BACKGROUND: The disproportionately high prevalence of HIV among men who have sex with men (MSM) is a global concern. Despite the increasing utilization of electronic health (eHealth) technology in the delivery of HIV prevention interventions, few studies have systematically explored its effectiveness and association with various intervention characteristics. OBJECTIVE: This study aimed to conduct a meta-analysis of the effectiveness of eHealth technology-based interventions for promoting HIV-preventive behaviors among MSM and to determine effectiveness predictors within a framework integrating design and implementation features. METHODS: A systematic literature search using terms related to eHealth technology, HIV, the MSM population, and an experimental study design was performed using 5 databases (ie, MEDLINE, PsycINFO, EMBASE, Web of Science, and ProQuest Dissertations & Theses) and other sources (eg, bibliographies of relevant reviews and JMIR Publications). First, primary meta-analyses were conducted to estimate the effectiveness of eHealth interventions (d+) in changing 3 HIV-preventive behaviors among MSM: unprotected anal intercourse (UAI), HIV testing, and multiple sex partnership (MSP). Moderation analyses were then conducted to examine a priori effectiveness predictors including behavioral treatment components (eg, theory use, tailoring strategy use, navigation style, and treatment duration), eHealth technology components (eg, operation mode and modality type), and intervention adherence. RESULTS: A total of 46 studies were included. The overall effect sizes at end point were small but significant for all outcomes (UAI: d+=-.21, P<.001; HIV testing: d+=.38, P<.001; MSP: d+=-.26, P=.02). The intervention effects on UAI were significantly larger when compared with preintervention groups than with concurrent groups. Greater UAI reductions were associated with the increased use of tailoring strategies, provision of feedback, and tunneling navigation in interventions with a concurrent group, whereas reductions were associated with the use of self-paced navigation in interventions with a preintervention group. Greater uptake of HIV testing was associated with longer treatment duration; computer-mediated communication; and the use of messaging, social media, or a combined technology modality. Higher intervention adherence consistently predicted larger effects on UAI and HIV testing. CONCLUSIONS: This study provided empirical evidence for the effectiveness of eHealth interventions in promoting HIV-preventive behaviors among MSM. Features of treatment content and eHealth technology might best predict the intervention effects on UAI and HIV testing, respectively. Most importantly, intervention adherence tended to play an important role in achieving better effectiveness. The findings could help inform the development of efficacious interventions for HIV prevention in the future.

Platypnea-orthodeoxia syndrome (POS) is a rare condition characterized by dyspnoea and deoxygenation in an upright position that is relieved by supine positioning. There are only five published accounts of it occurring post-lobectomy. We present the case of a 72-year-old male with 3 months of supposedly unexplained dyspnoea after right lower lobectomy for lung cancer who was confirmed to have POS. We highlight the importance of recognition and management as well as provide a brief summary of the pathophysiology.

Despite the availability of effective combination antiretroviral therapy (cART), liver disease is one of the leading causes of morbidity and mortality in Human Immunodeficiency Virus (HIV)-infected individuals, specifically, in the presence of viral hepatitis coinfection. HIV, a single stranded RNA virus, can bind to and activate both Toll-like receptor (TLR)7 and TLR8 in circulating blood mononuclear cells, but little is known about the effect of HIV on TLRs expressed in the liver. HIV can directly infect cells of the liver and HIV-mediated depletion of CD4+ T-cells in the gastrointestinal tract (GI tract) results in increased circulating lipopolysaccharide (LPS), both of which may impact on TLR signaling in the liver and subsequent liver disease progression. The potential direct and indirect effects of HIV on TLR signaling in the liver will be explored in this paper.

Background. The cutaneous microcirculation refers to the dermal ultrastructure and the microvascular physiology of the skin, in both healthy and injured states. In the specialty of burn surgery, this concept is particularly relevant owing to its strong association with wound healing. In the clinical context, our ability to assess the cutaneous microcirculation is an area of increasing research. The ability to support and optimise the cutaneous microcirculation in burn wounds is an area in which we lack experience, both clinically and academically. Objective. To collate information on methods of monitoring and supporting the cutaneous microcirculation in burn wounds. Methods. We conducted a systematic review to find new techniques used around the world to (i) assess the cutaneous microcirculation; and (ii) optimise the cutaneous microcirculation in burn wounds to improve patient outcomes. We used online and paper-based scientific databases for our search. The goal of the review was to find the techniques that showed the greatest potential in their clinical applicability to burn surgery. Results. A range of new techniques is being widely used to assess the cutaneous microcirculation. Most prominently, the use of laser Doppler flowmetry and in vivo reflectance confocal microscopy show the most promising results and the largest pool of data about their use. Both these methods are non-invasive and provide real-time in vivo information. However, the clinical applicability of these methods remains limited, and requires further research. A number of pilot studies have also been conducted using novel methods to optimise the cutaneous microcirculation in animals. These include the use of agents such as prostaglandins, doxycycline and extra-corporeal shockwaves to stimulate or inhibit pathways involved in the cutaneous microcirculation. Conclusion. Although there is a growing body of research into the assessment and optimisation of the cutaneous microcirculation in burn wounds, its clinical applicability still requires further investigation. The future is promising if further in vivo studies on animals and humans are conducted.

