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Aging into later life is often accompanied by social disconnection, anxiety, and sadness. Negative emotions are self-focused states with detrimental effects on aging and longevity. Awe-a positive emotion elicited when in the presence of vast things not immediately understood-reduces self-focus, promotes social connection, and fosters prosocial actions by encouraging a "small self." We investigated the emotional benefits of a novel "awe walk" intervention in healthy older adults. Sixty participants took weekly 15-min outdoor walks for 8 weeks; participants were randomly assigned to an awe walk group, which oriented them to experience awe during their walks, or to a control walk group. Participants took photographs of themselves during each walk and rated their emotional experience. Each day, they reported on their daily emotional experience outside of the walk context. Participants also completed pre- and postintervention measures of anxiety, depression, and life satisfaction. Compared with participants who took control walks, those who took awe walks experienced greater awe during their walks and exhibited an increasingly "small self" in their photographs over time. They reported greater joy and prosocial positive emotions during their walks and displayed increasing smile intensity over the study. Outside of the walk context, participants who took awe walks reported greater increases in daily prosocial positive emotions and greater decreases in daily distress over time. Postintervention anxiety, depression, and life satisfaction did not change from baseline in either group. These results suggest cultivating awe enhances positive emotions that foster social connection and diminishes negative emotions that hasten decline. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Abstract Purpose of Review Brain metastasis is a significant cause of mortality in breast cancer patients and treatment options are limited. This article will focus on the dynamic intercellular communication between metastatic cancer cells, the tumor microenvironment, and neighboring brain cells to breach the brain’s defenses and promote tumor progression. Recent Findings Recent advances have further elucidated how tumor cells traverse through the blood–brain barrier and implicated the blood–cerebrospinal fluid barrier as a potential entry point. Tumor cells once within the brain milieu utilize factors secreted by and dynamically reprogram neurons, glial cells, and infiltrating leukocytes for their own colonization and survival. Summary Current research has illuminated key mechanisms metastatic breast cancer cells utilize to infiltrate the brain and assimilate in their new environment. New multimodal treatments are investigating not only chemotherapy and radiation that can target metastatic tumor cells, but also immune checkpoint inhibitor–based therapies to sensitize the immune microenvironment.

Background: Telemedicine (TM) has been widely advocated and used to follow up patients with rheumatic diseases during the COVID-19 outbreak. However, there is no evidence supporting its use in systemic lupus erythematosus. We aimed to evaluate the short-term patient satisfaction, compliance, disease control and infection risk of TM compared with standard in-person follow-up (FU) for patients with lupus nephritis (LN) during the pandemic. Methods: This was a single-center open-label randomized controlled study. Consecutive patients followed at the LN clinic were randomized to either TM or standard FU (SF) group in a 1:1 ratio. Patients in the TM group received FU via videoconferencing. SF group patients continued conventional in-person outpatient care. The 6-month data were compared and presented. Results: From June to December 2020, 122 patients were randomized (TM: 60, SF: 62) and had at least 2 FUs. There were no baseline differences, including SLEDAI-2k and proportion of patients in lupus low disease activity state (LLDAS), between the 2 groups except a higher physician global assessment score (PGA) in the TM group (table). After a mean FU of 19.8 ± 4.5 weeks, the overall patient satisfaction score was higher in the TM group with a significantly shorter waiting time from entering the clinic waiting room (virtual or real) to seeing a rheumatologist (figure). More patients in the TM group had hospitalization (15/60, 25.0% vs 7/62, 11.3%;p=0.049) with higher baseline PGA (OR = 1.15, 95% CI 1.07-1.23) being the independent predictor. The proportions of patients remained in LLDAS were similar in the 2 groups (TM: 75.0% vs SF: 74.2%, p = 0.919). None of the patients had COVID-19. Conclusion: TM FU resulted in better patient satisfaction and similar short-term disease control in patients with LN compared to standard care. However, it was associated with more hospitalizations and might need to be complemented by in-person visits especially in patients with higher PGA. (Table Presented).

