bluuebunny/crossref_metadata_2025_split huggingface dataset:
P87 Development of regional good practice arrangements for the management of pregnant women with syphilis and their babies in the north east of England
Authors: Hew Y , Hussey J , Mitchell L , Vallappil M , Clarke J , Clarke J , Foster K 
Published: May 2012

BackgroundThe re-emergence of congenital syphilis in the North East and outcomes of a regional audit prompted the development of regional good practice arrangements in managing pregnant women with syphilis and their babies.AimsGuidance documents for the various clinical specialties were present for the management of pregnant women with syphilis in our region, but not a clear description of the whole patient (mother and baby) pathway. The overall aim of the good practice arrangement was to clarify precise roles of clinicians looking after these pregnant women, prompt re-testing of syphilis based on subsequent risks and concerns, create referral pathways and encourage multidisciplinary communication in management of pregnant women with syphilis.MethodCurrent national guidance was reviewed and discussed between Northern BASHH group, Health Protection Agency (HPU and virology), regional Paediatric Infectious Diseases and Antenatal screening coordinators. Audit outcomes highlighted areas needing improvement and these were addressed including use of named rather than numbered GUM serology specimens.ResultsThe good practice arrangement outlines clearly the patient journey from diagnosis to delivery and follow-up of her baby. It is divided into different stages, with each outlining clearly who is responsible for care, locally recommended practice and referring to national guidance where indicated for the management of that stage. These stages are antenatal screening and referral process to GUM, management of positive results in mother, investigations of baby at birth, follow-up of babies born to mothers with positive syphilis results and treatment of baby with suspected congenital syphilis. Good practice is included on the management of mothers who do not attend GUM follow-up, communication to those involved in care and a named lead paediatrician in every hospital trust in the North East region has been created.
P92 Routine enquiry for domestic violence, alcohol and drug use in a sexual health clinic
Authors: Loke W C , Maclellan J , Maurice J 
Published: May 2012

BackgroundAddressing domestic violence (DV) against women is highlighted in the 2011/12 NHS Operating Framework. Genitourinary medicine is cited as one of the services where victims of abuse may present. Alcohol and drug use are recognised as factors affecting sexual risk taking behaviour. Routine enquiry for DV (women only) and drug and alcohol use was implemented in this service in June 2011.AimsTo audit if routine enquiry for DV, alcohol and drug use was done and identify interventions when DV was disclosed or if risk taking was found to be affected by drug or alcohol use.MethodsA casenote review was done on all new and rebook (attending again after 3 months or more for a new episode of care) patients who attended during the first week of September 2011. The history proforma included questions on DV, alcohol consumption, recreational drug use and if they felt this affected their risk taking. Asymptomatic patients for screening were excluded as no detailed history was taken.ResultsThe history proforma was filled out for 55 women and 22 men. All were heterosexuals. The median age was 25. 26 attended for contraception, 44 for sexual health screen and 7 for both. 21 were rebook patients. 38/55 (69%) women were asked about DV. Five gave a history of DV, four were historic, one unspecified. 63 (82%) and 62 (81%) were asked their alcohol and drug use respectively. One man disclosed drinking >21 units/week and that it affected his risk taking. 10 used drugs: six cannabis, one cocaine and three unspecified. None were referred to other agencies. Of those not asked about DV, alcohol or drug use, no reason was documented.DiscussionThe relatively low rate of enquiry for DV may increase with training and awareness raising. Only one patient considered his risk taking affected by alcohol. This may be due to the lack of sensitivity of direct questioning. Closer working with supporting agencies for DV, alcohol and drug use may increase referrals.
P93 The acceptability of routine enquiry of gender-based violence at sexual health clinics
Authors: Innes K , Fraser P , Baguley S D K 
Published: May 2012

