Differential associations of emotional and physical domains of the MacNew Heart with changes in 6-minute walking test

Aims

Cardiac rehabilitation (CR), a key component of secondary prevention in cardiac patients, contributes fundamentally to improved cardiovascular health outcomes. Health-related quality of life (HRQOL) represents a widely employed outcome measure in CR, yet, its predictive properties on exercise capacity change during CR are poorly understood. Aim of this study was to examine the association between baseline HRQOL and its subdomains on improvement of exercise capacity during CR.

Methods

Study participants were 13,717 inpatients of six Swiss CR clinics from 2012 to 2018. We measured HRQOL at admission to CR with the MacNew Heart (MNH) questionnaire and exercise capacity at admission and discharge using the six-minutes walking test (6MWT). Following factorial analyses, we performed univariate and multivariate analyses to test the predictive properties of baseline global HRQOL and its domains for improvement in exercise capacity, adjusting for demographic and clinical characteristics.

Results

Mean improvement in 6MWT was 114 meters (SD=90), achieved after 17.4 days (SD=5.5). Lower emotional HRQOL (b=7.85, p≤0.001, 95% CI [−5.67, 10.03]) and higher physical HRQOL (b=−5.23, p<0.001, 95% CI [−6.56, −3.90]) were associated with less improvement in the 6MWT. Global MNH and social HRQOL showed no association with exercise capacity improvement.

Conclusion

Patients entering CR with low emotional and high physical HRQOL are at risk for a lower gain in exercise capacity during CR. Global MNH alone does not provide a reliable assessment of HRQOL; thus a focus on specific domains of HRQOL is needed.

Funding Acknowledgement

Type of funding sources: None.

Therapie des Antiphosphoplidsyndrom (APS) mit DOAK

Das Antiphospholipid-Syndrom ist eine der schwerwiegendsten thrombophilen Störungen, die nicht nur zu rezidivierenden venösen, sondern auch zu arteriellen Thromboembolien sowie Schwangerschaftskomplikationen führen kann. Zusammen mit dem klinischen Bild ist das APS durch spezifische Laborbefunde charakterisiert: 1. Lupus Antikoagulans (LA), 2. Anticardiolipin-Antikörper (ACA), 3. β2-Glykoprotein I-Antikörper (β2GPI-AK). Alle Testergebnisse müssen nach 12 Wochen bestätigt werden. Sind alle drei Testgruppen positiv, besteht das höchste thrombotische Risiko. Beachtet werden muss, dass LA-Tests unter UFH, VKA oder DOAKs falsch positiv ausfallen können; bei DOAKs scheint die Zugabe von Absorbern nach Blutentnahme zuverlässige Ergebnisse zu liefern.

Eine Vergleichsstudie (TRAPS) zwischen VKA und dem DOAK Rivaroxaban mit ausschliesslich 3-fach positiven Hochrisiko-Patienten wurde vorzeitig abgebrochen, wegen erhöhter Ereignisraten unter Rivaroxaban [19 % zumeist arterielle Ereignisse versus 3 % unter Warfarin (HR 7.4; 1.7–32.9)]. Ein daraufhin herausgegebener Rote-Hand-Brief warnt vor der Anwendung von DOAKs bei Patienten mit APS, insbesondere bei Hoch-Risiko- (3-fach positiven) Patienten, und empfiehlt die Überprüfung einer laufenden DOAK-Therapie und eine mögliche Umstellung auf VKA, insbesondere bei Hoch-Risiko-Patienten. Als Fazit soll 1. bei klinischem Verdacht eine sorgfältige APS-Diagnostik erfolgen. Viele Patienten haben aufgrund von inadäquater Diagnostik wahrscheinlich gar kein APS und können bei venöser Thromboembolie adäquat ein DOAK erhalten.

2. Bei einfach- oder zweifach-positiven Antiphospholipid-AK Tests ohne LA besteht ein vergleichbar niedriges Thromboserisiko; auch hier kann möglicherweise ebenfalls mit DOAKs behandelt werden, wenn venöse Thrombosen vorliegen – ausreichende Daten liegen noch nicht vor, aber Metaanalysen legen dies nahe. 3. Patienten mit Positivität in allen 3 APS-Tests und APS-Patienten mit arteriellen Thromboembolien haben ein sehr hohes Risiko. Die TRAPS-Studie zeigt, dass diese Patienten nicht mit DOAKs, sondern mit einem VKA behandelt werden sollen.

