THE CHILD'S SEXUAL LIFE—A Consideration of Clinical Implications

A healthy sexual life begins in childhood, and the groundwork for later difficulties also begins in childhood. For the child, sexuality is a rather general, pleasurable excitation, not a specific genital stimulation. Excessive attention to the perineal area, operation upon or injury to the genital area and injections are vicissitudes which may have an unhealthy influence on later sexual development. Healthy and informed parental attitudes are the key here, just as they are in the normal exhibitionism, curiosity and intense emotional attachments to parents. Parents infect children, healthily or unhealthily, with their attitudes. In healthy growth exhibitionism and peeping become transformed in socially acceptable ways. In unhealthy growth, either perversions or strong reactions like over-modesty or shame result. Masturbation is common and transitory in most children. Parents, and especially pediatricians to whom parents turn, have a golden opportunity to direct healthy growth by being well informed about the infant and child''s sexual growth and thus be enabled to advise upon or manage the common developmental phenomena with good commonsense and patience. Infants and children do not enter the world possessing the morals, standards or inhibitions of adults.     

STRESS INCONTINENCE OF URINE—A Consideration of Etiologic Factors in Women

Urinary continence in women is intimately associated with adequate support of the neck of the bladder. Any increase in tone of the bladder musculature, or in the intravesicular pressure, substantially increases the liability to incontinence. Obstetrical trauma may cause stress incontinence by disrupting supports of the neck of the bladder and by stretching the fascial structures of the posterior portion of the neck of the bladder. Minor injury not grossly demonstrable may occur in this way and upset the very delicate balance existing between the forces of the detrusor muscle and the resistance of the urethrovesical junction.In correcting the defects associated with stress incontinence, there are specific indications for various methods—active exercise, plastic reconstruction of the bladder and urethral supports, and the various operations for suspension of the neck of the bladder.     

The Incidence of Japanese Encephalitis in Taiwan—A Population-Based Study

Background

A mass Japanese encephalitis (JE) vaccination program targeting children was launched in Taiwan in 1968, and the number of pediatric JE cases substantially decreased thereafter. The aim of this study was to elucidate the long-term trend of JE incidence, and to investigate the age-specific seroprevalence of JE-neutralizing antibodies.

Methodology/Principal Findings

A total of 2,948 laboratory-confirmed JE cases that occurred between 1966 and 2012 were analyzed using a mandatory notification system managed by the Centers for Disease Control, Taiwan. A total of 6,594 randomly-sampled serum specimens obtained in a nationwide population-based survey in 2002 were analyzed to estimate the seroprevalence of JE-neutralizing antibodies in the general population. The average annual JE incidence rate of the group aged 30 years and older was 0.167 cases per 100,000 people between 2001 and 2012, which was higher than the 0.052 cases per 100,000 people among those aged under 30 years. These seroepidemiological findings indicate that the cohort born between 1963 and 1975, who generally received two or three doses of the vaccine and were administered the last booster dose more than 20 years ago, exhibited the lowest positive rate of JE-neutralizing antibodies (54%). The highest and second highest antibody rates were observed, respectively, in the oldest unvaccinated cohort (86%) and in the youngest cohort born between 1981 and 1986, who received four doses 10–15 years ago (74%).

Conclusion/Significance

Over the past decade, the main age group of the confirmed JE cases in Taiwan shifted from young children to adults over 30 years of age. People who were born between 1963 and 1975 exhibited the lowest seroprevalence of JE-neutralizing antibodies. Thus, the key issue for JE control in Taiwan is to reduce adult JE cases through a cost-effective analysis of various immunization strategies.     

HYPERINSULINISM AND NEUROMUSCULAR DISORDERS—A Consideration of the Association of Pancreatic Adenoma with Wasting States

Five cases, one reported herein, have been described in which progressive generalized muscle wasting, muscle fasciculations, increased myotatic irritability, and progressive motor disability were in evidence. In all of these cases, a pancreatic islet cell adenoma was present. In four of them arrest of the symptoms of muscular disease followed upon surgical removal of the islet cell adenoma. In the other case the tumor was not observed until postmortem examination, and in that case there was also histologic evidence of widespread and severe degeneration in the anterior horn cells of the spinal cord.The observations give rise to conjecture upon the possibility that endocrine dysfunction plays a part in the genesis of progressive muscular atrophy.     

