There is currently no consensus regarding the most appropriate methods of sampling for the detection of genital human papillomavirus (HPV) in men. We employed a recently developed collection method involving abrasion and moistened swabbing of the genital skin surface for the detection of HPV in a cohort of 136 university-affiliated males in Hawaii. Genital specimens collected by physicians using this method were compared with self-collected specimens from the same individuals obtained 24 h later. Self-collected specimens yielded a greater proportion of sufficient specimens than physician-collected specimens. HPV detection was comparable in physician-and self-collected specimens; detection was highest in the penile shaft (51.2% and 51.5%, respectively, P ‫؍‬ 0.96), followed by the scrotum (41.2% and 46.2%, P ‫؍‬ 0.43), the glans/coronal sulcus (31.9% and 33.1%, P ‫؍‬ 0.84), and the foreskin (33.3% and 28.6%, P ‫؍‬ 0.74). Site-specific agreement in HPV detection between paired physician-and self-collected samples ranged from 67.2% (kappa ‫؍‬ 0.34) for the penile shaft to 95.0% (kappa ‫؍‬ 0.89) for the foreskin. There was a high degree of concordance in HPV genotypes in HPV-positive pairs. The most common type was HPV type 84, which comprised approximately 15% of the specimens. The emery paper-swab method offers an efficient sampling method for genital HPV DNA detection in men that could be used both within and outside of the clinical setting.Natural-history studies of human papillomavirus (HPV) infection among males are an emerging area of epidemiological research. The types and distributions of genital HPV are largely uncharacterized. Because this is a novel area of scientific inquiry, there is currently no consensus on the most appropriate method of sampling for the detection of genital HPV infection among men. Differences in methodology make it difficult to compare penile HPV prevalence across studies and populations (2,3,10,13,14,17,20). Weaver et al. (19) recently reported enhanced specimen yield and HPV detection in male genitals through abrasion with emery paper followed by swabbing with a moistened Dacron swab (19). We employed this method to compare the detection of HPV DNA in genital specimens collected by physicians to self-collected specimens from the same individuals among a cohort of men in a university population. MATERIALS AND METHODSRecruitment. This study was approved by the Committee on Human Studies of the University of Hawaii. Written informed consent was obtained from all study subjects. The cohort study was initiated in July 2004 among a university population in Hawaii. Self-referred volunteers were recruited through campus-based media, including flyers and newspaper advertisements. Eligible men were 18 years old and older and English speaking with no history of blood-clotting disorders. Between July 2004 and April 2005, 136 adult males were recruited and followed up at 2-month intervals. All study visits were conducted at the University Health Services of the University of Hawaii.Genital s...

ContextThis commentary discusses the implications of disease-modifying treatments for Alzheimer’s disease which seem likely to appear in the next few years and results from a meeting of British experts in neurodegenerative diseases in Edinburgh. The availability of such treatments would help change public and professional attitudes and accelerate engagement with the prodromal and preclinical populations who might benefit from them. However, this would require an updated understanding of Alzheimer’s disease, namely the important distinction between Alzheimer’s disease and Alzheimer’s dementia.ConsensusSince treatments are likely to be most effective in the early stages, identification of clinically relevant brain changes (for example, amyloid burden using imaging or cerebrospinal fluid biomarkers) will be crucial. While current biomarkers could be useful in identifying eligibility for new therapies, trial data are not available to aid decisions about stopping or continuing treatment in clinical practice. Therefore, effective monitoring of safety and effectiveness when these treatments are introduced into clinical practice will be necessary to inform wide-scale use. Equity of access is key but there is a tension between universal access for everyone with a diagnosis of Alzheimer’s disease and specifying an eligible population most likely to respond. We propose the resources necessary for an optimal care pathway as well as the necessary education and training for primary and secondary care.ConclusionThe majority of current services in the UK and elsewhere would not be able to accommodate the specialist investigations required to select patients and prescribe these therapies. Therefore, a stepped approach would be necessary: from innovating sentinel clinical-academic centres that already have capacity to deliver the necessary phase IV trials, through early adoption in a hub and spoke model, to nationwide adoption for true equity of access. The optimism generated by recent and anticipated developments in the understanding and treatment of Alzheimer’s disease presents a great opportunity to innovate and adapt our services to incorporate the next exciting development in the field of dementia.

Purpose:Review published studies to investigate the value of clinical 3-deoxy-3-18F-fluorothymidine (FLT) positron emission tomography (PET) in predicting response to treatment.Materials and Methods:Interrogate databases to identify suitable publications between 2007 and 2013 with a minimum of five patients. Articles within the inclusion criteria were reviewed with major findings reported leading to a descriptive analysis of FLT PET in therapy response.Results:Lesions investigated included glioma, head and neck, esophageal, lung, breast, gastric, renal, rectal, sarcomas, germ cell, lymphomas, leukemia, and melanoma resulting in a total of 34 studies analyzed. A variety of therapies were applied and dissimilar PET protocols were widespread making direct comparison between studies challenging. Though baseline, early and late therapy scans were popular particularly in chemotherapy regimes. Most studies investigated showed significantly reduced FLT uptake during or after therapy compared with pretreatment scans.Conclusion:Current evidence suggests FLT PET has a positive role to play in predicting therapy response especially in brain, lung, and breast cancers where good correlation with Ki-67 is observed. However, careful attention must be placed in undertaking larger clinical trials where harmonization of scanning and analysis protocols are strictly adhered to fully assess the true potential of FLT PET in predicting response to treatment.

MR and CT images of the head can be accurately registered without using external markers or substantially altering image acquisition protocols. The resulting images can show the radiologic information more clearly than conventional viewing.