Development of health-related quality of life and symptoms in patients with advanced cancer in Greenland

A prospective national cohort study assessed the development of health-related quality of life (HRQoL) and symptoms in adult patients undergoing treatment and care for advanced cancer in Greenland. HRQol was examined by EORTC QLQ-C30 version 3.0 questionnaire monthly for 4 months. Changes over time and between-group comparisons were examined. Of 58 patients included in the study, 47% completed the questionnaire four times. Functioning was generally high, and improved social functioning was observed after 1 and 2 months. The highest symptom score was for fatigue followed by pain and nausea/vomiting. A high score for financial problems remained unchanged during the entire period. Patients with higher income had reduced pain intensity (p = .03) and diarrhoea (p = .05) than patients with income below the poverty line. After 1 month, reduction in pain intensity was observed for Nuuk citizens compared with non-Nuuk citizens (p = .05). After 2 months, non-Nuuk citizens reported improved social functioning compared with Nuuk citizens (p = .05). After 3 months, Global Health in Nuuk citizens was improved compared with non-Nuuk citizens (p = .05). An important clinical finding was that patients' needs for support are related to social status, and geographical factors should be taken into account when planning palliative care.

TaxMapper: an analysis tool, reference database and workflow for metatranscriptome analysis of eukaryotic microorganisms

Background

High-throughput sequencing (HTS) technologies are increasingly applied to analyse complex microbial ecosystems by mRNA sequencing of whole communities, also known as metatranscriptome sequencing. This approach is at the moment largely limited to prokaryotic communities and communities of few eukaryotic species with sequenced genomes. For eukaryotes the analysis is hindered mainly by a low and fragmented coverage of the reference databases to infer the community composition, but also by lack of automated workflows for the task.

Results

From the databases of the National Center for Biotechnology Information and Marine Microbial Eukaryote Transcriptome Sequencing Project, 142 references were selected in such a way that the taxa represent the main lineages within each of the seven supergroups of eukaryotes and possess predominantly complete transcriptomes or genomes. From these references, we created an annotated microeukaryotic reference database. We developed a tool called TaxMapper for a reliably mapping of sequencing reads against this database and filtering of unreliable assignments. For filtering, a classifier was trained and tested on each of the following: sequences of taxa in the database, sequences of taxa related to those in the database, and random sequences. Additionally, TaxMapper is part of a metatranscriptomic Snakemake workflow developed to perform quality assessment, functional and taxonomic annotation and (multivariate) statistical analysis including environmental data. The workflow is provided and described in detail to empower researchers to apply it for metatranscriptome analysis of any environmental sample.

Conclusions

TaxMapper shows superior performance compared to standard approaches, resulting in a higher number of true positive taxonomic assignments. Both the TaxMapper tool and the workflow are available as open-source code at Bitbucket under the MIT license: https://bitbucket.org/dbeisser/taxmapperand as a Bioconda package: https://bioconda.github.io/recipes/taxmapper/README.html.

Electronic supplementary material

The online version of this article (doi:10.1186/s12864-017-4168-6) contains supplementary material, which is available to authorized users.

A randomized clinical trial comparing plaque removal efficacy of an oscillating-rotating power toothbrush to a manual toothbrush by multiple examiners

OBJECTIVE

To determine whether multiple examiners can demonstrate consistent plaque removal advantages for an oscillating-rotating power toothbrush versus a manual toothbrush.

METHODS

This was a replicate-use, single brushing, examiner-blind, randomized, two-treatment, four-period crossover clinical trial involving four examiners. Subjects were randomized to one of four treatment sequences involving two toothbrushes: an oscillating-rotating power toothbrush or a manual toothbrush. At each of the four visits, subjects arrived having abstained from oral hygiene for 24 h prior, and brushed with their assigned toothbrush and a marketed fluoride dentifrice under supervision unaided by a mirror. Plaque was assessed by each examiner using the Turesky-Modified Quigley-Hein Plaque Index at each study period before and after brushing. Data was analysed separately for each examiner using the analysis of covariance for crossover design.

RESULTS

Ninety-five subjects between the ages of 18 and 70 met the entrance criteria and were enrolled in the study. Eighty-seven subjects completed all four periods of the study. Both brushes delivered a significant plaque reduction when compared to baseline. Significant treatment differences were observed for all four examiners - ranging from 0.10 to 0.16 - in favor of the oscillating-rotating brush (P < 0.001). There were no adverse events reported or observed for either brush.