The outflow of the autonomic nervous system (ANS) is continuous and dynamic, but its functional organization is not well understood. Whether ANS patterns accompany emotions, or arise in basal physiology, remain unsettled questions in the field. Here, we searched for brief ANS patterns amidst continuous, multichannel physiological recordings in 45 healthy older adults. Participants completed an emotional reactivity task in which they viewed video clips that elicited a target emotion (awe, sadness, amusement, disgust, or nurturant love); each video clip was preceded by a pre-trial baseline period and followed by a post-trial recovery period. Participants also sat quietly for a separate 2-min resting period to assess basal physiology. Using principal components analysis and unsupervised clustering algorithms to reduce the second-by-second physiological data during the emotional reactivity task, we uncovered five ANS states. Each ANS state was characterized by a unique constellation of patterned physiological changes that differentiated among the trials of the emotional reactivity task. These ANS states emerged and dissipated over time, with each instance lasting several seconds on average. ANS states with similar structures were also detectable in the resting period but were intermittent and of smaller magnitude. Our results offer new insights into the functional organization of the ANS. By assembling short-lived, patterned changes, the ANS is equipped to generate a wide range of physiological states that accompany emotions and that contribute to the architecture of basal physiology.

Aims/hypothesisThe quantity and quality of FODMAPs can alter the relative abundance of gut microbiota with metabolic consequences although similar data are lacking in people with prediabetes. We investigated associations between habitual FODMAP contents, gut microbiota and glucose/insulin responses in subjects with prediabetes.MethodsIn this prospective cross-sectional study, ninety-eight subjects with impaired glucose tolerance (IGT) (mean age: 57±7 years, 43 % men) had assessment of body composition, 6-point oral glucose tolerance tests (OGTT), Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) and 3-day dietary intake. We analysed faecal samples in a sub-group of 20 subjects with IGT and 10 subjects with normal glucose tolerance by 16S rRNA microbiome analysis.ResultsObese subjects with IGT had the lowest daily FODMAP intake compared with their non-overweight and non-obese counterparts (5.7 (3.9-7.9) vs 7.1 (5.0-11.3) vs 9.9 (4.1-22.4) g/day, p=0.024) despite having similar total daily energy intake. Total content of FODMAPs was negatively correlated with body fat. After adjustment for age and gender, total FODMAPs were negatively associated with BMI and HOMA-IR. This remained significant after adjustment for macronutrients and physical activity (p=0.032 and p=0.036 respectively). FODMAP contents were strongly associated with short-chain fatty acid (SCFA)-producing bacteria, such asLactobacillus(p=0.011),Akkermansia muciniphila(p=0.012), andBifidobacterium longum(p=0.010), the abundance of which were negatively correlated with 2-hr plasma glucose (r = -0.524, p =0.003).ConclusionIn individuals with IGT, higher habitual FODMAP intake was associated with lower body fat and insulin resistance and increased abundance of SCFA-producing bacteria, calling for interventional studies to evaluate the effects of FODMAP intake in prediabetes.

Different variants of particle swarm optimization (PSO) algorithms were introduced in recent years with various improvements to tackle different types of optimization problems more robustly. However, the conventional initialization scheme tends to generate an initial population with relatively inferior solution due to the random guess mechanism. In this paper, a PSO variant known as modified PSO with chaotic initialization scheme is introduced to solve unconstrained global optimization problems more effectively, by generating a more promising initial population. Experimental studies are conducted to assess and compare the optimization performance of the proposed algorithm with four existing well-establised PSO variants using seven test functions. The proposed algorithm is observed to outperform its competitors in solving the selected test problems.

