89] and 0.73 [0.61, 0.87], respectively) compared with their counterparts who were interviewed early. Conclusions Fewer overweight/obese adolescents self-perceived as such in the 2007–2012 survey compared with the 1988–1994 survey. The declining tendency among overweight or obese adolescents may be indicative of a generational shift in body weight perceptions.

Nowhere is improving understanding and accurate assessment of physical activity more important for disease prevention and health promotion than among health disparities populations such as those residing in rural and Appalachian regions. To enhance accurate assessment of physical activity and potentially improve intervention capacity, we conducted a mixed-methods study examining the acceptability and feasibility of self-report physical activity questionnaires, pedometers, and accelerometers among rural Appalachian children, adolescents, and adults. Most participants reported positive experiences with all three physical activity assessment tools. Several acceptability ratings differed by age group and by sex within each age group. With very few exceptions, no significant differences in acceptability were found by race, education, employment status, health status, BMI categories, income levels, or insurance status within age groups or overall. Several factors may impact the choice of the physical activity assessment method, including target population age, equipment cost, researcher burden, and potential influence on physical activity levels. Children and adolescents appear to have more constraints on when they can wear pedometers and accelerometers. While pedometers are inexpensive and convenient, they may influence physical activity levels, rather than simply measure them. Accelerometers, while less influential on behavior, consume extensive resources, including high purchase costs and researcher burden.

The clinical case of flebotodermia, which has arisen on a sting of the tick, is presented. The patient consulted a dermatologist about irritable papilloma in the left armpit. With careful examination and dermoscopy was detected tick in the skin with symptoms of inflammatory reaction around the bite. The tick removal by electrocoagulation was performed. The authors draw the attention of doctors of all specialties on the needfor careful and regular inspection of patients in hospitals for the presence and remove of ticks.

The clinical case of apocrine sweat glands disease - chromhidrosis, that is characterized by stains on linen and clothes in armpit, brushes, genitals, is presented. Stains can be various color, it depends on the reason that causes the pathology. Authors pay attention of doctors to necessity of inspection of such patients taking into account the anamnesis and a possible pathology of internal organs.

Review of modern non-invasive methods of localizedfat deposits removal, classification of liposuction methods, mechanisms of action are described. The basics of biological effects on tissue, the results of clinical trials, efficiency of the methods are presented. The method of cryolipolysis is described in details.

This study examined the feasibility and efficacy of Salud es Vida—a promotora-led, Spanish language educational group session on cervical cancer screening (Pap tests)—self-efficacy (belief in ability to schedule and complete a Pap test), and knowledge among immigrant Hispanic/Latina women from farmworker backgrounds. These women are disproportionately burdened with cervical cancer, with mortality rates significantly higher than non-Hispanic whites. The two-arm, quasi-experimental study was conducted in four rural counties of Southeast Georgia in 2014–2015. Hispanic/Latina immigrant women aged 21–65 years and overdue for a Pap test were included as intervention (N = 38) and control (N = 52) group participants. The intervention was developed in partnership with a group of promotoras to create the toolkit of materials which includes a curriculum guide, a brochure, a flipchart, a short animated video, and in-class activities. Twelve (32 %) intervention group participants received the Pap test compared to 10 (19 %) control group participants (p = 0.178). The intervention group scored significantly higher on both cervical cancer knowledge recall and retention than the control group (p < 0.001). While there was no statistically significant difference in cervical cancer screening self-efficacy scores between the group participants, both groups scored higher at follow-up, adjusting for the baseline scores. The group intervention approach was associated with increased cervical cancer knowledge but not uptake of Pap test. More intensive interventions using patient navigation approaches or promotoras who actively follow participants or conducting one-on-one rather than group sessions may be needed to achieve improved screening outcomes with this population.

OBJECTIVES: To examine prevalence and correlates of cervical cancer screening utilization and adherence among a growing population of Hispanic immigrant women in coastal South Carolina. METHODS: We conducted a cross-sectional survey of 196 women to assess recency of screening and hypothesized study predictors (health status, beliefs, self-efficacy, having a regular provider, barriers to screening, and trust in providers). Multiple ordinal logistic regressions identified final covariates which would predict recency of screening. RESULTS: Approximately 84% of women were up-to-date with their Pap tests and 47% had received a Pap test in the previous year. In the adjusted analyses, having a regular provider and having a chronic medical condition were significantly associated with recency of Pap test. CONCLUSIONS: Differences in cervical cancer screening for participants were partially explained by psychosocial factors, health status, and individual and structural barriers to healthcare.