CONCLUSIONS

All four examiners demonstrated the power toothbrush removed significantly more plaque after a single brushing than the standard manual toothbrush. Both brushes were well tolerated.

The experiences of and the nursing care for breast cancer patients undergoing immediate breast reconstruction

This study explores the experiences of and the nursing care for nine women with breast cancer undergoing immediate breast reconstruction (IBR) with a TRAM-flap. The study was prospective and descriptive and source and method triangulation was used. Source triangulation consisted of the patients' and nurses' perspectives, whilst method triangulation combined interviews, questionnaires and medical records. One result is that the meaning of IBR for the women operated is related to feelings of hope, normality and 'wholeness'. Another result is that not all the needs of the patients are assessed and met; the nursing care during admission is mainly focused on the physical care and after dismissal the patients are left in a situation characterized by vulnerability and a sense of emptiness. The study points to some implications in the means of quality development and rehabilitation.

Application of a fluorogenic PCR assay for typing and subtyping of influenza viruses in respiratory samples

A fluorogenic PCR-based method (TaqMan-PCR) was developed for typing and subtyping of influenza virus genomes in clinical specimens. The TaqMan-PCR employs a probe technology that exploits the endogenous 5'-3' nuclease activity of the Taq DNA polymerase to allow direct detection of the amplicon by release of a fluorescent reporter during the PCR. Therefore, post-PCR analysis is avoided since hybridization with the fluorogenic probe and quantification of the amplified product is performed simultaneously during PCR cycling. The specificity of the method was evaluated on 86 influenza A (25 H1N1 and 61 H3N2) and 49 influenza B virus reference strains and isolates. The sensitivity of the technique was found to be at the level of 0.1 50% tissue culture infective dose. This TaqMan-PCR was applied prospectively to surveillance work by community-based sampling in Germany during the last two influenza seasons. Seven hundred five throat swabs were analyzed during the winter of 1997-1998. A total of 195 of 705 samples (28%) were positive by PCR. Influenza viruses could be isolated from 125 specimens (18%). During the 1998-1999 season, 1,840 respiratory samples were received. Influenza viruses were isolated from 281 specimens (15%) out of 525 throat swabs (29%) which were positive for influenza A or B virus by TaqMan-PCR. Further differentiation of influenza A virus-positive swabs revealed an intensive circulation of the subtype H3N2 during both seasons, 1997-1998 and 1998-1999. The TaqMan-PCR was much more sensitive than culture and revealed an excellent correlation for typing and subtyping of influenza viruses when samples were positive by both methods.

An echovirus 30 outbreak with a high meningitis attack rate among children and household members at four day-care centers

Echovirus 30 (E 30) outbreaks in defined cohorts have rarely been reported. In June 1996, an outbreak of E 30 occurred in four day-care centers (DCCs) in neighboring villages in Germany. A retrospective cohort study of DCC children, employees and household members was done to determine the extent of the outbreak and risk factors for illness. Forty-two percent (39/92) of DCC children, 13% (30/228) of their household members, 5% (1/19) of employees and 2% (1/49) of household members of employees were ill. Onsets occurred over 31 days. Thirteen percent (12/92) of DCC children had meningitis. In only one of 16 households with multiple family members ill, illness in a family member preceeded that of the DCC child. Household members of ill DCC children were 15 times more likely to report illness than those of non-ill DCC children. We conclude that this outbreak was associated with a very high incidence of meningitis, the outbreak began in the DCCs and then spread to household members, and that household members of ill children compared to those of non-ill children were much more likely to report illness.

Identification of human cytomegalovirus variants by analysis of single strand conformation polymorphism and DNA sequencing of the envelope glycoprotein B gene region-distribution frequency in liver transplant recipients

Single strand conformation polymorphism analysis (SSCP) of PCR-amplified DNA and subsequent DNA sequencing of human cytomegalovirus (HCMV) glycoprotein B (gB) gene were applied to identify known HCMV strains and to detect new virus variants. 61 HCMV PCR positive patients were studied out of a cohort of 410 patients after liver transplantation (LTX). SSCP was able to distinguish between strains Davis, AD169, and Towne, and in addition could identify five new virus variants (Berlin B, C, E, F, and H). Their frequency, gB and gH types were determined. Simultaneous infections with two or three strains or variants, as well as a switch from one virus to another virus were observed during long-term follow-up. No correlation between the occurrence of certain virus strains or gB types and defined clinical manifestations of HCMV infection after LTX was drawn.