BackgroundIn 2008/09, 53 861 incidents of GBV were reported to the police in Scotland; 84% were male perpetrator against female victim and 14% female vs male. National guidance recommends routine enquiry of abuse (REA) amongst female attendees at sexual health clinics. Section SH 4.3 of the Sexual Health and Blood Borne Virus Framework says that levels of GBV should be recorded. Research in an antenatal setting found that 99% of respondents thought REA was acceptable. However, a literature review found no assessment of the acceptability of REA in sexual health clinics. It is also unclear what value there may be of REA in male attendees.AimIn order to elucidate these areas, attendees at the sexual health service in the city were asked for their opinion of REA and their experience of GBV.MethodAs part of our 2010 patient satisfaction survey, attendees were asked: We are considering asking people whether they have been a victim of domestic violence (eg, being hit by a girlfriend, boyfriend, husband or wife). Q1. Do you think we should routinely ask patients this? Q2. Have you ever been the victim of domestic violence? (Support is available here).ResultsOf the 110 respondents, 100 answered Q1 and 104 Q2. Of the 100, 81% (95% CI 72% to 88%) said REA would be acceptable. No significant difference between men and women or abused and non-abused (9/10 of abused, 90% (CI 56% to 100%)). One man (1/42 2% (CI 0.1% to 12.6%) and 10 women (10/42, 16% (CI 8% to 28%) reported GBV (p=0.025 for gender difference). One man and three women declined to answer. Comments from women who reported GBV included “Other departments should deal with this ” – 38 yr old seen at CSRH and “Gives them someone who will listen” – 64 yr old seen at GUM.DiscussionREA was acceptable to the majority. GBV history was not insignificant in men. This survey used a narrow definition of GBV and reports may have been higher had a more inclusive definition been used. Implications are that REA should be done in clinics and should be considered in men, perhaps using a self-completed questionnaire.
P98 Is pooling of self-taken specimens an effective and acceptable method of testing for sexually transmitted infections in MSMs?
Authors: Sultan B J , Fish R , Carrick G , Gilson R , Robinson A , Mercey D , White J , Benn P 
Published: May 2012

BackgroundAPTIMA Combo 2 (AC2) performs well for the detection ofChlamydia trachomatis(CT) andNeisseria gonorrhoeae(NG) from extra-genital sites in high prevalence groups such as men who have sex with men (MSM), but testing three samples (pharynx, urethra and rectum) is a significant cost pressure for services.AimsTo determine the; (1) Performance of AC2 to detect CT and NG from a pooled specimen: self-taken pharyngeal and rectal samples added to first-void urine (PS) compared with standard of care testing from individual sites (SOC). (2) Acceptability of pooling among MSM.MethodsMSM (symptomatic or contacts of CT/NG) attending two London sexual health services were recruited. Information about demographics, sexual behaviour, symptoms, signs and acceptability of pooling was collected. PS and SOC sampling order was randomised and results compared.ResultsOf the planned 1400 MSM, 99 (53 HIV+) have been recruited. Two equivocal results were excluded from analysis. Some of the questionnaire data were missing. 80%(73/91) were symptomatic and 60% (57/96) reported unprotected anal sex in the last month. The prevalence of CT and/or NG infection was 35% (95% CI 26% to 45%), CT alone 14% (95% CI 8% to 23%) and NG alone 21% (95% CI 13% to 30%). The sensitivity and specificity of PS vs SOC to detect CT/NG is 88% (95% CI 72% to 96%) and 100% (95% CI 93% to 100%), respectively (abstract P98 table 1). PS failed to detect four NG cases (3 pharynx, 1 rectum). MSM reported confidence (n=74, 86%) and willingness (n=75, 88%) to take their own samples (see abstract P98 table 1).Abstract P98 Table 1Sensitivity and specificity of pooled samples according to testNumber positive (%) SOC testing [95% CI]Number positive (%) PS testingSensitivity % [95% CI]Specificity % [95% CI]CT &/ or NG* (*CT&NG, n=4)34 (35) [26 to 45]30 (88)88 [72 to 96]100 [93 to 100]CT14 (14) [8 to 23]14 (100)100 [73 to 100]100 [95 to 100]NG20 (21) [13 to 30]16 (80)80 [56 to 93]100 [94 to 100]DiscussionPooling specimens in MSM offers the potential for significant savings and improved access to testing. Missed infections may be due to sampling error or low organism load. The evaluation of this strategy continues.
P99 Socio-demographic and behavioural characteristics of men who have sex with men (MSM) and heterosexuals infected with gonorrhoea
Authors: Obi C , Chisholm S , Webster E , Town K , Anderson J , Nichols T , Ison C , Lowndes C 
Published: May 2012