Metabolic decompensation in inborn errors of metabolism (IEM) is characterized by a rapid deterioration in metabolic status leading to life-threatening biochemical perturbations (e.g. hypoglycemia, hyperammonemia, acidosis, organ failure). Infection is the major cause of metabolic decompensation in patients with IEM. We hypothesized that activation of the immune system during infection leads to further perturbations in end-organ metabolism resulting in increased morbidity. To address this, we established model systems of metabolic decompensation due to infection. Using these systems, we have described the pathologic mechanisms of metabolic decompensation as well as changes in hepatic metabolic reserve associated with infection. First and foremost, our studies have demonstrated that the liver experiences a significant local innate immune response during influenza infection that modulates hepatic metabolism. Based on these findings, we are the first to suggest that the role of the liver as a metabolic and immunologic organ is central in the pathophysiology of metabolic decompensation due to infection in IEM. The dual function of the liver as a major metabolic regulator and a lymphoid organ responsible for immunosurveillance places this organ at risk for hepatotoxicity. Mobilization of hepatic reserve and the regenerative capacity of a healthy liver compensates for this calculated risk. However, activation of the hepatic innate immune system may be deleterious in IEM. Based on this assertion, strategies aimed at modulating the innate immune response may be a viable target for intervention in the treatment of hepatic metabolic decompensation.

Rural Mexican immigrant women in the U.S. are infrequently screened and experience health disparities from cervical cancer. We explored cancer-related cultural beliefs in this population. We administered a cross-sectional survey to 39 Mexican immigrant women due for screening. We conducted univariate and bivariate analyses of participants’ characteristics, Pap test history, cancer-related knowledge and beliefs, and cultural consensus analysis about causes of cervical cancer and barriers to screening. For all the cultural consensus tasks, there was consensus (Eigenratios >3:1) among survey participants. Comparing the rankings of risk factor clusters, clusters related to sexual behaviors were ranked more severely than clusters related to genetic or other behavioral factors. There was agreement on ideas of cervical cancer causation and barriers to screening among these women. Hence, improved methods of disseminating important health information and greater access to care are needed, particularly in relationship to stigma about sex and birth control practices.

Adults with diabetes are at increased risk of being diagnosed with and dying from colorectal cancer, but it is unclear whether colorectal cancer screening (CRCS) use is lower in this population. Using the 2008 and 2010 National Health Interview Survey data, we examined whether guideline-concordant CRCS is lower among men and women with self-reported diabetes. We calculated the weighted percentage of guideline-concordant CRCS and unadjusted and adjusted prevalence ratios (PR) comparing adults aged 51–75 years with diabetes (n = 6,514) to those without (n = 8,371). We also examined effect modification by age (51–64 and 65–75), race/ethnicity, and number of medical office visits (0–3, ≥4). The unadjusted prevalence of CRCS among men with diabetes was significantly higher than men without (63.3 vs. 58.0 %; PR = 1.09 95 % CI 1.03–1.16). In adjusted models, this relationship was evident among older [adjusted PR (aPR) = 1.13 95 % CI 1.06–1.21] but not younger men (aPR = 0.99 95 % CI 0.91–1.08; p for interaction term ≤0.01). There was no significant association between diabetes and CRCS among women overall (56.6 vs. 57.9 %; PR = 0.98 95 % CI 0.92–1.04) or by age group. Race/ethnicity and the number of medical visits did not significantly modify the association between diabetes and CRCS for men or women. Men and women with self-reported diabetes were not less likely to be up to date with CRCS than those without diabetes. Older men with diabetes were more likely to be up to date with CRCS than those without diabetes.