Community-wide outbreak of enteroviral illness caused by echovirus 30: a cross-sectional survey and a case-control study

BACKGROUND

In June, 1997, 21 children from a single community in Germany were hospitalized with aseptic meningitis. An epidemiologic investigation was conducted to determine the extent of the outbreak and risk factors for illness.

METHOD

The extent of the outbreak was assessed with a cross-sectional survey of every 10th child listed in the town register among the 2240 town children < 16 years old. A case-control study determined risk factors for illness. Sixty-two cases were identified through the cross-sectional survey from hospitalized persons and from persons seen by local physicians. Controls were 114 asymptomatic persons identified from the cross-sectional survey.

RESULTS

The overall attack rate was 16%, with the highest attack rates (24%) among the 6- to 8-year olds. Onsets occurred during a 37-day period. Among the 2240 town children <16 years of age, an estimated 353 met the case definition for enteroviral illness, 168 visited a doctor and 21 were hospitalized. Data from the case-control study indicated that contact with an ill household member [odds ratio (OR) = 6.3; 95% confidence interval (CI) 2.6 to 15.5], day-care attendance (OR = 2.6; 95% CI 1.1 to 6.2) and playground use, either two to three times per week (OR = 3.7; 95% CI 1.3 to 10.2) or daily (OR = 4.3; 95% CI 1.6 to 11.3), were risk factors for illness.

CONCLUSION

Echovirus 30 caused substantial morbidity during this community outbreak caused by person-to-person spread. Household contacts, day-care centers and playgrounds were prominent risk factors for transmission.

Influenza A outbreak among adolescents in a ski hostel

An outbreak of influenza A H3N2 with a high attack rate (49%) and abrupt onset (69% became ill within 2 days) occurred among 81 ski school participants who stayed in a crowded hostel in Austria in early 1997. Two students were hospitalized with pneumonia; one of them died. Cultures of blood and/or respiratory secretions from the hospitalized students yielded toxin-producing Staphylococcus aureus. Influenza A H3N2 was confirmed serologically in four participants, including one surviving hospitalized student, and by polymerase chain reaction of lung tissue from the deceased student. This investigation demonstrates that influenza can cause an explosive outbreak among skiers in a crowded hostel, leading to severe complications among previously healthy adolescents.

Presence of antibodies reacting with porcine circovirus in sera of humans, mice, and cattle

Antibodies reacting with porcine circovirus (PCV) were found in sera of humans, mice, and cattle by means of an indirect immunofluorescence assay (IFA) and an ELISA. In man, the highest seroprevalence (23.9% in IFA and 30.2% in ELISA) was found among hospitalized patients with fever of partially unclear etiology. Non-hospitalized "healthy" persons of the former German Democratic Republic showed a significantly higher number of positive sera (IFA = 20%) than blood donors from Berlin-West (IFA = 8.6%). Murine sera reacted positive with PCV in IFA between 12 to 69% in different breeding groups and about 35% of cattle sera were found reactive with PCV in IFA. Double-staining IFAs, immuno-electron microscopy and immunoblotting showed that non-porcine antibodies reacted with PCV structural antigen. Mathematical analysis revealed that in ELISA, non-porcine antibodies reacted specifically with PCV. Loss of binding specificity of non-porcine antibodies in ELISA after storage of sera and lower maximal optical densities obtained at equal titers in ELISA with non-porcine than with porcine sera suggest that antibodies in man, mice and cattle are caused by related species specific viruses sharing antigenic epitopes with PCV.

[Results of neutron therapy in recurrent malignant salivary gland tumors in the head and neck area]

PURPOSE

The records of 33 patients of recurrent salivary gland tumors of the head and neck regions were analysed.

PATIENTS AND METHODS

33 patients with recurrent salivary gland tumors were treated with fast neutrons of a 14 MeV DT generator. All patients had been operated several times. 10 patients had been irradiated before with photons or electrons. 24 patients had macroscopic tumor. In many cases advanced tumors were treated.

RESULTS

The median follow-up of our patients is 33 months. 6 patients are still alive without disease. 5 patients are alive with local recurrence or tumor progression. The calculated survival rate for all patients is 45% at 5 years. The calculated control rate for all patients is 43% at 5 years. Most of the late side effects according to the RTOG/EORTC-score were moderate. Only in one case severe late side effects could be observed.

CONCLUSION

According to the literature advanced recurrences of salivary gland tumors should be treated with fast neutrons.

