Latamoxef versus carbenicillin plus gentamicin or carbenicillin plus mecillinam in leukopenic, febrile patients with solid tumors

Sixty-six febrile episodes associated with leukopenia were observed in 56 patients with solid tumors, WBC less than 1.5 X 10(9)/l and temperature greater than or equal to 38.5 degrees C. Stratification to antibiotic treatment regimen was made with regard to prior cis-dichlorodiamineplatinum (cis-platinum) treatment or not. Patients who had received no cis-platinum were randomized between carbenicillin 10 g every 8 h plus gentamicin 80 mg every 8 h or latamoxef 2 g every 8 h (group I). Patients having received cis-platinum were treated with carbenicillin 10 g every 8 h plus mecillinam 800 mg every 8 h or latamoxef 2 g every 8 h (group II). The first dose of latamoxef was preceded by 10 mg of vitamin K i.v. In group I, clinical response was observed in 10 of 19 febrile episodes (52.6%) treated with carbenicillin plus gentamicin and in 10 of 14 (71.4%) treated with latamoxef (p greater than 0.05). In group II, 6 of 14 febrile episodes treated with carbenicillin plus mecillinam responded (42.9%) while 11 of 19 (57.9%) responded to latamoxef (p greater than 0.05). No bleeding due to antibiotic treatment was observed. No statistical difference between standard antibiotic therapy and latamoxef was seen in this subset of patients.

Thrombotic thrombocytopenic purpura: treatment with a combination of antiplatelet drugs

Thrombotic thrombocytopenic purpura (TTP) is a rare disease with a vary high mortality. Different modalities of therapy have been tried, but often with no effect. Recently, interest has focused on drugs interfering with platelet function, though few patients have received antiplatelet drugs as the only therapy. We describe a patient with TTP, who recovered completely on a combination therapy with dextran, aspirin and dipyridamole.

ProtSweep, 2Dsweep and DomainSweep: protein analysis suite at DKFZ

The wealth of transcript information that has been made publicly available in recent years has led to large pools of individual web sites offering access to bioinformatics software. However, finding out which services exist, what they can or cannot do, how to use them and how to feed results from one service to the next one in the right format can be very time and resource consuming, especially for non-experts. Automating this task, we present a suite of protein annotation pipelines (tasks) developed at the German Cancer Research Centre (DKFZ) oriented to protein annotation by homology (ProtSweep), by domain analysis (DomainSweep), and by secondary structure elements (2Dsweep). The aim of these tasks is to perform an exhaustive structural and functional analysis employing a wide variety of methods in combination with the most updated public databases. The three servers are available for academic users at the HUSAR open server http://genius.embnet.dkfz-heidelberg.de/menu/biounit/open-husar/

Differences in proteoglycan deposition in the airways of moderate and severe asthmatics

Excess deposition of proteoglycans (PGs) has been described in the subepithelial layer of the asthmatic airway wall. However, less is known about deposition in the airway smooth muscle (ASM) layer, and whether the pattern of deposition is altered depending upon disease severity. Endobronchial biopsies were performed in patients with severe or moderate asthma (defined using American Thoracic Society criteria) and in control subjects. Biopsies were immunostained for the PGs biglycan, lumican, versican and decorin. PG deposition was measured in the subepithelial and ASM layers, the former by calculating the area of positive staining, and the latter by determining the percentage area stained using point counting. Immunostaining for PGs was prominent in biopsies from both moderate and severe asthmatics, compared with control subjects. While there was no difference in the amount of PG in the subepithelial layer between the two asthmatic groups, the percentage area of biglycan and lumican staining in the ASM layer was significantly greater in moderate versus severe asthmatics. Differences in the deposition of proteoglycans within the airway smooth muscle layer of moderate versus severe asthmatics potentially impact on the functional behaviour of the airway smooth muscle in these two groups of patients.

Ultracold heteronuclear molecules in a 3D optical lattice

We report on the creation of ultracold heteronuclear molecules assembled from fermionic 40K and bosonic 87Rb atoms in a 3D optical lattice. Molecules are produced at a heteronuclear Feshbach resonance on both the attractive and the repulsive sides of the resonance. We precisely determine the binding energy of the heteronuclear molecules from rf spectroscopy across the Feshbach resonance. We characterize the lifetime of the molecular sample as a function of magnetic field and measure lifetimes between 20 and 120 ms. The efficiency of molecule creation via rf association is measured and is found to decrease as expected for more deeply bound molecules.