Summary The urea cycle functions to incorporate ammonia, generated by normal metabolism, into urea. Urea cycle disorders (UCD) are caused by loss of function in any of the enzymes responsible for ureagenesis, and are characterized by life-threatening episodes of acute metabolic decompensation with hyperammonemia (HA). A prospective analysis of interim HA events in a cohort of patients with ornithine transcarbamylase (OTC) deficiency, the most common UCD, revealed that intercurrent infection was the most common precipitant of acute HA and was associated with markers of increased morbidity when compared to other precipitants. To further understand these clinical observations, we developed a model system of metabolic decompensation with HA triggered by viral infection (PR8 influenza) using spf-ash mice, a model of OTC deficiency. Both WT and spf-ash displayed similar cytokine profiles and lung viral titers in response to PR8 influenza infection. During infection, spf-ash displayed an increase in liver transaminases suggesting a hepatic sensitivity to the inflammatory response and an altered hepatic immune response. Despite having no visible pathologic changes by histology, WT and spf-ash had reduced CPS1 and OTC enzyme activities, and unlike WT, spf-ash failed to increase ureagenesis. Depression of urea cycle function was seen in liver amino acid analysis with reductions seen in aspartate, ornithine and arginine during infection. In conclusion, we developed a model system of acute metabolic decompensation due to infection in a mouse model of a urea cycle disorder. In addition, we have identified metabolic perturbations during infection in the spf-ash mice, including a reduction of urea cycle intermediates. This model of acute metabolic decompensation with HA due to infection in UCD serves as a platform for exploring biochemical perturbations and the efficacy of treatments, and may be adapted to explore acute decompensation in other types of inborn errors of metabolism.

Citrullinemia type 1 (CTLN1) is an autosomal recessive disorder of metabolism caused by a deficiency of argininosuccinate synthetase. Despite optimal management, CTLN1 patients still suffer from lethal metabolic instability and experience life-threatening episodes of acute hyperammonemia. A murine model of CTLN1 (fold/fold) that displays lethality within the first 21 days of life was used to determine the efficacy of adeno-associated viral (AAV) gene transfer as a potential therapy. An AAV serotype 8 (AAV8) vector was engineered to express the human ASS1 cDNA under the control of a liver-specific promoter (thyroxine-binding globulin, TBG), AAV8-TBG-hASS1, and delivered to 7-10 days old mice via intraperitoneal injection. Greater than 95% of the mice were rescued from lethality and survival was extended beyond 100 days after receiving a single dose of vector. AAV8-TBG-hASS1 treatment resulted in liver-specific expression of hASS1, increased ASS1 enzyme activity, reduction in plasma ammonia and citrulline concentrations and significant phenotypic improvement of the fold/fold growth and skin phenotypes. These experiments highlight a gene transfer approach using AAV8 vector for liver-targeted gene therapy that could serve as a treatment for CTLN1.

More than 1 in 5, or 72 million people, will be age 65 or older in the US by the year 2030.1 The unprecedented growth of the older population portends huge increases in the simultaneous occurrence of concurrent chronic health conditions, or multiple morbidity (MM),2 forcing providers and patients to face increasingly complex clinical and lifestyle decisions. These decisions include how to fit effective prevention efforts into disease management activities.3 Since those with MM are more likely than in years past to experience long life expectancy, there is utility in understanding the relationship between MM management and disease prevention. Insights on these relationships are particularly needed among traditionally underserved populations that face the highest rates of diseases and the lowest level of preventive care.4-6 This paper contributes to the emerging body of research by examining rural residents’ perceptions of their MM and the burdens of disease management in relation to colorectal cancer screening (CRCS). In general, rural residents tend to be older, poorer, less educated, are more likely to be uninsured, and suffer higher rates of disease and disability than their urban counterparts.4-6 Those who reside in rural Appalachia are particularly disadvantaged. Residents of Appalachian Kentucky (54 of 120 counties) are characterized by socioeconomic status indicators that are among the lowest in the United States.7-10 For example, in 2009, the per capita personal income in Appalachian Kentucky was $26,157 (compared to $39,635 nationally and $32,426 in the Appalachian region).7,8 The percentage of Appalachian Kentucky residents below poverty level was nearly double the national and Appalachian region averages (24% vs 14% and 16%, respectively),9 and 63% had graduated from high school compared to 82% in the US and 77% in the Appalachian region overall.10 There are fewer health care professionals, particularly specialists, in rural areas—yet many challenges exist, including transportation barriers, in rural locations.11,12 Consequently, Appalachian and rural residents often experience a more pernicious version of the nation’s health problems, including a higher MM incidence and colorectal cancer incidence and mortality.12-14 Based on the 2005 analyses of cancer registries of Kentucky, Pennsylvania, and West Virginia, the incidence of colon and rectal cancers in the Appalachian region was 44.1 and 17.6 per 100,000 population. The estimated local-stage colorectal cancer rate was low in comparison to the elevated colorectal cancer mortality rate in the region, suggesting modest utilization of CRCS among vulnerable rural and Appalachian residents.15 Thus, research efforts focused on this disadvantaged population are warranted given the combination of higher disease rates and fewer resources (on both individual and community levels) to manage existing conditions and prevent future disease. Research on etiology of the relationship between disease management and prevention, including CRCS, remains scant. On one hand, according to the surveillance hypothesis, individuals diagnosed with MM tend to have greater contact with the health care system and, consequently, an increased likelihood of being encouraged to receive a colorectal examination.16,17 Proponents of the competing demand hypothesis, on the other hand, speculate that MM competes for the time and focus of physicians and resources of the individual, thus undermining prevention efforts like cancer screening.18-20 Consistent with several observational studies,21-27 our recent study of this vulnerable population suggests that the overall presence of MM is associated with increased rates of CRCS.28 In this study, we aim to better understand the mechanisms that underlie CRCS among those with MM by examining individuals’ perceived burdens of chronic conditions, as proxies of their competing demands and coping abilities. We hypothesize that: (i) individuals’ perceptions are reflective of their actual MM burdens, and (ii) those who perceive their chronic conditions to constitute a burden may be less inclined to obtain screening.29