To develop an MR multitasking-based dynamic imaging for cerebrovascular evaluation (MT-DICE) technique for simultaneous quantification of permeability and leakage-insensitive perfusion with a single-dose contrast injection.MT-DICE builds on a saturation-recovery prepared multi-echo fast low-angle shot sequence. The k-space is randomly sampled for 7.6 min, with single-dose contrast agent injected 1.5 min into the scan. MR multitasking is used to model the data into six dimensions, including three spatial dimensions for whole-brain coverage, a saturation-recovery time dimension, and a TE dimension for dynamicmml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"mml:semanticsmml:mrowmml:msubmml:miT/mml:mimml:mn1/mml:mn/mml:msub/mml:mrowmml:annotation$$ {\mathrm{T}}_1 $$/mml:annotation/mml:semantics/mml:mathandmml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"mml:semanticsmml:mrowmml:msubsupmml:miT/mml:mimml:mn2/mml:mnmml:mo*/mml:mo/mml:msubsup/mml:mrowmml:annotation$$ {\mathrm{T}}_2^{\ast } $$/mml:annotation/mml:semantics/mml:mathquantification, respectively, and a contrast dynamics dimension for capturing contrast kinetics. The derived pixel-wisemml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"mml:semanticsmml:mrowmml:msubmml:miT/mml:mimml:mn1/mml:mn/mml:msubmml:mo//mml:momml:msubsupmml:miT/mml:mimml:mn2/mml:mnmml:mo*/mml:mo/mml:msubsup/mml:mrowmml:annotation$$ {\mathrm{T}}_1/{\mathrm{T}}_2^{\ast } $$/mml:annotation/mml:semantics/mml:mathtime series are converted into contrast concentration-time curves for calculation of kinetic metrics. The technique was assessed for its agreement with reference methods inmml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"mml:semanticsmml:mrowmml:msubmml:miT/mml:mimml:mn1/mml:mn/mml:msub/mml:mrowmml:annotation$$ {\mathrm{T}}_1 $$/mml:annotation/mml:semantics/mml:mathandmml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"mml:semanticsmml:mrowmml:msubsupmml:miT/mml:mimml:mn2/mml:mnmml:mo*/mml:mo/mml:msubsup/mml:mrowmml:annotation$$ {\mathrm{T}}_2^{\ast } $$/mml:annotation/mml:semantics/mml:mathmeasurements in eight healthy subjects and, in three of them, inter-session repeatability of permeability and leakage-insensitive perfusion parameters. Its feasibility was also demonstrated in four patients with brain tumors.MT-DICEmml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"mml:semanticsmml:mrowmml:msubmml:miT/mml:mimml:mn1/mml:mn/mml:msubmml:mo//mml:momml:msubsupmml:miT/mml:mimml:mn2/mml:mnmml:mo*/mml:mo/mml:msubsup/mml:mrowmml:annotation$$ {\mathrm{T}}_1/{\mathrm{T}}_2^{\ast } $$/mml:annotation/mml:semantics/mml:mathvalues of normal gray matter and white matter were in excellent agreement with reference values (intraclass correlation coefficients = 0.860/0.962 for gray matter and 0.925/0.975 for white matter ). Both permeability and perfusion parameters demonstrated good to excellent intersession agreement with the lowest intraclass correlation coefficients at 0.694. Contrast kinetic parameters in all healthy subjects and patients were within the literature range.Based on dynamicmml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"mml:semanticsmml:mrowmml:msubmml:miT/mml:mimml:mn1/mml:mn/mml:msubmml:mo//mml:momml:msubsupmml:miT/mml:mimml:mn2/mml:mnmml:mo*/mml:mo/mml:msubsup/mml:mrowmml:annotation$$ {\mathrm{T}}_1/{\mathrm{T}}_2^{\ast } $$/mml:annotation/mml:semantics/mml:mathmapping, MT-DICE allows for simultaneous quantification of permeability and leakage-insensitive perfusion metrics with a single-dose contrast injection.