Die endoprothetische Versorgung des oberen Sprunggelenkes bei hämophiler Arthropathie

Die endoprothetische Versorgung des oberen Sprunggelenkes aufgrund einer ausgeprägten Arthrose hat in den vergangenen Jahren deutlich zugenommen. Gegenüber der etablierten Arthrodese hat sich die Alloarthroplastik zu einer guten Alternative entwickelt. Die Hauptindikationen zur Implantation einer Sprunggelenksendoprothese sind die sekundären Arthrosen bei rheumatischen Erkrankungen und posttraumatischen Zuständen. Kasuistische Berichte über den endoprothetischen Ersatz bei hämophiler Arthropathie zeigen übereinstimmend mit den eigenen Fällen, dass der Kunstgelenkersatz am oberen Sprunggelenk unter bestimmten Voraussetzungen ein erfolgreiches Behandlungsverfahren auch in dieser Klientel sein kann. Der besondere Vorzug ist im Erhalt einer für Alltagsbewegungen ausreichenden Beweglichkeit und damit einer physiologischeren Gangabwicklung zu sehen. Mit neuen Osteosynthesetechniken ist im Versagensfall eine relativ sichere Rückzugsmöglichkeit bei den meist noch jüngeren Patienten gegeben. Bei schmerzhafter und funktionsbehindernder fortgeschrittener Arthrose am oberen Sprunggelenk kann auch bei hämophiler Arthropathie die endoprothetische Versorgung erwogen werden.

Patienten mit Hämophilie A, B oder von-Willebrand-Syndrom Typ 3

Die Diagnostik und Therapie von Patienten mit schweren hämorrhagischen Diathesen – Hämophilie A, B oder von- Willebrand-Syndrom (VWS) Typ 3 – bedürfen hoher Therapiestandards in den Behandlungseinrichtungen. Daher ist eine enge Kooperation zwischen diesen Behandlungs - einrichtungen notwendig. Aus diesem Grund wurde das Kompetenznetz Hämorrhagische Diathesen Ost gegründet. Methoden: Zur systematischen Erhebung der epidemiologischen Daten und der Therapiekonzepte erfolgte eine Befragung der Behandlungseinrichtungen mit dem Schwerpunkt Hämophilie in Ostdeutschland. Es wurden allgemeine Daten zur schweren, mittelschweren und leichten Hämophilie A und B sowie zum VWS Typ 3 erhoben. Der anonymisierte Fragebogen erfasste die Art der Therapie (Prophylaxe oder nur Substitution im Blutungsfall), den jährlichen Verbrauch an Faktorenkonzentraten, den Hemmkörpernachweis sowie den Infektionsstatus mit HIV und Hepatitis C. Ergebnisse: 27 von 37 Behandlungseinrichtungen übermittelten ihre Daten vollständig. Es wurden 838 Patienten mit schwerer hämorrhagischer Diathese gemeldet, darunter 201 Kinder bzw. Jugendliche (<18 Jahre), (5–151 pro Behandlungseinrichtung). Unter den Kindern litten 81 (40%) an schwerer Hämophilie A, 20 (10%) an schwerer Hämophilie B und 10 (5%) an einem VWS Typ 3. Von den 637 Erwachsenen wiesen 246 (38,6%) eine schwere Hämophilie A, 51 (8%) eine schwere Hämophilie B and 28 (4,3%) ein VWS Typ 3 auf. Insgesamt erhielt die Mehrzahl der Patienten eine prophylaktische Therapie mit einem Gerinnungsfaktorenkonzentrat. In der Altersgruppe unter 18 Jahren wurde bei 90%, im Alter von mindestens 18 Jahren bei 64% eine Prophylaxe bevorzugt. Zum Erhebungszeitpunkt ließ sich nur bei 10 Erwachsenen (1,6%) und bei vier Kindern (1,9%) ein positiver Hemmkörpertiter (BethesdaMethode, Plasmatauschtest) nachweisen. Schlussfolgerung: Durch die Datenerhebung des regionalen Kompetenznetzes Hämorrhagische Diathesen Ost wird ein erster Überblick zur aktuellen Situation der schweren hämorrhagischen Diathesen in Ostdeutschland gegeben.

