Publications

By homology to triggering receptor expressed by myeloid cells-2, we screened the mouse expressed sequence tag database and isolated a new single Ig domain receptor, which we have expressed and characterized. The receptor is most similar in sequence to the human CMRF-35 receptor, and thus we have named it CMRF-35-like molecule (CLM)-1. By screening the mouse genome, we determined that CLM-1 was part of a multigene family located on a small segment of mouse chromosome 11. Each contains a single Ig domain, and they are expressed mainly in cells of the myeloid lineage. CLM-1 contains multiple cytoplasmic tyrosine residues, including two that lie in consensus immunoreceptor tyrosine-based inhibitory motifs, and we demonstrate that CLM-1 can associate with Src-homology 2 containing phosphatase-1. Expression of CLM-1 mRNA is down-regulated by treatment with receptor activator of NF-kappaB ligand (RANKL), a cytokine that drives osteoclast formation. Furthermore, expression of CLM-1 in the osteoclastogenic cell line RAW (RAW.CLM-1) prevents osteoclastogenesis induced by RANKL and TGF-beta. RAW.CLM-1 cells fail to multinucleate and do not up-regulate calcitonin receptor, but they express tartrate-resistant acid phosphatase, cathepsin K, and beta(3) integrin, suggesting that osteoclastogenesis is blocked at a late-intermediate stage. Thus, we define a new family of myeloid receptors, and demonstrate that the first member of this family, CLM-1, is an inhibitory receptor, able to block osteoclastogenesis.

OBJECTIVE

To estimate the incidence of lipoatrophy and lipohypertrophy among HIV-infected and HIV-uninfected women from the Women's Interagency HIV Study.

DESIGN

Eight hundred fifteen women with semiannual data on self-report of bidirectional change in body fat, anthropometric measurements, weight, and bioelectric impedance analysis were included in a 30-month incidence analysis.

METHODS

Lipoatrophy and lipohypertrophy in both peripheral (arms, legs, and buttocks) and central (waist, chest, and upper back) sites were defined by self-report of either a decrease or an increase in a body fat region over the previous 6 months that was confirmed by a corresponding change in anthropometric measurement.

RESULTS

Weight and total body fat increased in HIV-uninfected women but remained stable in HIV-infected women over 30 months. Among HIV-infected women, the incidence of peripheral (relative hazard, 2.1; 95% confidence interval [CI], 1.4-3.3) and central (relative hazard, 1.9; 95% CI, 1.2-2.8) lipoatrophy was about double that among HIV-uninfected women, after adjustment for age and race. The incidence of peripheral lipohypertrophy appeared lower among HIV-infected women than among HIV-uninfected women (relative hazard, 0.8; 95% CI, 0.6-1.1), while the incidence of central lipohypertrophy did not differ by HIV status. Of HIV-infected women with 2 of 4 lipodystrophy outcomes, most (81%) had combined peripheral and central lipoatrophy or combined peripheral and central lipohypertrophy. Only 14% of these women had both peripheral lipoatrophy and central lipohypertrophy.

CONCLUSIONS

These prospective data suggest that lipoatrophy, affecting both peripheral and central sites, predominates in HIV-infected women. The simultaneous occurrence of peripheral lipoatrophy and central lipohypertrophy was uncommon.

OBJECTIVE

To describe the experiences of postmenopausal women who try to stop hormone therapy and to identify characteristics associated with inability to stop.

METHODS

We conducted telephone interviews with 377 randomly selected female members of the Kaiser Foundation Health Plan, aged 50-69 years, who regularly used hormone therapy for at least 1 year before July 1, 2002 and had attempted to stop between July 2002 and March 2003.

RESULTS

Of the 377 women, 280 (74%) successfully stopped and 97 (26%) resumed taking hormone therapy. The major predictor of resuming hormone therapy use was the development of troublesome withdrawal symptoms (odds ratio 8.8; 95% confidence interval 4.9, 16.0). Report of hysterectomy, hormone therapy prescribed by a nongynecologist, and perception of high risk of hip or spine fracture were independently associated with a higher likelihood of unsuccessful stopping. Women with a hysterectomy who had used hormone therapy for 10 or more years and who started hormone therapy mainly for reasons other than health promotion were more likely (P <.001) to be unsuccessful in quitting (44%) compared with those with one or two (25%) or none (9%) of these three characteristics. Most successful stoppers (71%) stopped hormone therapy abruptly, but 29% tapered off hormone therapy; there was no difference in the incidence of troublesome withdrawal symptoms or successful quitting between these two groups.