STUDY QUESTION Are there phase-specific changes in the early secretory (ES) phase human tubal lavage proteome that can inform and potentially optimize IVF culture media? SUMMARY ANSWER The human tubal lavage proteome during the ES phase relative to the menstrual phase reveals substantial differential protein abundance in pathways such as glycolysis, redox homeostasis and activation of 14-3-3 zeta-mediated signaling. WHAT IS KNOWN ALREADY The Fallopian tube is uniquely suited to the development of the preimplantation embryo as it transits the tube during the ES phase of the menstrual cycle. Euploid cleavage-stage embryo arrest may reflect incomplete recapitulation of in-vivo conditions by current media formulations. STUDY DESIGN, SIZE, DURATION Proteome-wide analysis of distal tubal lavage specimens collected from 26 healthy women undergoing open microtubal anastomosis surgery from January 2013 to January 2018 was performed. Specimens were grouped by menstrual cycle phase in order to analyze phase-specific differences in protein abundance. For the murine embryo assay, single-cell embryos (N = 482) were collected from superovulated wild type C57BL/6 female mice and cultured in microdrops over 5 days for the assessment of blastocyst development. PARTICIPANTS/MATERIALS, SETTING, METHODS Human tubal lavage specimens were processed for label-free mass spectrometry. Reported menstrual cycle day was confirmed by measuring serum hormones. Key protein targets in the ES phase were validated via immunoblot. The ES phase-specific increase in 14-3-3 zeta protein was confirmed via ELISA of conditioned media obtained from primary human Fallopian tube epithelial cell culture. A murine embryo assay was performed to investigate the impact of graduated concentrations of 14-3-3 zeta on the blastocyst development rate. MAIN RESULTS AND THE ROLE OF CHANCE Comparison of the ES and menstrual phase human tubal lavage proteomes revealed 74 differentially expressed proteins with enrichment of pathways and biological processes involved in the regulation of carbohydrate metabolism, oxidative stress and cell survival. The adapter-regulator protein 14-3-3 zeta was among the most significantly increased in the ES phase. Supplementation of embryo culture media with 14-3-3 zeta at concentrations tested did not significantly improve the murine blastocyst development. LIMITATIONS, REASONS FOR CAUTION Although select associations were recapitulated in the conditioned media from sex steroid exposed primary human tubal epithelial cells, cell culture represents an in-vitro approximation. Changes to embryo culture media, such as protein supplementation, must undergo rigorous preclinical safety testing prior to adoption for human use. WIDER IMPLICATIONS OF THE FINDINGS This study represents the first description of the human Fallopian tube lavage proteome across the menstrual cycle, revealing a unique proteomic signature during the ES phase. Although supplementation of culture media with 14-3-3 zeta at appropriate concentrations showed no significant impact on the murine blastocyst development rate, other biologically plausible candidate proteins for individual or high throughput testing strategies are identified. STUDY FUNDING/COMPETING INTEREST(S) This work was funded in part by an Army Medical Department Advanced Medical Technology Initiative grant from the United States Army Medical Research and Materiel Command’s Telemedicine and Advanced Technology Research Center. There are no competing interests. TRIAL REGISTRATION NUMBER N/A

Among existing research on social vulnerability, virtually no studies have considered homelessness as a variable in their vulnerability assessments. This study identified the relevance of homelessness as a key index in social vulnerability assessment to inform the public, policymakers and the broader body of literature of its impacts on shaping vulnerability patterns in cities. In this study, the 2018 Homeless data for Austin was disaggregated from the council district level to block group level using dasymetric mapping in Geographic Information System (GIS). Principal Component Analysis (PCA) was used to group highly correlated demographic and socioeconomic variables into factors, which were normalized and summed to model social vulnerability with homeless index (SOVI_H) and without homeless index (SOVI) for each Austin Blockgroup. The result revealed significant differences in geographic patterns between SOVI_H and SOVI. SOVI_H showed hotspots of vulnerabilities in Downtown and East-Austin neighborhoods, depicting a slight shift of social vulnerability westwards of the city. This finding differs from past results of social vulnerabilities in Austin where it used to be predominant in the East. This study showed that incorporating homelessness in identifying social vulnerability can help researchers and other associated organizations identify the most vulnerable groups when conducting social vulnerability assessments.

Soft tissue sarcomas are a heterogenous group of neoplasms without well-validated biomarkers. Cancer-related inflammation is a known driver of tumor growth and progression. Recent studies have implicated a high circulating neutrophil-lymphocyte ratio as a surrogate marker for the inflammatory tumor microenvironment and a poor prognosticator in multiple solid tumors, including colorectal and pancreatic cancers. The impact of circulating neutrophil-lymphocyte ratio in soft tissue sarcomas has yet to be elucidated.We performed a retrospective analysis of patients undergoing curative resection for primary or recurrent extremity soft tissue sarcomas at academic centers within the US Sarcoma Collaborative. Neutrophil-lymphocyte ratio was calculated retrospectively in treatment-naïve patients using blood counts at or near diagnosis.A high neutrophil-lymphocyte ratio (≥4.5) was associated with worse survival on univariable analysis in patients with extremity soft tissue sarcomas (hazard ratio 2.07; 95% confidence interval, 1.54-2.8; P.001). On multivariable analysis, increasing age (hazard ratio 1.03; 95% confidence interval, 1.02-1.04; P.001), American Joint Committee on Cancer T3 (hazard ratio 1.89; 95% confidence interval, 1.16-3.09; P = .011), American Joint Committee on Cancer T4 (hazard ratio 2.36; 95% confidence interval, 1.42-3.92; P = .001), high tumor grade (hazard ratio 4.56; 95% confidence interval, 2.2-9.45; P.001), and radiotherapy (hazard ratio 0.58; 95% confidence interval, 0.41-0.82; P = .002) were independently predictive of overall survival, but a high neutrophil-lymphocyte ratio was not predictive of survival (hazard ratio 1.26; 95% confidence interval, 0.87-1.82; P = .22).Tumor inflammation as measured by high pretreatment neutrophil-lymphocyte ratio was not independently associated with overall survival in patients undergoing resection for extremity soft tissue sarcomas.

