Challenges to PrEP use and perceptions of urine tenofovir adherence monitoring reported by individuals on PrEP.

Maximizing the impact of HIV pre-exposure prophylaxis (PrEP) requires optimizing access and adherence for those at risk of contracting HIV. This study examined challenges to the processes of accessing and adhering to PrEP encountered by participants from a large, U.S. urban clinical center and assessed the utility of objectively monitoring PrEP adherence via urine. Most participants (65%) reported starting PrEP within 1-3 months of hearing about it, although 35% of participants encountered a provider unwilling to prescribe PrEP. Self-reported adherence was high among this population, with remembering to take the medication reported as the major barrier to adherence (44%) rather than cost or stigma. Urine tenofovir (TFV) monitoring was highly acceptable to this population, and participants indicated greater willingness to undergo urine monitoring every 3 months compared to finger prick (dried blood spot), phlebotomy, or hair follicle testing. These findings highlight the importance of focusing efforts toward reducing obstacles to PrEP use and support the use of urine TFV adherence monitoring as a marker of PrEP adherence.

Medical Student Perspectives on LGBTQ Health.

INTRODUCTION: Lesbian, gay, bisexual, transgender, and queer (LGBTQ) community members experience adverse health outcomes at higher rates than non-LGBTQ individuals. We examined the impact of student demographics as well as gender and sexuality didactic instruction on the attitudes of first-year medical students toward LGBTQ patients. METHODS: In January 2017, 255 first-year students at an urban allopathic medical school participated in a gender and sexuality health curriculum. We assessed student attitudes regarding LGBTQ patients using anonymous pre- and postintervention surveys. Each item was measured on a 5-point Likert scale. RESULTS: Of 255 possible respondents, we received 244 responses to the preintervention survey (95.7% response rate) and 253 to the postintervention survey (99.2% response rate). Participants were predominantly white (66.8%), heterosexual (94.7%), and cisgender (100%). Respondents who identified as LGBQ were significantly (P<.05) more likely than heterosexual students to agree with the following preintervention statements, among others: (1) Discordance between birth sex and gender is a natural human phenomenon, (2) When meeting a patient for the first time, I feel comfortable asking what pronoun they use, (3) I am able to empathize with the life experience of an LGB/T patient, (4) I am motivated to seek out opportunities to learn more about LGBTQ-specific health care issues. Statistically significant changes in attitudes between time points are seen in 4 out of 15 items. CONCLUSION: A focused gender and sexuality curriculum appears to impact medical student attitudes regarding LGBTQ patients. Furthermore, recruitment of LGBTQ-identifying medical students may translate into improved workforce motivation to provide health care for LGBTQ patients.

The Arabidopsis At1g30680 gene encodes a homologue to the phage T7 gp4 protein that has both DNA primase and DNA helicase activities.

BACKGROUND: The Arabidopsis thaliana genome encodes a homologue of the full-length bacteriophage T7 gp4 protein, which is also homologous to the eukaryotic Twinkle protein. While the phage protein has both DNA primase and DNA helicase activities, in animal cells Twinkle is localized to mitochondria and has only DNA helicase activity due to sequence changes in the DNA primase domain. However, Arabidopsis and other plant Twinkle homologues retain sequence homology for both functional domains of the phage protein. The Arabidopsis Twinkle homologue has been shown by others to be dual targeted to mitochondria and chloroplasts. RESULTS: To determine the functional activity of the Arabidopsis protein we obtained the gene for the full-length Arabidopsis protein and expressed it in bacteria. The purified protein was shown to have both DNA primase and DNA helicase activities. Western blot and qRT-PCR analysis indicated that the Arabidopsis gene is expressed most abundantly in young leaves and shoot apex tissue, as expected if this protein plays a role in organelle DNA replication. This expression is closely correlated with the expression of organelle-localized DNA polymerase in the same tissues. Homologues from other plant species show close similarity by phylogenetic analysis. CONCLUSIONS: The results presented here indicate that the Arabidopsis phage T7 gp4/Twinkle homologue has both DNA primase and DNA helicase activities and may provide these functions for organelle DNA replication.

Contralateral radiculopathy after transforaminal lumbar interbody fusion.

Transforaminal lumbar interbody fusion (TLIF) is an effective treatment for patients with degenerative spondylolisthesis and degenerative disc disease. Opposite side radiculopathy after the TLIF procedure has been recognized in this institution but has not been addressed in the literature. We present a case of opposite side radiculopathy after the TLIF procedure. We believe that this complication is related to asymptomatic stenosis on the contralateral side that is unmasked by the increased lordosis of the TLIF. The authors recommend increasing both disc height and foraminal height when choosing an interbody graft, and possibly decompressing the opposite foramen when preoperative MRI demonstrates foraminal stenosis.

Return of normal urological and neurological function after revision surgery for spondyloptosis. Case report.

The authors report on the return of neurological and urological function in an adolescent after revision surgery for spondyloptosis 5 years after the index procedure for high-grade spondylolisthesis. This 16-year-old girl with Grade 3 spondylolisthesis was initially treated with a posterolateral reduction and fusion. Following surgery, cauda equina syndrome symptoms developed and did not resolve despite subsequent surgical decompression. Five years later, because of worsening radicular pain, an inability to walk for significant distances, and no resolution of persistent bladder dysfunction, the patient presented with spondyloptosis. Posterior decompression, sacral dome osteotomy, and posterior reduction were performed and followed 3 days later with the placement of an anterior fibula autograft. Her bladder function recovered within 6 months, and at the 18-month follow up the patient reported a normal ability to ambulate.

Expandable cage placement via a posterolateral approach in lumbar spine reconstructions. Technical note.

The authors describe a technique for inserting an expandable cage via a posterior extracavitary approach while protecting the segmental nerves. The advent of expandable cages has allowed the use of a less invasive anterior access to the spine, thereby decreasing the surgery-induced insult to the patient. In an attempt to minimize this trauma, the authors have used a posterolateral approach that has allowed them to perform neural decompression, anterior reconstruction with an expandable cage, and posterior stabilization with posterior pedicle screws. The authors describe their surgical technique of posterior circumferential decompression, which entails the use of an expandable cage that is inserted at 90 degrees, rotated in place where the corpectomy has been performed, and then expanded with special custom-made tools, thus respecting the segmental nerves of the lumbar spine. One case example is provided to illustrate the technique.