Oocyte Maturation,Mos and Cyclins—A Matter of Synthesis: Two Functionally Redundant Ways to Induce Meiotic Maturation

ABSTRACT The development of an immature oocyte into a fertilizable gamete is a process known as meiotic maturation. In vertebrates, it corresponds to the transition from the prophase arrest of the first meiotic division (usually considered as a late G2 phase) to the metaphase arrest of the second meiotic division. This transition is controlled by modulating the activity of the cyclin B-Cdc2 complex, MPF (M-phase promoting factor), the universal regulator of the G2/M transition. Meiotic maturation of frog oocytes is triggered by steroid hormones through a rapid, necessary and sufficient suppression of PKA and requires ongoing protein synthesis. A long-standing question has been to identify key protein(s) required to trigger the activation of MPF in response to the hormonal signal. Here we will discuss data supporting the view that steroids bring about meiotic maturation through functionally redundant pathways involving synthesis of Mos or of cyclin proteins, reinforcing the robustness of the system.     

GENERAL ANESTHESIA FOR EYE OPERATIONS—A Consideration of Some Pertinent Factors Involved in Administration

In the administration of general anesthesia for surgical operations on the eye, care must be taken to consider the patient''s total physiological condition. A patient with eye problems may have generalized changes of more than moderate extent. Most patients are in the age group in which the incidence of cardiovascular and pulmonary problems is relatively high. If the patient is in a younger age group, perhaps diabetes or the collagen diseases must be suspected. Care must be taken to prevent undue strains to the eye during and immediately after the operation.Constant care and an awareness of possible complication is necessary for successful management in these cases.     

GROUP PSYCHOTHERAPY FOR CRIMINAL OFFENDERS—A Program for Parolees Under Social-Psychological Coercion

Selected prisoners, most of them with severe character disorders, are permitted to serve the remaining portion of their sentence on parole in the community on condition that they be patients in psychotherapy at a psychiatric clinic created in 1953 for this purpose. Nearly all the patients begin without personal motivation for such treatment. Attendance has been attained because parole officers are assigned to the task of enforcing attendance.Coercion can bring these reluctant patients to expose themselves to treatment, but staff members then have the task to overcome hostility, combat extensive rationalizations, and transform an initially poor rapport into patient participation in working through major personality change.This clinic provides an interesting laboratory for the development of a psychiatric treatment program for adults who have not responded well to a great variety of forms of correctional care.     

SPONTANEOUS EPISTAXIS—Theoretical Consideration of Etiologic Factors and Treatment

In a study of data on 136 hemorrhages in 14 patients with posterior epistaxis it was noted that the incidence of bleeding was higher at some hours of the day than at others. The times of highest incidence were more or less inverse to hours of peak systolic blood pressure in normal subjects, suggesting that bleeding occurs as a result of dislodgement of an embolus at times of vasodilation. If that is true, then it should be possible to control bleeding by giving vasoconstrictive drugs. There are not as yet enough data on trial of that method to warrant conclusions.     

Latently Infected Cell Activation: A Way to Reduce the Size of the HIV Reservoir?

While antiretroviral drugs can drive HIV to undetectably low levels in the blood, eradication is hindered by the persistence of long-lived, latently infected memory CD4 T cells. Immune activation therapy aims to eliminate this latent reservoir by reactivating these memory cells, exposing them to removal by the immune system and the cytotoxic effects of active infection. In this paper, we develop a mathematical model that investigates the use of immune activation strategies while limiting virus and latent class rebound. Our model considers infection of two memory classes, central and transitional CD4 T cells and the role that general immune activation therapy has on their elimination. Further, we incorporate ways to control viral rebound by blocking activated cell proliferation through anti proliferation therapy. Using the model, we provide insight into the control of latent infection and subsequently into the long term control of HIV infection.     