The magnetic resonance imaging (MRI) appearance of the brain and spinal cord in humans with neuroangiostrongyliasis (NA) due to Angiostrongylus cantonensis infection has been well reported. Equivalent studies in animals are lacking. This case series describes clinical and MRI findings in 11 dogs with presumptively or definitively diagnosed NA. MRI of the brain and/or spinal cord was performed using high-field (1.5 T) or low-field (0.25 T) scanners using various combinations of transverse, sagittal, dorsal and three-dimensional (3D) T1-weighted (T1W), transverse, sagittal and dorsal T2-weighted (T2W), T2W fluid-attenuated inversion recovery (FLAIR) and T2*-weighted (T2*W) gradient echo (GRE), dorsal T2W short tau inversion recovery (STIR) and post-gadolinium transverse, sagittal, dorsal and 3D T1W and transverse T2W FLAIR sequences. In 4/6 cases where the brain was imaged, changes consistent with diffuse meningoencephalitis were observed. Evidence of meningeal involvement was evident even when not clinically apparent. The spinal cord was imaged in 9 dogs, with evidence of meningitis and myelitis detected in regions consistent with the observed neuroanatomical localization. Pathognomonic changes of neural larva migrans, as described in some human patients with NA, were not detected. NA should be considered in the differential diagnosis of dogs with MRI evidence of focal or diffuse meningitis, myelitis and/or encephalitis, especially in areas where A. cantonensis is endemic. If not precluded by imaging findings suggestive of brain herniation, cerebrospinal fluid (CSF) collection for cytology, fluid analysis, real-time polymerase chain reaction (qPCR) and enzyme-linked immunosorbent assay (ELISA) testing should be considered mandatory in such cases after the MRI studies.

Superconductivity in infinite-layer nickelates holds exciting analogies with that of cuprates, with similar structures and 3d-electron count. Using resonant inelastic x-ray scattering, we studied electronic and magnetic excitations and charge density correlations in Nd_{1-x}Sr_{x}NiO_{2} thin films with and without an SrTiO_{3} capping layer. We observe dispersing magnons only in the capped samples, progressively dampened at higher doping. We detect an elastic resonant scattering peak in the uncapped x=0 compound at wave vector (∼⅓,0), remindful of the charge order signal in hole doped cuprates. The peak weakens at x=0.05 and disappears in the superconducting x=0.20 film. The role of the capping on the electronic reconstruction far from the interface remains to be understood.

Surgery resident mental health, burnout, and overall well-being are constantly scrutinized, and improving surgery resident well-being programs continuously requires refinement. We sought to evaluate the effectiveness of human-centered design (HCD) sprints to enhance our surgery resident well-being program.An HCD sprint was conducted with 34 surgery residents in a single session using seven separate domains, including Mental Health/Reflection and Therapy; Mentoring or Faculty Engagement; Physical Well-being; Retreats; Scheduled Breaks or Free Time; Social Connection; and Well-being Lectures, Emails, or Curriculum. Responses were characterized as: "How might we", Suggestions, Useful, and Not Useful.Well-being Lectures, Emails, or Curriculum were overwhelmingly viewed, as Not Useful (77%), as was Mental Health/Reflection and Therapy (42%). Scheduled Breaks or Free Time was viewed as the most Useful (42%). This category also had the most suggestions and "How might we" ideas for improvement (41%). Lastly, Suggestions and "How might we" ideas were also common for improving Mentoring or Faculty Engagement (31% and 29%, respectively). These results were incorporated into multiple strategies to improve surgery resident well-being and also shared in a Department of Surgery Grand Rounds.Surgery resident well-being and a targeted approach by a well-being program are critical to a residency program, particularly with the arduous nature of surgical training during the pandemic resulting in periods of prolonged social isolation. HCD sprints are an effective means to refine a surgery resident well-being program and to involve the residents themselves in that process.