BackgroundAs well as monitoring antimicrobial resistance, the enhanced Gonococcal Resistance to Antimicrobial Surveillance Programme dataset can be used to understand the epidemiology of gonococcal infection.ObjectiveTo explore socio demographic and behavioural characteristics of MSM (HIV positive and negative) and heterosexuals (male and female) infected with gonorrhoea.MethodsDemographic and behavioural data from Gonococcal Resistance to Antimicrobial Surveillance Programme, collected annually between July and September 2005–2010 from 26 sentinel GUM clinics were analysed.ResultsOf 9239 gonorrhoea cases, 3089 (36%) were in MSM, of whom 861 (28%) were HIV positive; 5588 in heterosexuals, of whom 3012 (54%) were men. Predominantly of white ethnic background, HIV positive MSM (mean age 36 y) were older than HIV negative MSM (mean age 30 y). A higher proportion of HIV positive than negative MSM were co-infected with another STI (OR=1.6, 95% CI 1.3 to 1.9), mainly chlamydia (18% vs 15%) or syphilis (5% vs 2%). HIV positive MSM were also more likely (OR=1.5, CI 1.3 to 1.8) to report rectal gonococcal infection. Over a quarter of HIV positive MSM reported ≥6 sexual partners in the past 3 months compared to 18% of HIV negative MSM. Within the heterosexual population, higher proportion of women than men were of white ethnic background (74% vs 43%) and <25 y (72% vs 47%). Compared to heterosexual men, women were more likely to be co-infected with another STI (OR=1.5, CI 1.4 to 1.7) primarily chlamydia (41% vs 35%). Nearly two-third of heterosexual men reported ≥2 sexual partners in past 3 months while most women (64%) reported one or no sexual partners.ConclusionGonorrhoea is concentrated amongst specific population sub-groups. Our analysis indicates that these groups are at high risk of contracting and transmitting other STIs as well as HIV, and underlines the need for targeted interventions.
B1 Is super accelerated hepatitis B vaccination best way forward?
Authors: Thomas J , Busby S , Chauhan M 
Published: May 2012

BackgroundHepatitis B vaccination offers protection against hepatitis B in high-risk individuals like IVDU, homosexuals and in sex workers. Super accelerated vaccination schedule of 0, 7, 21 days has been found to increase the compliance to the vaccination and has been found to be effective against hepatitis B transmission. We followed this schedule in our GUM clinic.Objectives1. To assess the uptake of Hepatitis B vaccination in homosexual and bisexual men. 2. To assess whether full STI screening including testing for HIV, hepatitis B and C is being done along with checking HBs antibody levels in those already immunised.MethodsWe looked at 30 patient notes, which included homosexual and bisexual men.ResultsAll (100%) patients got full STI screen including HIV, hepatitis B and C testing. 30% of patients were vaccinated before and so immune to hepatitis B as shown by HBs antibody levels. Out of the remaining 70% of patients, 40% received three doses of Hepatitis B vaccination on the super accelerated vaccination schedule. 13% got two doses, 10% got only one dose and the remaining 7% declined.ConclusionAll high risk individuals attending the sexual health clinic should receive a full STI screen including HIV, Hepatitis B, C testing and HBs antibody levels checked who has previously received vaccination. The accelerated vaccination schedule encourages patients to receive the full course of immunisation. Education of highrisk individuals is necessary to improve the vaccination uptake. A written card with vaccination appointment dates given to patients at the beginning will further improve the patient attendance to finish the full course of the vaccination.
B2 Space occupying lesion in an HIV positive male- are common things always common?
Authors: Haidari G , Singh S , Freudenthal B , Peters B , Kulasegaram R , Desai M , Bodi I 
Published: May 2012

A 62-year-old man with well controlled HIV infection presented to clinic in December 2011, with a 6 week history of increasing forgetfulness, unsteady gait and visual disturbance. He was well established on highly active antiretroviral therapy, with a CD4 count of 524 and an undetectable viral load. On examination his GCS was 15/15, and he was noted to have a homonymous hemianopia. MRI confirmed a large mass in the deep thalamus extending into the brainstem which did not typically enhance. He went on to have a brain biopsy confirming a high grade glioblastoma multiforme. Post biopsy he developed a dense right sided hemiplegia thought to be due to disease progression. There have been 21 case reports of glioblastoma multiforme in HIV, raising the possibility we are now seeing an increasing number in HIV positive patients. In all documented cases, HIV was not found in glial tumours, although it is thought the role of the immune system in glial cell transformation could be compromised in HIV.DiscussionHIV patients with glioblastoma multiforme are presenting at younger ages and have poorer outcomes than non-HIV patients. Glioblastoma multiforme should be considered in the differential for HIV patients presenting with neurological symptoms, especially in patients stable on highly active antiretroviral therapy with a good CD4 count, in an effort to reduce diagnostic delay.
B3 Social and welfare in clinic support service
Authors: Hale J 
Published: May 2012