CARE OF THE UMBILICAL CORD IN THE NEWBORN—A Program to Reduce Infection and Promote Healing

Problems related to infection, slow-healing and continued moisture of the umbilical cord stump were considerably reduced at an Army Hospital nursery by a program of meticulous care that included shortening the stump, exposure to air (sometimes with added heat) and application of povidone-iodine solution.     

REACTIONS TO INSECT ALLERGENS—The Incidence of Response to Testing Among Allergic and Nonallergic Persons

Positive reactions to skin tests with extracts of various insects were found to be significantly higher in 200 patients with allergic disease than in 150 nonallergic controls.Forty-seven per cent of the allergic group had positive reaction to bee, 46 per cent to house fly, 39.5 per cent to moth, 29.5 to ant and 28.5 to aphid. Ant and house fly extract caused the greatest number of severe reactions (4+), with moth second and bee third.Because extracts of nonstinging insects caused reaction almost as often and as strong as stinging insects, it may be inferred that sensitization is due to inhaled insect particles. There appeared to be no necessary connection between a history of having been stung and a strong skin test reaction to bee protein.Testing for insect sensitivity appears a good way to get diagnostic information that can enhance the effectiveness of treatment.     

Irradiation as an Alternative to Mastectomy for Early Breast Cancer—An Important Consideration Because of Changes in Laws

Between May 1973 and December 1980 there were 76 patients (78 breasts) with clinical stage I or II breast carcinoma treated by biopsy and definitive radiotherapy at Stanford University Medical Center. Local-regional control has been achieved thus far in 76 of 78 cases (97 percent) with a median follow-up time of 26 months. Transient lymphedema of the breast, arm edema and breast fibrosis were the most commonly noted complications. The cosmetic result was analyzed and scored as excellent in 78 percent, satisfactory in 18 percent and unsatisfactory in 4 percent. The three unsatisfactory results occurred in patients in whom severe fibrosis developed as a result of suboptimal radiation techniques. Interdisciplinary cooperation among surgical, medical and radiation oncologists is important. The 97 percent local-regional control and the 96 percent excellent-to-satisfactory results support the use of primary radiotherapy in early stage breast carcinoma.     

Cost-Effectiveness of an Intervention to Reduce HIV/STI Incidence and Promote Condom Use among Female Sex Workers in the Mexico–US Border Region

Background

Previous research demonstrated efficacy of a brief behavioral intervention to reduce incidence of HIV and sexually transmitted infections (STIs) among female sex workers (FSWs) in Tijuana and Ciudad Juarez, Mexico, cities on Mexico''s border with the US. We assessed this intervention''s cost-effectiveness.

Methodology and Principal Findings

A life-time Markov model was developed to estimate HIV cases prevented, changes in quality-adjusted life expectancy (QALE), and costs per additional quality-adjusted life year gained (QALY), comparing (in US$2,009) no intervention to a once-only and annual intervention. Future costs and health benefits were discounted annually at 3%. Sensitivity analyses evaluated model robustness. We found that for a hypothetical 1,000 FSWs receiving the once-only intervention, there were 33 HIV cases prevented and 5.7 months of QALE gained compared to no intervention. The additional cost per QALY gained was US$183. For FSWs receiving the intervention annually, there were 29 additional HIV cases prevented and 4.5 additional months of QALE compared to the once-only intervention. The additional cost per QALY was US$1,075. When highly active antiretroviral therapy (HAART) was included in the model, the annual intervention strategy resulted in net savings and dominated both once-only and no intervention strategies, and remained robust across extensive sensitivity analyses. Even when considering clinical benefits from HAART, ignoring added costs, the cost per QALY gained remained below three times the Mexican GDP per capita, and below established cost-effectiveness thresholds.

Conclusions/Significance

This brief intervention was shown to be cost-effective among FSWs in two Mexico-US border cities and may have application for FSWs in other resource-limited settings.

Trial Registration

ClinicalTrials.gov {type:clinical-trial,attrs:{text:NCT00338845,term_id:NCT00338845}}NCT00338845     

From Cytometry to Cell Cycle—A Portrait of Zbigniew Darzynkiewicz

No abstract available.