Kardiochirurgische Eingriffe bei schweren Blutungsdiathesen

Cardiovascular diseases are the most common disorder in the developed countries. Invasive cardiological and cardiosurgical techniques are known therapies.Yet, patients with severe hereditary haemorrhagical diseases (haemophilia, rare deficiencies of coagulation factors) have an increased bleeding risk by the use of anticoagulants. Therefore, the treatment of these patients requires a concomitant therapy.

This article shows eight patients with a severe bleeding diathesis and cardiosurgical interventions in the years 2006 to 2011. This case report shall demonstrate that an adequate therapy can be accomplished with the help of a good cooperation between haemostaseologists and colleagues of the cardioinvasive/ cardiosurgical disciplines.

Von-Willebrand-Syndrom Typ 1 und Schwangerschaft

The von Willebrand-Jürgens syndrome (VWJS) type 1 is a common hereditary bleeding disorder with a bleeding tendency located especially in the mucous membranes. Women suffering from VWJS type 1 show menorrhagia and prolonged postoperative bleedings. During pregnancy the clinical presentation varies by the increase of the von Willebrand factors.

In this article the laboratory findings and the clinical presentation of patients with VWJS during pregnancy was examined. The necessity of interventions during pregnancy and at the time of delivery was under consideration.

Diagnostic and prognostic value of factor VIII binding antibodies in acquired hemophilia A: data from the GTH-AH 01/2010 study

Essentials Factor VIII (FVIII) binding IgG detected by ELISA could be an alternative to the Bethesda assay. We studied the performance of anti-FVIII IgG ELISA in patients with acquired hemophilia and controls. Anti-FVIII IgG > 99th percentile of controls was highly sensitive and specific. Patients with high anti-FVIII IgG have a lower chance of achieving remission.

SUMMARY

Background Acquired hemophilia A is a severe bleeding disorder that requires fast and accurate diagnosis as it occurs often unexpectedly in previously healthy men and women of every age. The Nijmegen-modified Bethesda assay is the diagnostic reference standard for detecting neutralizing autoantibodies against factor VIII (FVIII), but is not widely available, not ideal for quantifying the complex type 2 inhibitors seen in acquired hemophilia, and suffers from high inter-laboratory variability. Objectives To assess the diagnostic and prognostic value of FVIII-binding antibodies as detected by ELISA compared with the Nijmegen Bethesda assay. Methods Samples from the time of first diagnosis and clinical data were available from 102 patients with acquired hemophilia enrolled in the prospective GTH-AH 01/2010 study. Controls (n = 102) were matched for gender and age. Diagnostic cut-offs were determined by receiver-operator curve analysis. The prognostic value was assessed in 92 of the 102 patients by Cox regression analysis of time to partial remission. Results Anti-FVIII IgG above the 99th percentile (> 15 arbitrary units per mL) revealed high sensitivity and specificity (both 0.99; 95% confidence interval, 0.95-1.0) for diagnosing acquired hemophilia. The likelihood of achieving partial remission was related to anti-FVIII IgG concentration (< 300 arbitrary units, 1.0; 300-1050, 0.65; > 1050, 0.39). The Bethesda titer was only associated with the likelihood of partial remission when analyzed in the central laboratory, but not when data from local GTH study sites were used. Conclusion Although the Nijmegen-modified Bethesda assay is the reference standard for demonstrating neutralizing antibodies, the detection of FVIII-binding antibodies by ELISA is similarly sensitive and specific for diagnosing acquired hemophilia. In addition, anti-FVIII IgG may provide prognostic information.

Application of the local effect model to predict DNA double-strand break rejoining after photon and high-LET irradiation

In the recent version of the local effect model (LEM), the biological effects of ionising radiation can be well described trough the consideration of DNA double-strand breaks (DSB) clustering at the micrometre scale. Assuming a giant-loop organisation for the chromatin higher-order structure, two classes of DSB are defined, namely isolated (iDSB) and clustered DSB (cDSB), according to whether exactly one or more than one DSB are induced in a loop, respectively. Here, a DSB kinetic rejoining model based on the LEM is applied to the description of two specific aspects of DSB rejoining, namely the dose dependence of the rejoining capacity after photon radiation and the residual damage observed at late times after ion irradiation. Based on the hypothesis that iDSB and cDSB can be associated to the fast and slow components of rejoining, the model is able to reproduce the experimental data, therefore supporting the relevance of micrometre scale clustering of damage for photon radiation as well as for high-LET radiation.

