The purpose of this study was to determine the pattern and extent of caudate nucleus and putamen atrophy in HIV-infected men with well-controlled immune status and viral replication. 155 men underwent structural brain magnetic resonance imaging; 84 were HIV-infected and 71 were uninfected controls. MRI data were processed using the Fully Deformable Segmentation routine, producing volumes for the right and left caudate nucleus and putamen, and 3-D maps of spatial patterns of thickness. There was significant atrophy in the HIV-infected men in both the caudate and putamen, principally in the anterior regions. The volume of the basal ganglia was inversely associated with the time since first seropositivity, suggesting that either there is a chronic, subclinical process that continues in spite of therapy, or that the extent of the initial insult caused the extent of atrophy.Electronic supplementary materialThe online version of this article (doi:10.1007/s11682-011-9113-8) contains supplementary material, which is available to authorized users.

The daily administration of ethanol locks into lumens of central venous catheters effectively reduces the incidence of CABSI.

Introduction The purpose of this study was to characterize brain volumetric differences in HIV seropositive and seronegative men and to determine effects of age, cardiovascular risk, and HIV infection on structural integrity. Methods Magnetic resonance imaging was used to acquire high-resolution neuroanatomic data in 160 men aged 50 years and over, including 84 HIV seropositive and 76 seronegative controls. Voxel-based morphometry was used to derive volumetric measurements at the level of the individual voxel. Data from a detailed neuropsychological test battery were recombined into four summary scores representing psychomotor speed, visual memory, verbal memory, and verbal fluency. Results Both age and HIV status had a significant effect on both gray matter (GM) and white matter (WM) volume. The age-related GM atrophy was primarily in the superior temporal and inferior frontal regions; the HIV-related GM loss included the posterior and inferior temporal lobes, the parietal lobes, and the cerebellum. Among all subjects, the performance on neuropsychological tests, as indexed by a summary variable, was related to the volume of both the GM and WM. Contrary to our predictions, the CVD variables were not linked to brain volume in statistically adjusted models. Conclusion In the post-HAART era, having HIV infection is still linked to atrophy in both GM and WM. Secondly, advancing age, even in this relatively young cohort, is also linked to changes in GM and WM volume. Thirdly, CNS structural integrity is associated with overall cognitive functions, regardless of the HIV infection status of the study volunteers.

Background The effectiveness of colorectal cancer (CRC) screening is limited by underuse, particularly among underserved populations. Among a racially diverse and socioeconomically disadvantaged cohort of patients, we compared effectiveness of FIT outreach and colonoscopy outreach to increase screening participation rates, compared to usual visit-based care. Methods Patients, aged 50–64 years who were not up-to-date with CRC screening, but used primary care services in a large safety-net health system were randomly assigned to mailed FIT outreach (n=2400), mailed colonoscopy outreach (n=2400), or usual care with opportunistic visit-based screening (n=1199). Patients who did not respond to outreach invitations within 2 weeks received follow-up telephone reminders. The primary outcome was CRC screening completion within 12 months after randomization. Results Baseline patient characteristics across groups were similar. Using intention-to-screen analysis, screening participation rates were higher for FIT outreach (58.8%) and colonoscopy outreach (42.4%) than usual care (29.6%) (p< 0.001 for both). Screening participation with FIT outreach was higher than colonoscopy outreach (p< 0.001). Among responders, FIT outreach had a higher proportion who responded prior to reminders (59.0% vs. 29.7%, p< 0.001). Nearly half of colonoscopy outreach patients crossed over to complete FIT via usual care, whereas <5% of FIT outreach patients underwent usual care colonoscopy. Conclusions Mailed outreach invitations can significantly increase CRC screening rates among underserved populations. FIT-based outreach was more effective than colonoscopy-based outreach to increase one-time screening participation. Studies with longer follow-up are needed to compare effectiveness of outreach strategies for promoting completion of the entire screening process.