Effects of depot-medroxyprogesterone acetate on the immune microenvironment of the human cervix and endometrium: implications for HIV susceptibility.

Depot-medroxyprogesterone acetate is a commonly used injectable contraceptive that has been associated with an increased risk of HIV acquisition. This study compares effects of depot-medroxyprogesterone acetate on immune parameters from several upper reproductive tract compartments relevant to HIV-1 susceptibility in repetitive samples from 15 depot-medroxyprogesterone acetate users and 27 women not on hormonal contraceptives. Compared with samples from unexposed women in the mid-luteal phase, depot-medroxyprogesterone acetate use was associated with: increased endocervical concentrations of MCP1 and IFNalpha2; decreased endocervical concentrations of IL1beta and IL6; increased proportions of endometrial CD4+ and CD8+ cells expressing the activation marker HLADR; increased density of endometrial macrophages; and decreased density of endometrial regulatory T cells. Unlike previous reports with samples from the vagina, we did not observe increased expression of the HIV co-receptor CCR5 on CD4+ T cells in the endocervix or endometrium. Our results indicate important differences in anatomic compartments regarding mechanisms by which depot-medroxyprogesterone acetate could be associated with increased risk of HIV acquisition, including increased recruitment of macrophages to the endometrium, decreased levels of pro-inflammatory cytokines in the endocervix possibly leading to enhanced susceptibility to viral infection, and activation of endometrial T cells.

Patient outcomes after spinal reconstructive surgery in patients > or = 40 years of age.

This study provides outcome data on the quality of life in 84 patients 40 years of age or older who had spinal reconstructive surgery. A 30-min questionnaire covering the patients' pre- and postoperative functional status, expectations for surgery, medication use, quality of life, and overall satisfaction was administered via telephone by a trained interviewer. Clinical data were obtained from chart and radiographic review. The majority of the patients had back or leg pain as their indication for surgery. Diagnoses included kyphosis, scoliosis, spinal stenosis, spondylolisthesis, and failed surgery. Overall satisfaction with functional status and surgical outcome was 81%, and there was significant improvement in most functional measures. This study suggests that improved qualify of life for the majority of appropriately selected spinal reconstruction patients is achievable in this mature population.