Clot waveform analysis in patients with haemophilia A

Clot waveform analysis extends the interpretation of aPTT measurement curves. The curve is mathematically processed to obtain information about fibrin formation kinetics including semiquantitative determination of thrombin, prothrombinase and tenase activity.

PATIENTS, METHOD

In this study the feasibility of clot waveform analysis for monitoring of haemophilia A was investigated using blood samples from healthy controls as well as haemophilia A patients under various clinical conditions.

RESULTS

Thrombin, prothrombinase and tenase activity show a high correlation to factor VIII levels. Tenase activity was found to exhibit a linear relationship to factor VIII levels over a very large concentration range and was able to discriminate patients with severe, moderate and mild haemophilia.

CONCLUSION

Clot waveform analysis is an easy, fast and cheap method to access disturbances in clot formation and can be done without any additional measurements beside an aPTT.

[Therapy of inherited diseases of platelet function. Interdisciplinary S2K guideline of the Permanent Paediatric Committee of the Society of Thrombosis and Haemostasis Research (GTH e. V.)]

Inherited disorders of platelet function are a heterogeneous group. For optimal prevention and management of bleeding, classification and diagnosis of the underlying defect are highly recommended. An interdisciplinary guideline for a diagnostic approach has been published (AWMF # 086-003 S2K; Hämostaseologie 2014; 34: 201-212). Underlying platelet disorder, platelet count, age and clinical situation modify treatment. Exclusive transfusion of platelet concentrates may be inappropriate as potentially adverse effects can outweigh its benefit. A stepwise and individually adjusted approach for restitution and maintenance of haemostasis is recommended. Administration of antifibrinolytics is generally endorsed, but is of particular use in Quebec disease. Restricted to older children, desmopressin is favourable in storage pool disease and unclassified platelet disorders. Although licensed only for patients with Glanzmann thrombasthenia and alloantibodies, in clinical practice rFVIIa is widely used in inherited platelet disorders with severe bleeding tendency. This guideline aims at presenting the best available advice for the management of patients with inherited platelet function disorders.

Kmasker--a tool for in silico prediction of single-copy FISH probes for the large-genome species Hordeum vulgare

Specific localization of large genomic fragments by fluorescence in situ hybridization (FISH) is challenging in large- genome plant species due to the high content of repetitive sequences. We report the automated work flow (Kmasker) for in silico extraction of unique genomic sequences of large genomic fragments suitable for FISH in barley. This method can be widely used for the integration of genetic and cytogenetic maps in plants and other species with large and complex genomes if the probe sequence (e.g. BACs, sequence contigs) and a low coverage (8-fold) of unassembled sequences of the species of interest are available. Kmasker has been made publicly available as a web tool at http://webblast.ipk-gatersleben.de/kmasker.

[Cardiac surgery in severe haemorrhagical diseases]

Cardiovascular diseases are the most common disorder in the developed countries. Invasive cardiological and cardiosurgical techniques are known therapies. Yet, patients with severe hereditary haemorrhagical diseases (haemophilia, rare deficiencies of coagulation factors) have an increased bleeding risk by the use of anticoagulants. Therefore, the treatment of these patients requires a concomitant therapy. This article shows eight patients with a severe bleeding diathesis and cardiosurgical interventions in the years 2006 to 2011. This case report shall demonstrate that an adequate therapy can be accomplished with the help of a good cooperation between haemostaseologists and colleagues of the cardioinvasive/cardiosurgical disciplines.

[Von Willebrand disease type 1 and pregnancy]

The von Willebrand-Jürgens syndrome (VWJS) type 1 is a common hereditary bleeding disorder with a bleeding tendency located especially in the mucous membranes. Women suffering from VWJS type 1 show menorrhagia and prolonged postoperative bleedings. During pregnancy the clinical presentation varies by the increase of the von Willebrand factors. In this article the laboratory findings and the clinical presentation of patients with VWJS during pregnancy was examined. The necessity of interventions during pregnancy and at the time of delivery was under consideration.