High levels of amyloid-β (Aβ) have been associated with greater rates of decline in episodic memory over 18 months in healthy older adults. Serial assessments over shorter time intervals may facilitate earlier detection of Aβ-related memory decline in healthy older adults. In forty-four healthy older adults enrolled in the Australian Imaging, Biomarkers and Lifestyle Rate of Change Sub-Study, we compared rates of change in cognition over six months in healthy older adults with high and low levels of Aβ. High Aβ was associated with greater decline in episodic memory measures over 6 months in healthy older adults.

We aimed to characterize the nature and magnitude of cognitive decline in a group of healthy older adults with high and low levels of amyloid-β (Aβ) and who were APOE ε4 carriers and non-carriers. Healthy older adults underwent positron emission tomography neuroimaging for Aβ, APOE genotyping, and cognitive and clinical assessment as part of their baseline assessment in the Australian Imaging, Biomarker, and Lifestyle study. Cognitive function and clinical ratings were reassessed 18 months later. Linear mixed model analyses adjusted for baseline cognitive function indicated that relative to healthy older adults with low Aβ, healthy older adults with high Aβ showed greater decline in episodic memory and language at 18 months. No decline on any measure of executive function, attention, or clinical rating was observed for healthy older adults with high Aβ levels. Compared to non-carriers, APOE ε4 carriers showed a greater decline only on the task of visual memory at the 18 month assessment. Importantly though, no interaction between APOE ε4 and Aβ was observed on any measure of cognitive function. The results of this study suggest that high Aβ load was associated with greater decline in episodic memory and language, that the magnitude of this decline was moderate and equivalent across both domains, and that APOE ε4 carriage did not moderate the relationship between Aβ and decline in memory and language functions.

A total knee arthroplasty can be completed using two techniques; measured resection or gap balancing. A prospective blinded randomized controlled trial was completed with 103 patients randomized to measured resection (n = 52) or gap balancing (n = 51). Primary outcome measure was femoral component rotation. Secondary outcome measures were joint-line change, gap symmetry and function and quality-of-life outcomes. Gap balancing resulted in a significantly raised joint-line compared to measured resection. Gap symmetry was significantly better using gap balancing. Functional outcomes and quality-of-life were not significantly different at 24 months. Using computer navigation, gap balancing significantly raises the joint-line in order to improve gap symmetry. This does not result in a clinical difference in function or quality of life at 24 months.

PURPOSE: Overstuffing the patellofemoral joint has been associated with poor post-operative outcomes. No study has assessed the effect of over-distracting the tibio-femoral joint in the vertical plane and its effects on function and quality of life. The purpose of this study is to assess the effect of tibio-femoral joint distraction on function and quality of life after total knee arthroplasty. METHODS: Measurements of knee joint distraction were devised using long-leg alignment radiographs. Seventy-three patients were prospectively recruited and their joint distraction measured post-operatively. A comparison was made between the level of joint distraction and functional outcomes as measured by the International Knee Society score and its components, such as pain and flexion, and the Knee injury and Osteoarthritis Outcome Score and quality of life as measured by the Short-Form 12 score. Twelve-month follow-up was achieved. RESULTS: Knee joint over-distraction post-arthroplasty correlated significantly with Knee Society score (p = 0.041), flexion (p = 0.005) and pain (p = 0.002). Those knees that were over-distracted post-operatively suffered more pain, less flexion and a lower International Knee Society score compared with their counterparts. No correlation was found between over-distracting the knee joint and quality of life. CONCLUSION: Over-distracting the tibio-femoral joint during arthroplasty is a significant predictor of reduction in function and increase in pain in the short to medium term. When between sizes of tibial inserts, the surgeon should consider using the thinner option.