Purpose: To report the patterns of use of hypofractionated radiotherapy (HFRT) (≤16 fractions)in breast cancer and ductal carcinoma in situ (DCIS) patients in Ontario, Canada from 2009 to 2015 and identify factors related to HFRT use. Methods: A retrospective cohort study of Ontario women diagnosed with breast cancer or DCIS followed by adjuvant breast or chest wall radiation (RT) from 2009 to 2015 was conducted using data from the Institute for Clinical Evaluative Sciences (ICES). Logistic regression models were used to identify factors associated with HFRT use. Physician was included as a random effect. To calculate the potential amount of time that could be saved if all patients were to receive 16 fractions of HFRT, the number of extra RT treatments after the 16th visit was multiplied by the median amount of time spent to treat one patient at our cancer centre (8.76 minutes). This time was found with Sunnybrook Health Sciences Centre data collected from October 2017 to March 2018 (n=523) and represents the amount of time from when a patient enters the RT unit for treatment setup, until the RT beam is turned off. Results: A total of 42,072 patients were included. Most patients were aged between 50 and 69 years old (56.7%) with stage I or II breast cancer (74.6%) and had breast conserving surgery (BCS) (76.9%). Half previously received chemotherapy and 7.9% were DCIS patients. Use of sequential boost, simultaneous boost, and regional nodal RT was 17.2%, 3.1%, and 31.7% respectively. Institutional variation in HFRT use ranged from 27.5% to 71.6%. HFRT use has increased in all patient populations over the study period. HFRT use was more common in breast cancer and DCIS patients with BCS than in chest wall and nodal RT. Simultaneous boost (OR=0.09), nodal RT (OR=0.08), previous chemotherapy (OR=0.7), stage 0, II, and III breast cancer (OR=0.06 relative to stage I), were correlated with less HFRT use. Older age, later year of diagnosis, sequential boost (OR=0.09), BCS and no surgery (OR=1.2, 1.5 relative to mastectomy) were correlated with higher HFRT use. Institution was significantly correlated to HFRT use. The variance estimate for the physician random effect was 0.33 (p Trends in the use of HFRT (%) from 2009 to 2015 for DCIS and breast cancer patients in Ontario.YearStage I-IV + BCS + Breast RTStage I-IV + BCS + Breast + Nodal RTStage I-IV + Mastectomy + Breast RTStage I-IV + Mastectomy + Breast + Nodal RTDCIS + BCS200962.610.329.09.545.2201062.06.323.76.951.2201162.24.121.34.752.7201263.79.621.711.452.0201365.112.629.315.057.3201469.37.835.415.164.5201573.711.839.217.573.4BCS: breast conserving surgery, RT: radiation treatment Conclusions: HFRT use in Ontario has increased over time for all patient populations, and reflects the current evidence supporting HFRT in different patient populations, with lower HFRT use seen in chest wall and nodal RT and higher HFRT use in early-stage breast cancer patients with BCS. Citation Format: Chow E, Chan S, Yao Z, Sutradhar R, Lee J, Wan BA, Paszat L. Fractionation patterns in adjuvant breast radiotherapy in Ontario, Canada from 2009 to 2015 [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-12-05.

Background Current international guidelines on HIV Pre-Exposure Prophylaxis (PrEP) recommend serological screening for syphilis at routine three-monthly PrEP appointments. The aim of our study was to describe the pattern of clinical presentation of syphilis among men who have sex with men (MSM) taking PrEP. We were interested in whether syphilis is detected through screening at scheduled three-monthly PrEP clinic appointments or whether primary or secondary syphilis presented at unscheduled interval visits. Methods This was a retrospective study of MSM attending the PrEP clinic at the Melbourne Sexual Health Centre between February 2016 and March 2019. Serological screening for syphilis was routinely undertaken at three-monthly PrEP clinic appointments. Diagnoses of early syphilis were identified from PrEP clinic visits and from interim walk-in STI clinic attendances. Results There were 69 cases of early syphilis among 61 MSM taking PrEP during the study period. There were 24 (35%) primary, 16 (23%) secondary and 29 (42%) early latent infections. The incidence of early syphilis was 8.6 per 100 person-years. A substantial proportion of primary (58%) and secondary (44%) syphilis diagnoses were made at interim STI clinic attendances, between PrEP appointments. Conclusions Syphilis screening at routine three-monthly PrEP visits alone fails to detect a proportion of primary and secondary syphilis infections and may be insufficient in preventing onward transmission. Education of MSM taking PrEP regarding the risk of syphilis and symptom recognition is necessary together with access to syphilis testing between PrEP visits.