Listening to music and physiological and psychological functioning: the mediating role of emotion regulation and stress reactivity

Music listening has been suggested to have short-term beneficial effects. The aim of this study was to investigate the association and potential mediating mechanisms between various aspects of habitual music-listening behaviour and physiological and psychological functioning. An internet-based survey was conducted in university students, measuring habitual music-listening behaviour, emotion regulation, stress reactivity, as well as physiological and psychological functioning. A total of 1230 individuals (mean = 24.89 ± 5.34 years, 55.3% women) completed the questionnaire. Quantitative aspects of habitual music-listening behaviour, i.e. average duration of music listening and subjective relevance of music, were not associated with physiological and psychological functioning. In contrast, qualitative aspects, i.e. reasons for listening (especially 'reducing loneliness and aggression', and 'arousing or intensifying specific emotions') were significantly related to physiological and psychological functioning (all p = 0.001). These direct effects were mediated by distress-augmenting emotion regulation and individual stress reactivity. The habitual music-listening behaviour appears to be a multifaceted behaviour that is further influenced by dispositions that are usually not related to music listening. Consequently, habitual music-listening behaviour is not obviously linked to physiological and psychological functioning.

[BEO'S - physical activity and healthy eating at schools in Oberfranken, Bavaria concept and first results of a resource-oriented, systemic approach in school-based health promotion]

BACKGROUND

The high prevalence of overweight among children and adolescents has led to an increase in school-based prevention programmes. The aim of the present paper is to present the concept of an initiative called "BEO'S" as well as the experience made with the implementation und acceptance of this programme in the participating schools.

METHODS

Different from the majority of school-based projects for healthy eating and physical activity, BEO'S pursues a systemic approach that includes the whole school and is tailored to the school's respective resources. Characteristics are (1) the participation of teachers, students, parents, and caretakers, (2) the motivation and empowerment of schools to plan and implement activities by themselves, (3) the focus on environmental approaches, and (4) addressing and considering the individual school's needs and resources. The university project team supports the schools by individual counselling as well as providing information materials, trainings and workshops for teachers, an internet page, newsletters, and financial support. In the school years 2007/08 and 2008/09, BEO'S was conducted at 14 primary and secondary schools in the district of Oberfranken, Bavaria. It was extended to other schools in 2009/10. The short- and mid-term goals are the improvement of the school's environments as well as the eating behaviour and physical activity of the students. In the long run, it is intended to prevent obesity and improve the students' health and school performance.

RESULTS

The implementation processes showed that the teachers for physical education and domestic science as well as the headmasters were especially committed. The participation of the teaching staff, the students and the parents proved to be difficult, however. The schools implemented many activities for healthy eating and physical activity, but the planning process was not very systematic: needs assessment, status quo analysis, identification of successful strategies and definition of aims was difficult for the schools. The provided financial support, training programmes and workshops, and the exchange with other schools were widely used, in contrast to the offered internet-based tools. The acceptance of BEO'S was (very) good by teachers (n=97), students (n=674) and their parents (n=522). The teachers preferred the workshops and trainings to the internet page. The students appreciated the possibilities for physical activity and the emphasis on healthy eating; primary school students and girls more than secondary school students and boys. One third of the parents would like to be involved to a higher degree.

CONCLUSION

BEO'S was well received by all the people involved. Yet, there are still deficits concerning the implementation process, especially in the participation of students and parents.

[Caregiver burden with dementia patients. A validation study of the German language version of the Zarit Burden Interview]

Despite the large number of studies dealing with dementia caregivers in Europe, a valid German version of the most widely used measurement of caregiver burden, the Zarit Burden Interview, has not been published. The purpose of this study was to evaluate the psychometric properties of the German Zarit Burden Interview (G-ZBI). A sample of community-dwelling older couples (n=37) with the husband suffering from dementia and the wife being the primary caregiver participated in this study. The G-ZBI and related constructs were assessed in order to test for reliability and construct validity. The G-ZBI revealed psychometric properties comparable with those of the original instrument and empirically validated translations. Results indicate high internal consistency (Cronbach's alpha=0.91) and good validity due to strong correlations with caregiver life satisfaction and depression, as well as patients' dependency, neuropsychiatric symptoms, and dementia severity. The psychometric qualities of the G-ZBI indicate that it is both a reliable and valid instrument to assess caregiver burden and to detect highly stressed individuals.