CONCLUSION

Approximately one quarter of women who try to stop report that they are unable to discontinue postmenopausal hormone therapy, primarily because they develop troublesome withdrawal symptoms. Effective approaches to reducing hormone therapy withdrawal symptoms should be a priority for future research.

OBJECTIVE

To examine whether women who were using postmenopausal hormone therapy (HT) before publication of Women's Health Initiative findings about risks associated with HT had been informed about the findings once published; and to estimate how knowledge of these findings was associated with their decision to discontinue HT.

METHODS

We performed a telephone survey of 670 female members of a large health maintenance organization, aged 50-69 yr, who had regularly used HT from July 1, 2001, through June 30, 2002.

RESULTS

Most women (93%) reported hearing about the new findings; however, only 57% considered the quality of this information to be good, regardless of its source: mass media (21%), the health plan (32%), or a health care practitioner (34%). Women's knowledge of Women's Health Initiative findings was generally poor; 64% did not know what the findings were, 7% were unsure of their knowledge, 6% had incorrect knowledge, and 23% had correct knowledge of Women's Health Initiative findings. On a simple, five-question, true-or-false quiz about HT risks, 30% of respondents answered four to five questions correctly. Although not well informed, 56% reported attempting to discontinue HT in the 6 to 8 months after July 2002. Our multivariable model included five statistically significant predictors of attempting to stop HT: having been sent a letter about Women's Health Initiative findings (odds ratio [OR] 2.7; 95% confidence interval [CI] 1.8, 3.9), reporting good-quality information from media (OR 2.1; 95% CI 1.3, 3.3), having started HT for health promotion (OR 2.0; 95% CI 1.2, 3.3), using a lower-than-standard dosage of estrogen (OR 1.9; 95% CI 1.1, 3.1), and correctly answering four or more items on the HT quiz (OR 1.9; 95% CI 1.2, 2.8).

CONCLUSION

During the 6-8 months after publication of Women's Health Initiative trial findings, most regular postmenopausal HT users tried to stop using HT, despite not being well informed about the Women's Health Initiative findings.

BACKGROUND & AIMS

In the United States, upper gastrointestinal endoscopy is usually performed using intravenous sedation. Sedation increases the rate of both complications and costs of endoscopy. Unsedated esophagogastroduodenoscopy (EGD) using conventional 8-11-mm endoscopes is an alternative to sedated endoscopy but is generally perceived as unacceptable to many American patients. Unsedated EGD using ultrathin 5-6-mm endoscopes is better tolerated. A randomized trial comparing unsedated ultrathin EGD (UT-EGD) with sedated conventional EGD (C-EGD) in a diverse American population is needed.

METHODS

In this multicenter, randomized, controlled trial, 80 patients scheduled to undergo elective outpatient EGD were randomized to unsedated UT-EGD or sedated C-EGD. The study was carried out at San Francisco General Hospital, San Francisco Veterans Affairs Medical Center, and the Liver and Digestive Health Medical Clinic, San Jose.

RESULTS

Baseline characteristics of patients randomized to unsedated UT-EGD and sedated C-EGD were similar. Moreover, there were no significant differences in overall patient satisfaction and willingness to repeat endoscopy in the same manner among the 2 study groups. There was, however, a significant difference in median total procedure time between the 2 study groups of 1.5 hours (P < 0.0001). The mean (+/- SD) total procedure cost was 512.4 US dollars (+/- 100.8 US dollars) for sedated C-EGD and 328.6 US dollars (+/- 70.3 US dollars) for unsedated UT-EGD (P < 0.0001).

CONCLUSIONS

Patients undergoing unsedated UT-EGD are as satisfied as patients undergoing sedated C-EGD and are just as willing to repeat an unsedated UT-EGD. Unsedated UT-EGD was also faster, less costly, and may allow greater accessibility to this procedure.