Background The study aims to examine the trends of syphilis infection in Victoria and the characteristics of notified cases of syphilis among different population groups stratified by risk and in different geographical distributions. Methods We analysed the demographic characteristics, notification trends and geographical distribution of notified cases of syphilis in Victoria between 2015 and 2018. Infectious syphilis cases were categorised into four population groups: men who have sex with men (MSM), men who have sex with women (heterosexual males), females, and men who have sex with men and women (bisexual males). We examined the staging of syphilis, geographic location by residence of cases, HIV status, reasons for testing, and notifying source. Results Of the 4,808 notified infectious syphilis cases, there were 3,801 (64%) MSM, 593 (12%) heterosexual males, 465 (10%) females, and 118 (2%) bisexual males. Females (219% increase, ptrend Conclusion Notified cases of syphilis infection had significantly increased across all population groups but particularly in heterosexual males and females. Campaigns and control measures should be specific for each population group with targeted screening and education in areas with a high number of syphilis cases.

The World Health Organization declared the coronavirus disease 2019 (COVID-19) as a pandemic on 11 March 2020. Since then, many countries have introduced national responses to the COVID-19 pandemic and these include the closure of international borders, stay at home orders, restrictions of movement, curfews, physical distancing and wearing face masks. This talk will discuss how these restrictions have impacted sexual practices among individuals, access to healthcare seeking as well as the diagnoses of sexually transmitted infections globally.

Background Rectal chlamydia is the most commonly diagnosed bacterial sexually transmissible infection among men who have sex with men (MSM) and there is increasing concern about rectal chlamydia in women. The absence of randomised controlled trial (RCT) evidence means there is ongoing debate about the most efficacious treatment. Methods We conducted a double-blind double-dummy RCT to compare the efficacy of azithromycin 1g singledose with 7-days doxycycline 100mg twice daily for the treatment of asymptomatic rectal chlamydia. MSM diagnosed with asymptomatic rectal chlamydia infection at five sexual health clinics in Australia were randomly assigned to receive either doxycycline or azithromycin. Primary outcome was rectal chlamydia microbiological cure defined as a negative nucleic acid amplification test at four weeks. Logistic regression was used to calculate the difference in microbial cure within a modified intention to treat population that excluded L2 serovar diagnoses post-recruitment. Results We enrolled 625 men and randomly assigned 314 to doxycycline and 311 to azithromycin between August 2016 and August 2019. Primary outcome data were available for 290 (92%) assigned to doxycycline and 297 (96%) assigned to azithromycin. In the modified intention to treat population, the observed microbiological cure was 281/290 (96.9%; 95%CI: 94.9, 98.9) for doxycycline and 227/297 (76.4%; 95%CI: 73.8, 79.1) for azithromycin, with an adjusted risk difference of 19.9% (95% CI: 14.6, 25.3; p Conclusions The efficacy of doxycycline was found to be substantially superior to azithromycin in the treatment of asymptomatic rectal chlamydia infection among MSM. Doxycycline must replace azithromycin as firstline treatment for symptomatic rectal chlamydia.