[The total ankle replacement for severe arthropathy in haemophilia]

The endoprosthetic surgery of the upper ankle joint in profound arthrosis has significantly increased over the last years. Along with the established arthodesis the alloarthroplastic became a good alternative. The main indication for the implantation of an ankle joint endoprosthesis is a secondary arthrosis in patients with rheumatic diseases or post-traumatic status. In accordance with our experience case reports on the total ankle arthroplasty in haemophilic arthropathy show that the artificial substitute of the upper ankle joint can be a successful treatment of these patients under certain conditions. The outstanding benefit is to be seen in the preservation of a sufficient mobility for everyday movements and a more physiological process of walking. In case of endoprosthetic failure a relatively save opportunity for revision in the mostly younger patients can be found in the new osteosynthesis techniques. Also in haemophilic arthropathy with painful advanced arthrosis and functional limitation of the upper ankle joint the endoprosthetic care can be taken into consideration.

[Haemophilia A, B or von Willebrand disease type 3. Census of patients in the eastern part of Germany]

Diagnostics and treatment of severe forms of haemorrhagic diatheses (HD), such as haemophilia A, B or type 3 von Willebrand disease (VWD) need high standards in haemophilia treatment centers (HTCs). Due to their generally low incidence, a close cooperation of haemophilia treaters is needed to optimize treatment strategies. For this purpose, the Kompetenznetz Hämorrhagische Diathesen Ost was founded. The first project was the conduction of a survey of epidemiological data of patients with HA, HB and type 3 VWD in all HTCs in the eastern part of Germany.

METHOD

The study assessed the data regarding numbers of patients treated with HA, HB or type 3 VWD, disease severity, regime of coagulation factor replacement (CFR) and the frequency of factor VIII and IX inhibitors.

RESULTS

Up to now, data of 838 patients from 27 HTCs were evaluated (5-151 per HTCs). Among the included patients, 201 were children or adolescents (<18 years). 81 children suffered from severe HA, 20 from severe HB and 10 from type 3 VWD. In 637 adults we found 246 with severe HA, 51 severe HB and 28 VWD of type 3. The most commonly used treatment of CFR in patients with severe disease was prophylactic modality. 90% of the children received prophylaxis, but also in 64% of the adults an intermittent or long-term secondary prophylaxis was the preferred treatment. At the time of survey conduction, a factor VIII or IX inhibitor was present in 1.9% of the children and in 1.6% of the adults with haemophilia.

CONCLUSION

Our data allow an overview of the number of patients and treatment strategies in the eastern part of Germany.

CR-EST: a resource for crop ESTs

The crop expressed sequence tag database, CR-EST (http://pgrc.ipk-gatersleben.de/cr-est/), is a publicly available online resource providing access to sequence, classification, clustering and annotation data of crop EST projects. CR-EST currently holds more than 200,000 sequences derived from 41 cDNA libraries of four species: barley, wheat, pea and potato. The barley section comprises approximately one-third of all publicly available ESTs. CR-EST deploys an automatic EST preparation pipeline that includes the identification of chimeric clones in order to transparently display the data quality. Sequences are clustered in species-specific projects to currently generate a non-redundant set of approximately 22,600 consensus sequences and approximately 17,200 singletons, which form the basis of the provided set of unigenes. A web application allows the user to compute BLAST alignments of query sequences against the CR-EST database, query data from Gene Ontology and metabolic pathway annotations and query sequence similarities from stored BLAST results. CR-EST also features interactive JAVA-based tools, allowing the visualization of open reading frames and the explorative analysis of Gene Ontology mappings applied to ESTs.

Molecular mapping of resistance to Fusarium head blight in the spring wheat cultivar Frontana

Fusarium head blight (FHB) is a destructive disease of wheat. The objective of this study was to characterise the FHB resistance of the Brazilian spring wheat cultivar Frontana through molecular mapping. A population of 210 doubled-haploid lines from a cross of Frontana (partially resistant) and Remus (susceptible) was evaluated for FHB resistance during three seasons. Spray and single-spikelet inoculations were applied. The severity, incidence and spread of the disease were assessed by visual scoring. The population was genotyped with 566 DNA markers. The major QTL effect associated with FHB resistance mapped to chromosome 3A near the centromere, explaining 16% of the phenotypic variation for disease severity over 3 years. The most likely position is in the Xgwm720-Xdupw227 interval. The genomic region on 3A was significantly associated with FHB severity and incidence in all years evaluated, but not with FHB spread, indicating the prominent contribution of this QTL to resistance against initial infection. The map interval Xgwm129-Xbarc197 on chromosome 5A also showed consistent association with FHB severity and accounted for 9% of the phenotypic variation. In addition, smaller effects for FHB severity were identified on chromosomes 1B, 2A, 2B, 4B, 5A and 6B in single years. Individual QTLs for resistance to FHB spread accounted for less than 10% of the variation in trait expression. The present study indicates that FHB resistance of Frontana primarily inhibits fungal penetration (type I resistance), but has a minor effect on fungal spread after infection (type II resistance).