Placental expression of glycophosphatidylinositol (GPI)-anchored proteins in paroxysmal nocturnal haemoglobinuria

Paroxysmal nocturnal haemoglobinuria (PNH) is a clonal stem cell disorder in which a defect of glycophosphatidylinositol (GPI)-anchored proteins leads to higher morbidity and mortality because of intravascular haemolysis, haemoglobinuria, pancytopenia and an increased frequency of thrombotic events. We report here the clinical features of a pregnant woman with PNH and present an immunhistochemical analysis of complement regulators, leukocyte activation markers and placental alkaline phosphatase (PALP) on syncytiotrophoblasts and inflammatory cells in her placenta. Placental tissue from normal deliveries served as controls. The patient had severe PNH with haemolysis, thrombosis episodes and signs of bone marrow failure. Placental syncytiotrophoblasts and villous cells of fetal origin in both normal placentas and the placenta from the PNH patient expressed PALP and the complement regulators CD46, CD55 and CD59. Additionally, CD11b-positive leukocytes of presumed maternal origin were negative for CD15 in the PNH placenta, while they stained positive within the villous space and in normal placentas. These findings show that fetally derived cells in the PNH placenta expressed GPI-linked molecules that are known to be of importance for a successful pregnancy outcome.

Localization of bosonic atoms by fermionic impurities in a three-dimensional optical lattice

We observe a localized phase of ultracold bosonic quantum gases in a 3-dimensional optical lattice induced by a small contribution of fermionic atoms acting as impurities in a Fermi-Bose quantum gas mixture. In particular, we study the dependence of this transition on the fermionic (40)K impurity concentration by a comparison to the corresponding superfluid to Mott-insulator transition in a pure bosonic (87)Rb gas and find a significant shift in the transition parameter. The observed shift is larger than expected based on a simple mean-field argument, which indicates that disorder-related effects play a significant role.

Low-dose inhaled and nasal corticosteroid use and the risk of cataracts

Orally inhaled corticosteroid use has been convincingly linked to an increase in the risk of cataracts, although the risk at lower doses in common use remains uncertain. The potential risk of cataracts with the use of nasal corticosteroids is unknown. A matched nested case-control analysis was performed in a population-based cohort of elderly people who had been dispensed medications for airway disease, as identified through a universal drug benefit plan. Inhaled corticosteroid use was associated with a dose-related increase in both the risk of all cataracts and severe cataracts requiring extraction, and the increase in risk of severe cataracts was apparent even at daily doses of </=500 microg. An excess risk with nasal corticosteroids was not apparent for severe cataracts. It is concluded that, among the elderly, even low doses of inhaled corticosteroids are associated with a small but significant excess risk of cataracts requiring extraction. Such an excess risk was not observed with nasal corticosteroids.

Cost of autologous peripheral blood stem cell transplantation: the Norwegian experience from a multicenter cost study

High-dose therapy with autologous blood progenitor cell support is now routinely used for patients with certain malignant lymphomas and multiple myeloma. We performed a prospective cost analysis of the mobilization, harvesting and cryopreservation phases and the high-dose therapy with stem cell reinfusion and hospitalization phases. In total, 40 consecutive patients were studied at four different university hospitals between 1999 and 2001. Data on direct costs were obtained on a daily basis. Data on indirect costs were allocated to the specific patient based on estimates of relevant department costs (ie the service department's costs), and by means of predefined allocation keys. All cost data were calculated at 2001 prices. The mean total costs for the two phases were US$ 32,160 (range US$ 19,092-50,550). The mean total length of hospital stay for two phases was 31 days (range 27-37). A large part of the actual cost in the harvest phase was attributed to stem cell mobilization, including growth factors, harvesting and cryopreservation. In the high-dose chemotherapy phase, the most significant part of the costs was nursing staff. Average total costs were considerably higher than actual DRG-based reimbursement from the government, indicating that the treatment of these patients was heavily subsidized by the basic hospital grants.

Low-dose inhaled corticosteroids and the risk of acute myocardial infarction in COPD

Inflammation plays a major role in the development and complications of atherosclerosis. Here, the dose-related impact of inhaled corticosteroids (ICS), used for their anti-inflammatory properties, on the risk of acute myocardial infarction (AMI) is studied in a cohort of chronic obstructive pulmonary disease (COPD) patients. Saskatchewan (Canada) health services databases were used to form a population-based cohort of 5,648 patients, > or =55 yrs, who received a first treatment for COPD between 1990 and 1997. A nested case-control analysis was conducted, where 371 cases presenting with a first AMI were matched with 1,864 controls, based on the date of cohort entry and age. A conditional logistic regression was used to estimate the effect of ICS, after adjusting for use of oral corticosteroids, severity of COPD, sex, systemic hypertension, diabetes and cardiovascular disease. ICS were used in the prior year by 42.2% of cases and 46.4% of controls. Overall, current use of ICS was not associated with a significant decrease in the risk of AMI. However, a 32% reduction in the risk of AMI was observed for doses ranging 50-200 microg x day(-1). In conclusion, very low doses of inhaled corticosteroids may be associated with a reduction in the risk of acute myocardial infarction.