Background The association between meeting partners online and sexual practices has been under-studied in heterosexuals. This study aimed to examine the associations between the methods of meeting partners with sexual practices, as well as sexually transmitted infections (STIs) and human immunodeficiency virus (HIV), in heterosexuals. Methods We conducted a survey among heterosexuals attending the Melbourne Sexual Health Centre between March and April 2019. This survey asked about the methods through which participants had met their sexual partner(s), sexual practices and intravenous drug use (IVDU) over the past 3 months. Participants’ HIV/STI (chlamydia, gonorrhoea, syphilis) status was obtained from clinical testing. A multivariable logistic regression was used to examine the association between each method of meeting partners and the participants’ sexual practices, IVDU, and STI status. Results A total of 698 participants (325 males, 373 females) were included in the study. The majority of participants reported using only one method to meet partners (68.3% males, 65.7% females, p=0.0462). Males most commonly met partners at social-venues (e.g. bar, pub, party) (38.8%, n=126), whilst females most commonly met through friends/family (47.7%, n=178). Paying for sex was associated with males meeting partners at sex-venues (AOR=145.34, 95%CI: 26.13–808.51) and the internet (AOR=10.00, 95%CI: 3.61–27.55). There was no association between IVDU and methods of meeting. Social-venues were associated with condomless vaginal sex in males (AOR=3.31, 95%CI: 1.94–5.71) and females (AOR=2.58, 95%CI: 1.61–4.13) and testing STI positive in males (AOR=3.04, 95%CI: 1.24–7.48) and females (AOR=3.75, 95%CI: 1.58–8.89). Conclusion Heterosexuals that met sexual partners at social-venues had a more than threefold risk of testing positive for STIs, indicating that heterosexuals may benefit from health promotion campaigns that are delivered through a more public setting.

Background Men-who-have-sex-with-men (MSM) living with HIV have a high prevalence of high-risk human papillomavirus (hrHPV) in the anus, and a high incidence of anal cancer. We conducted an open-label, single-arm pilot study to assess the utility of imiquimod cream against hrHPV among MSM living with HIV.[ACTRN12617001355369] Methods The study was conducted at Melbourne Sexual Health Centre between April 2018 and June 2020. MSM aged ≥18 years, living with HIV, who tested positive for any anal hrHPV on clinician-collected swabs were eligible. We instructed men to apply 5% imiquimod cream (6.25 mg) intra-anally and peri-anally 3 doses per-week for 16-weeks (Phase 1), followed by a maintenance period of 1 dose per-week for 48-weeks (Phase 2). We collected adverse events (AE) using text messages and questionnaires. Results Thirty MSM were enrolled to phase 1 and 27 completed the week 16 follow-up(median age 50). Twenty-four MSM (86%) applied at least 50% of imiquimod doses. All men reported AE, with 39.5% reporting grade 1,39.5% grade 2, and 21% grade 3 AEs. Eighteen MSM (67%) required treatment interruption. The reasons for interruption were haemorrhoids (n=3), herpes genitalis reactivation (n=2), and grade 2–3 AEs (n=11) such as irritation, itching and tenderness. 60% of MSM with grade 2(n=6) and 33% with grade 3 AEs (n=2) opted to continue to phase 2. Eighteen MSM were enrolled to phase 2 and 13 completed the week 48 follow-up. All MSM took at least 50% of doses. No treatment-limiting AEs were reported. 10 MSM in phase 1 (37%) and none in phase 2 reported their sex life was negatively impacted from imiquimod use. Conclusion Intra-anal and peri-anal imiquimod at 3 doses per-week was poorly tolerated over 16 weeks and most men required treatment interruption due to AEs. In contrast, once-a-week application was well tolerated with no treatment-limiting AEs reported over 48-weeks.

Background While syphilis transmission is increasing, precisely how Treponema pallidum is transmitted sexually is unclear. This study of MSM with early syphilis determined the frequency of Treponema pallidum shedding from potentially asymptomatic sites and the stage with the most frequent shedding. Methods MSM were recruited between 2015 and 2019, at Melbourne Sexual Health Centre, Australia. Men were eligible if they reported sex with men during the previous year, were aged ≥18 years and had laboratory-confirmed primary, secondary, or early latent syphilis. All syphilis lesions were swabbed. Non-lesion samples collected were oral rinse, oral cavity swab, anal canal swab, urine, and semen. Specimens were tested for T. pallidum using two PCR assays. Results 200 men with serologically-confirmed early syphilis were included: 54 (27%) primary, 93 (46·5%) secondary and 53 (26·5%) early latent cases. T. pallidum DNA was detected orally in 48 (24%; 95% CI: 18.3–30.5%) men by oral rinse and/or oral lesion swab, 24 with no oral lesion. Oral T. pallidum detection was most frequent during secondary syphilis compared to other stages, (44%(41/93) versus 7% (7/107), p Conclusion Unrecognised oral and anal shedding of T. pallidum may be a factor in sustaining syphilis transmission. Secondary syphilis may be the most infectious stage, with oral transmission possibly being important. Earlier detection and treatment for syphilis to prevent progression to the secondary stage may improve syphilis control.