BackgroundPatients social and welfare care needs can be poorly served. Two factors contributed to this, lack of a specialised staff member for social and welfare needs and the few external organisation that are known, frequently changed their criteria or closed down.AimProvide stable background for patient's thus decreasing non-adherence, enabling more free appointment time for increasing number of new diagnosis.MethodEmploy an experienced worker, to complete the multidisciplinary holistic care for people living with HIV, ensuring joined-up care between medical and social well-being with an excellent two way communication. We have one set of notes for all these needs and one focal point for external services to feedback to. Patients receive full assessment in addition to their presenting issue.During an assessment, advice and referrals are offered on:Social/Peer Support GroupsBenefits/Housing: assess patient's entitlement, avoiding unnecessary supporting medical letters. Alleviates patients approaching different legal orgs with same request. This system ensures who do require the help receive it.ImmigrationEmployment skills and voluntary workTravelling abroad with HIVInsuranceHIV at workComplimentary therapiesRecreational drug misuseDomestic violenceSex workersCharity goodsResults and Conclusions350 patients seen, 1 h each per year. Service currently just 2 days per week Full time role is envisaged. Database used to produce outcomes including needs, referrals made and gaps in services. Clinic staff freed to spend time on medical issues.
B4 In PID
Authors: de Burgh-Thomas A , Hills A , Medland V 
Published: May 2012

ObjectivesTo review the management of PID in hospital inpatients and compare it to standards of care.MethodsWe reviewed the management of all those women admitted to hospital in Gloucestershire over a calendar year who were coded as having PID. We compared their management against BASHH and the RCOG standards (see abstract B4 table 1).Abstract B4 Table 1Compliance of management of patients with PID with standardsTargetAchievedAdequate sexual history95%25%Chlamydia testing100%55%Gonorrhoea testing100%70%Appopriate antibiotics100%75%GUM follow-up arranged95%5%Contact tracing 6/12 pre60%0%Results20 Patients were identified.ConclusionsThere is insufficient liaison between Gynaecology and GUM. We will discuss simple measures that have been introduced and planned changes to improve the management of PID.
Serum Insulin-Like Growth Factor-1 Levels Predict Outcomes of Patients with Advanced Hepatocellular Carcinoma Receiving Antiangiogenic Therapy
Authors: Shao Yu-Yun , Huang Chien-Chung , Lin Shiou-Der , Hsu Chih-Hung , Cheng Ann-Lii 
Published: May 2012

Abstract
Purpose: Patients with liver cirrhosis or hepatocellular carcinoma (HCC) have decreased serum insulin-like growth factor (IGF)-1 levels. We evaluated whether IGF-1 levels were associated with the outcomes of patients with advanced HCC treated with systemic antiangiogenic therapy.
Experimental Design: The study was based on patients with advanced HCC who were enrolled in two clinical trials evaluating first-line combination antiangiogenic therapy. Serum samples were collected before treatment and four to six weeks after the start of treatment. The levels of IGF-1, IGF-2, and IGF-binding protein-3 (IGFBP3) were analyzed for their associations with treatment outcomes.
Results: A total of 83 patients were included in the study. Patients who had high (≥the median level) baseline IGF-1 levels had significantly higher disease control rate (DCR) than patients who had low (&lt;the median level) levels (71% vs. 39%, P = 0.003). The levels of posttreatment IGF-1, and pre- or posttreatment IGF-2 and IGFBP3 were not associated with DCR. Patients with high baseline IGF-1 levels, compared with patients with low levels, had significantly longer progression-free survival (PFS; median, 4.3 vs. 1.9 months, P = 0.014) and overall survival (OS; median, 10.7 vs. 3.9 months, P = 0.009). The high baseline IGF-1 level remains an independent factor associated with favorable PFS and OS in multivariate analysis.
Conclusions: High pretreatment IGF-1 levels were associated with better DCR, PFS, and OS of patients who received antiangiogenic therapy for advanced HCC. This finding warrants validation in large studies. Clin Cancer Res; 18(14); 3992–7. ©2012 AACR.
Molecular Mechanisms Involved in the Synergistic Interaction of the EZH2 Inhibitor 3-Deazaneplanocin A with Gemcitabine in Pancreatic Cancer Cells
Authors: Avan Amir , Crea Francesco , Paolicchi Elisa , Funel Niccola , Galvani Elena , Marquez Victor E , Honeywell Richard J. , Danesi Romano , Peters Godefridus J. , Giovannetti Elisa 
Published: May 2012