Human papillomavirus, coinfection with Schistosoma hematobium, and cervical neoplasia in rural Tanzania

Cervical cancer is the most common malignant tumor among women in Tanzania and other countries in tropical Africa. Genital schistosomiasis has been proposed as a possible cofactor in the genesis of this malignant disease that might contribute to its high incidence in regions where bilharzias is endemic. One hundred nine Tanzanian patients from an area with endemic bilharzias who were transferred to a gynecologic out-patient clinic were age-matched with 109 German controls. In patients and controls, separate samples were taken for cytologic assessment and human papillomavirus (HPV) DNA detection using the Hybrid Capture 2 assay (HC2) and PCR (GP5+/6 +). Samples that tested positive for HPV DNA with general primers were re-tested with HPV type-specific primers. After application of 3% acetic acid, punch biopsies were taken from any cervical lesion. Patients were interviewed for recent symptoms or clinical history suggestive of bilharzias. Urine samples from all patients were examined for the presence of schistosoma hematobium ova. Additionally six Tanzanian patients with invasive cervical cancer were included for separate analysis. Patients and controls had an identical prevalence of HPV-DNA (21.5%) using HC2. Based on PCR results with general primers, the corresponding prevalence was 34.5% for Tanzanian cases and 26.9% for German controls. A history suggestive of bilharzias and/or active schistosomiasis were associated with a significantly increased risk for infection with high-risk HPV types. We conclude that infection with Schistosoma hematobium seems to favor persistent genital HPV infection either by traumatizing the genital epithelium and/or by local immunosuppression.

Human papillomavirus, coinfection with Schistosoma hematobium, and cervical neoplasia in rural Tanzania

Cervical cancer is the most common malignant tumor among women in Tanzania and other countries in tropical Africa. Genital schistosomiasis has been proposed as a possible cofactor in the genesis of this malignant disease that might contribute to its high incidence in regions where bilharzias is endemic. One hundred nine Tanzanian patients from an area with endemic bilharzias who were transferred to a gynecologic out-patient clinic were age-matched with 109 German controls. In patients and controls, separate samples were taken for cytologic assessment and human papillomavirus (HPV) DNA detection using the Hybrid Capture 2 assay (HC2) and PCR (GP5+/6 +). Samples that tested positive for HPV DNA with general primers were re-tested with HPV type-specific primers. After application of 3% acetic acid, punch biopsies were taken from any cervical lesion. Patients were interviewed for recent symptoms or clinical history suggestive of bilharzias. Urine samples from all patients were examined for the presence of schistosoma hematobium ova. Additionally six Tanzanian patients with invasive cervical cancer were included for separate analysis. Patients and controls had an identical prevalence of HPV-DNA (21.5%) using HC2. Based on PCR results with general primers, the corresponding prevalence was 34.5% for Tanzanian cases and 26.9% for German controls. A history suggestive of bilharzias and/or active schistosomiasis were associated with a significantly increased risk for infection with high-risk HPV types. We conclude that infection with Schistosoma hematobium seems to favor persistent genital HPV infection either by traumatizing the genital epithelium and/or by local immunosuppression.

RAMEDIS- rare metabolic diseases publishing tool for genotype-phenotype correlation

To gain further knowledge about rare genetic diseases, a world wide method for data collection via the Internet has been established. This new approach will improve collecting valuable data from single case reports. RAMEDIS saves standardised patient data which will be usable for statistics, longitudinal examinations and co-operative studies in future time. Embedded in the scene of the German Human Genome Project, RAMEDIS directly will enable phenotype-genotype correlation's. Technically RAMEDIS is based on the Oracle database management system with some additional tools. Since November 2000 first case reports are committed online. Beside the better characterisation of clinical heterogeneity of rare diseases, there may be a great benefit for the treatment of these patients in whom prospective studies are otherwise expensive and difficult to perform. Quality of clinical diagnostic process and therapy will increase.