Inhaled corticosteroids and the risk of a first exacerbation in COPD patients

The role of inhaled corticosteroids (ICS) in asthma is well established, but their benefit in the management of chronic obstructive pulmonary disease (COPD) is still controversial. The current study assessed whether ICS are effective in preventing a first exacerbation of COPD. A cohort of newly treated COPD patients was formed from the Administrative Databases of Saskatchewan Health. The outcome was the occurrence of a first moderate or severe exacerbation from 1990-1999. Moderate exacerbations involved prescriptions for an antibiotic and an oral corticosteroid on the same day. Severe exacerbations were hospitalisations with a primary discharge diagnosis of COPD. A nested case-control design was used and matched on year of birth and cohort entry. Rate ratios (RR) were further adjusted for use of other medication and other confounders. There were 995 exacerbations among 4,455 subjects. The rate of a first exacerbation was increased with any use of ICS in the year prior to the index date (RR: 1.27; 95% CI: 1.08-1.48) and with current use (RR: 1.51; 95% CI: 1.22-1.87), and it increased with increasing daily doses of ICS. Inhaled corticosteroids do not seem to be beneficial in reducing the risk of a first exacerbation of chronic obstructive pulmonary disease.

The Helmholtz Network for Bioinformatics: an integrative web portal for bioinformatics resources

SUMMARY

The Helmholtz Network for Bioinformatics (HNB) is a joint venture of eleven German bioinformatics research groups that offers convenient access to numerous bioinformatics resources through a single web portal. The 'Guided Solution Finder' which is available through the HNB portal helps users to locate the appropriate resources to answer their queries by employing a detailed, tree-like questionnaire. Furthermore, automated complex tool cascades ('tasks'), involving resources located on different servers, have been implemented, allowing users to perform comprehensive data analyses without the requirement of further manual intervention for data transfer and re-formatting. Currently, automated cascades for the analysis of regulatory DNA segments as well as for the prediction of protein functional properties are provided.

AVAILABILITY

The HNB portal is available at http://www.hnbioinfo.de

Inhaled corticosteroids and hospitalisation due to exacerbation of COPD

Previous studies have provided conflicting evidence as to the possible benefits of inhaled corticosteroids in the treatment of chronic obstructive pulmonary disease (COPD). Using the Saskatchewan healthcare databases subjects were identified who were aged > or = 55 yrs, initiating regular treatment for COPD but without any prior treatment for asthma. In the current nested case-control analysis, the authors concentrated on 1,742 subjects with a first hospitalisation for COPD after January 1, 1990 and examined whether the use of inhaled corticosteroids was associated with a change in the risk of a subsequent hospitalisation for COPD. The cases consisted of 846 patients with a subsequent hospitalisation for COPD. These were matched on age, time since the prior hospitalisation and use of other respiratory therapy to all possible person moments in the cohort without rehospitalisation. After further adjustment for comorbidity, sex, calendar year and intensity of other drug therapy, inhaled corticosteroids were not significantly associated with risk of a subsequent COPD hospitalisation. Even relatively high doses of inhaled corticosteroids, >800 microg of beclomethasone or the equivalent per day, were not associated with the risk of COPD hospitalisation. No reduction in chronic obstructive pulmonary disease exacerbations requiring hospitalisation, in relation to the use of inhaled corticosteroids, were observed.

Inhaled short acting beta agonist use in COPD and the risk of acute myocardial infarction

BACKGROUND

A recent study found that short acting beta agonists used in the treatment of asthma and chronic obstructive pulmonary disease (COPD) may increase the risk of acute myocardial infarction. We investigated this hypothesis in patients with COPD already at high risk of cardiac disease.

METHODS

The Saskatchewan Health Services databases were used to form a population based cohort of all patients newly diagnosed with COPD over the age of 55 years identified between 1980 and 1997. All subjects were followed up until 1999, death, or the first occurrence of acute myocardial infarction. Those with a first acute myocardial infarction, fatal or non-fatal, were matched on calendar time and age with cohort members.

RESULTS

The cohort consisted of 12 090 subjects including 1127 cases with fatal or non-fatal acute myocardial infarction. The adjusted rate ratio for current use of inhaled beta agonists was 1.12 (95% confidence interval (CI) 0.95 to 1.33), and for first time use it was 1.02 (95% CI 0.52 to 2.00). There was also no significant increase in risk when the analysis was restricted to subjects with cardiac risk factors such as hypertension and diabetes, or to subjects not having been prescribed beta blocker medications.

CONCLUSION

Short acting inhaled beta agonist use among patients with COPD does not appear to increase the risk of fatal or non-fatal acute myocardial infarction.