Comparison of polymerase chain reaction from plasma and buffy coat with antigen detection and occurrence of immunoglobulin M for the demonstration of cytomegalovirus infection after liver transplantation

We compared the value of PCR on plasma with PCR on buffy coat leukocytes, Ag assay, and the determination of IgM antibodies by ELISA for the diagnosis and follow-up of cytomegalovirus infection. Thirty patients were followed after liver transplantation (LTX). We compared the tests to assess their clinical usefulness. Fourteen of 30 (46%) patients were both positive in plasma and buffy coat PCR and Ag test. Sixteen patients were negative in both procedures. There was a 97.2% concordance between PCRs done from plasma or buffy coat. The concordance of results of PCR and Ag test in single samples was 94.3%. Discordant results were found in 5.6% of samples. Discordance was observed in the early and the late phase of CMV infection and was due to positive PCRs preceding positive Ag tests for 1-3 weeks in one-half of the patients. IgM antibodies were first observed after a median period of 8 weeks (range, 6-11 weeks) after LTX. Positive PCRs and Ag tests preceded clinical manifestation of CMV disease by a 1 week median (range, 0-3 weeks), whereas positive IgM ELISAs occurred after a median period of 2.5 weeks (range, 0-4 weeks) after the onset of CMV disease. The sensitivity and specificity of both PCR and Ag test were identical, 100% and 76%, respectively. However, for the IgM ELISA, the sensitivity was only 66%, and the specificity was 84%. In conclusion, plasma or buffy coat PCR and Ag test are equally reliable procedures for early detection and monitoring of CMV infection. PCR can become positive earlier than the Ag test, but it is technically more demanding to perform. The demonstration of IgM antibodies is of little practical help because an antibody response occurs too late in relation to infection.

[Possibilities of driver fitness diagnosis and training using a stationary training car]

The study presented had dealt with the potential of a stationary training car in assessing and improving the driving skills of patients having neurological disorders, with reaction testing and reaction training carried out by means of the training car. The aim had been to verify whether, and to what extent, such a device might contribute to driving fitness diagnosis and improvement. The sample was comprised of patients who, mostly following brain injury, participated in an in-patient rehabilitation programme. It was found that an individual's driving fitness cannot be diagnosed on the basis of laboratory testing alone. The deficits elicited by the tests have to be verified concerning their impact in real road traffic in every individual case, taking adaptive potential into account. In view of improved driving skills, the findings show performance improvements in various reaction tests as well as better driving sample ratings.

Demonstration of cytomegalovirus after bone marrow transplantation by polymerase chain reaction, virus culture and antigen detection in buffy coat leukocytes

We prospectively monitored buffy coat leukocytes of 47 patients after 50 marrow transplantations (autologous n = 18, allogeneic n = 32) by polymerase chain reaction (PCR) for the presence of cytomegalovirus (CMV). None of the 18 autologous graft recipients (9 seropositive, 9 seronegative) had positive PCR results or CMV disease throughout the post-transplantation course. Six of 32 allograft recipients (19 seropositive, 13 seronegative) became PCR positive, four of whom developed CMV disease. PCR positive patients were found more often (5 of 10) in the group with acute GVHD grade II-IV compared with 1 of 22 in the group without or with grade I acute GVHD (p = 0.002). Comparison of PCR with antigen assay and virus culture showed an agreement in 90 of 96 (94%) samples. Discordant results were due to a higher sensitivity of the PCR compared with antigen assay (n = 4) and virus culture (n = 6). In conclusion, PCR helps to identify those patients who will not develop CMV disease and narrows down the number of patients who eventually will suffer symptomatic CMV infection. Furthermore, PCR is a useful tool for following the post-transplantation course with respect to CMV and for judging the effect of antiviral treatment.

Safety of alternating ganciclovir and foscarnet maintenance therapy in human immunodeficiency virus (HIV)-related cytomegalovirus infections. An open-labeled pilot study

In the treatment of cytomegalovirus (CMV) disease in patients with AIDS, a life-long suppression therapy following an induction therapy consisting of ganciclovir or foscarnet is essential. Due to drug-related toxicities, anti-CMV therapy frequently has to be discontinued. To determine whether toxicities and side effects may be reduced with an alternating combination therapy consisting of ganciclovir and foscarnet (ganciclovir: 5 mg/kg every other day; foscarnet: 120 mg/kg every other day), 10 AIDS patients with CMV disease received this maintenance therapy for a median time of 18.5 weeks (5-51 weeks). Side effects were reported from 5 patients (nausea 5, malaise/fatigue 2, penile ulcers 1). Hematological or renal toxicities were mild, 1-week discontinuation of therapy due to neutropenia was necessary in 1 patient. Progression of CMV disease was observed in 3 patients at 2, 6, and 30 weeks of maintenance therapy. Median relapse-free interval for all patients was 105 days. We conclude that combination therapy with ganciclovir and foscarnet can be used safely for induction and maintenance therapy. Therefore, this regimen should be assessed in further trials to evaluate safety, efficacy, and the development of resistance in comparison to ganciclovir or foscarnet monotherapy.