Abstract
Pancreatic ductal adenocarcinoma (PDAC) is characterized by overexpression of enhancer of Zeste homolog-2 (EZH2), which plays a pivotal role in cancer stem cell (CSC) self-renewal through methylation of histone H3 lysine-27 (H3K27me3). Against this background, EZH2 was identified as an attractive target, and we investigated the interaction of the EZH2 inhibitor DZNeP with gemcitabine. EZH2 expression was detected by quantitative PCR in 15 PDAC cells, including seven primary cell cultures, showing that expression values correlated with their originator tumors (Spearman R2 = 0.89, P = 0.01). EZH2 expression in cancer cells was significantly higher than in normal ductal pancreatic cells and fibroblasts. The 3-deazaneplanocin A (DZNeP; 5 μmol/L, 72-hour exposure) modulated EZH2 and H3K27me3 protein expression and synergistically enhanced the antiproliferative activity of gemcitabine, with combination index values of 0.2 (PANC-1), 0.3 (MIA-PaCa-2), and 0.7 (LPC006). The drug combination reduced the percentages of cells in G2–M phase (e.g., from 27% to 19% in PANC-1, P &lt; 0.05) and significantly increased apoptosis compared with gemcitabine alone. Moreover, DZNeP enhanced the mRNA and protein expression of the nucleoside transporters hENT1/hCNT1, possibly because of the significant reduction of deoxynucleotide content (e.g., 25% reduction of deoxycytidine nucleotides in PANC-1), as detected by liquid chromatography/tandem mass spectrometry. DZNeP decreased cell migration, which was additionally reduced by DZNeP/gemcitabine combination (–20% in LPC006, after 8-hour exposure, P &lt; 0.05) and associated with increased E-cadherin mRNA and protein expression. Furthermore, DZNeP and DZNeP/gemcitabine combination significantly reduced the volume of PDAC spheroids growing in CSC-selective medium and decreased the proportion of CD133+ cells. All these molecular mechanisms underlying the synergism of DZNeP/gemcitabine combination support further studies on this novel therapeutic approach for treatment of PDACs. Mol Cancer Ther; 11(8); 1735–46. ©2012 AACR.
Human ESC Self-renewal Promoting microRNAs Induce Epithelial–Mesenchymal Transition in Hepatocytes by Controlling the PTEN and TGFβ Tumor Suppressor Signaling Pathways
Authors: Jung Christine J. , Iyengar Sushma , Blahnik Kimberly R. , Jiang Joy X. , Tahimic Candice , Torok Natalie J. , de vere White Ralph W. , Farnham Peggy J. , Zern Mark 
Published: May 2012

Abstract
The self-renewal capacity ascribed to embryonic stem cells (ESC) is reminiscent of cancer cell proliferation, raising speculation that a common network of genes may regulate these traits. A search for general regulators of these traits yielded a set of microRNAs for which expression is highly enriched in human ESCs and liver cancer cells (HCC) but attenuated in differentiated quiescent hepatocytes. Here, we show that these microRNAs promote hESC self-renewal, as well as HCC proliferation, and when overexpressed in normally quiescent hepatocytes, induce proliferation and activate cancer signaling pathways. Proliferation in hepatocytes is mediated through translational repression of Pten, Tgfbr2, Klf11, and Cdkn1a, which collectively dysregulates the PI3K/AKT/mTOR and TGFβ tumor suppressor signaling pathways. Furthermore, aberrant expression of these miRNAs is observed in human liver tumor tissues and induces epithelial–mesenchymal transition in hepatocytes. These findings suggest that microRNAs that are essential in normal development as promoters of ESC self-renewal are frequently upregulated in human liver tumors and harbor neoplastic transformation potential when they escape silencing in quiescent human hepatocytes. Mol Cancer Res; 10(7); 979–91. ©2012 AACR.