Objectives To examine adherence to the American College of Sports Medicine and American Cancer Society guidelines on leisure-time aerobic and muscle-strengthening physical activity (PA) of older cancer survivors. Design Cross-sectional study based on the 2014 National Health Interview Survey. Setting United States. Participants Young-old (65–74) (n = 627), old-old (≥75) (n = 656), and middle-aged (45–64) (n = 786) cancer survivors and adults without cancer (n = 18,369), stratified according to the same age groups. Measurements Weighted percentages were used to describe sociodemographic and health-related characteristics of the study population. Unadjusted and adjusted predicted probabilities from generalized ordered and multinomial logistic regressions were estimated to examine levels of aerobic and muscle-strengthening PA in the study population. Results Cancer survivors and those without a cancer diagnosis had similarly low rates of adherence to PA guidelines according to age group. In unadjusted analyses, the age effect was statistically significant in long-term cancer survivors only. Adjusting for sociodemographic and health-related characteristics, on average, 34.0% of young-old and 35.4% of old-old cancer survivors engaged in sufficient levels of aerobic PA, versus 44.3% of their middle-aged counterparts (P's

Restimulation-induced cell death (RICD) regulates immune responses by restraining effector T cell expansion and limiting nonspecific damage to the host. RICD is triggered by re-engagement of the TCR on a cycling effector T cell, resulting in apoptosis. It remains unclear how RICD sensitivity is calibrated in T cells derived from different individuals or subsets. In this study we show that aerobic glycolysis strongly correlates with RICD sensitivity in human CD8+ effector T cells. Reducing glycolytic activity or glucose availability rendered effector T cells significantly less sensitive to RICD. We found that active glycolysis specifically facilitates the induction of proapoptotic Fas ligand upon TCR restimulation, accounting for enhanced RICD sensitivity in highly glycolytic T cells. Collectively, these data indicate that RICD susceptibility is linked to metabolic reprogramming, and that switching back to metabolic quiescence may help shield T cells from RICD as they transition into the memory pool.

Research Objective To estimate the effects of smoking bans on neonatal health outcomes and maternal smoking behavior during pregnancy. Data Sources Restricted-use 1991–2009 Natality Detail Files, a Clean Air Dates Table Report, and the Tax Burden of Tobacco. Study Design A quasi-experimental study using difference-in-differences estimation based on legislative history of smoking restrictions or bans by type/place/county/state level. Dependent variables included average monthly percentage of healthy neonates, of term neonates born with low and very low birth weight, of premature births, of maternal smokers, and average number of cigarettes smoked daily during pregnancy. The analyses were restricted to singleton births and those that occurred in the same county as mother's county of residence. Data Collection/Extraction Methods The data from three data sources were combined using Federal Information Processing Standard codes. Principal Findings Results of the overall and stratified by maternal smoking status, educational level, and age regression analyses suggested no appreciable effect of smoking bans on neonatal health. Smoking bans had also no effect on maternal smoking behavior. Conclusion While there are health benefits to the general population from smoking bans, their effects on neonatal health outcomes and maternal smoking during pregnancy seem to be limited.