Demonstration of cytomegalovirus by polymerase chain reaction after liver transplantation

The polymerase chain reaction (PCR) is a highly sensitive and specific technique for detection of cytomegalovirus DNA. With this method we prospectively analyzed buffy coat leukocytes at weekly intervals over 3 months in 60 patients after liver transplantation (LTX). The PCR results were correlated with the pretransplant donor/recipient CMV antibody status and with the occurrence of CMV-induced disease. Thirty-three of 60 (55%) patients became PCR-positive during their posttransplant course. None of the 27 patients with permanent negative PCRs developed CMV disease. Of 33 patients with positive PCRs, 13 (39%) became ill. CMV disease developed in 9 of 22 (41%) antibody-negative recipients but only in 4 of 38 (10%) seropositive graft recipients. The incidence of CMV disease was 75% (9 of 12 patients) in seronegative recipients who converted to positive PCR results and 19% (4 of 21 patients) in seropositive patients with positive PCR findings. The predictive value of a positive PCR was 75% in seronegative patients but it was low (19%) in seropositive recipients. The predictive value of a negative PCR is 100%. Thus, PCR determinations are useful in identifying patients who will not develop CMV disease and in narrowing down the number of individuals who will become sick. Further, PCR is a helpful tool in the follow-up of patients under antiviral treatment.

Oscillatory CO2 evolution in glycolysing yeast extracts

The rate of formation of carbon dioxide in cytoplasmic yeast extracts in an open system with continuous infusion of glucose was measured by membrane inlet mass spectrometry during glycolytic oscillations. The rate of CO2 production rose in the first third of each cycle to a maximum of about 100 mumol per ml yeast extract per hour and subsequently diminished to a final level of about 50 mumol per h. Measurements of the NADH light absorption under the same conditions revealed oscillations of relaxation type. The phase of high CO2 production could be related to the phase of the high NADH level, giving evidence that the flux in glycolysis is increased during the phase of high NADH concentration. Only half of the amount of injected glucose was metabolized to CO2 during the sustained oscillation, although free glucose did not accumulate.

Cytomegalovirus associated oral ulcerations in HIV-infected patients

Oral ulcerations associated with disseminated cytomegalovirus (CMV) infection were observed in four patients with AIDS manifestations showing low CD4 counts. Virus cultures of urine and saliva samples were positive for CMV in all cases. The lesions were characterized by a punched-out appearance, non-indurated borders, low bleeding tendency and lack of inflammatory wall. Light microscopy revealed granulation tissue containing "owl's eye" like cells in all specimens. Presence of CMV was confirmed by immunohistochemistry and in situ hybridization. The ulcerations were infiltrated with T-lymphocytes of the helper, suppressor and cytotoxic subset, most were positive for HLA DR. Despite the local invasion with immunocytes and high serum titers of serum antibodies the patients experienced progressive CMV disease.

[Gastrointestinal cytomegalovirus manifestations in AIDS]

Cytomegalovirus (CMV) infection is one of the most important intestinal opportunistic infections in AIDS. In severe cases ulcerations and colitis are the commonest manifestations. 184 HIV positive patients with gastrointestinal symptoms were investigated by endoscopy of the gastrointestinal tract. While culture, immunohistochemical staining and histology from biopsies were performed, the results of all three methods were compared. In one third the cases CMV associated lesions could be found by endoscopy. Erosions or ulcerations are the most frequent tissue lesions. In 95% the culture was positive. In addition, immunohistochemical staining in 75% and histology in 61.7% were positive in patients with more serious manifestations. For early diagnosis endoscopy of the gastrointestinal tract and histological, histochemical and microbiological investigations of biopsies are essential.

[The effect of Voltaren on the gastrointestinal excretion of blood (author's transl)]

24 subjects were treated with Voltaren 150 mg per day for 21 days, or with Naproxen 750 mg per day and ASA 3.0 g per day. In all patients the physiological excretion of blood from the intestine markedly increased, to a very great extent with Naproxen and ASA. From this aspect, Voltaren is highly significantly superior in maximal doses to the other two medicaments.

Systemic Induction of Sprouting in White Potatoes by Foliar Applications of Gibberellin

Images