Hemodynamic changes after levothyroxine treatment in subclinical hypothyroidism

In hypothyroidism, lack of thyroid hormones results in reduced cardiac function (cardiac output [CO]), and an increase of systemic vascular resistance (SVR). We speculated whether hemodynamic regulation in subjects with subclinical hypothyroidism (SH) (defined as mildly elevated thyrotropin [TSH] despite free thyroxine [T(4)] and triiodothyronine [T(3)] estimates within reference range) would benefit from levothyroxine (LT(4)) substitution. CO was measured by impedance cardiography, which is an observer independent method with high precision, and mean arterial pressure (MAP) by oscillometry. SVR was then calculated as MAP/CO. Measurements were performed before and after 60 degrees head-up tilting, and before and after LT(4) substitution. Plasma levels of catecholamines were also measured. In 16 otherwise healthy women with SH (ages 44-74 years; serum TSH in mean 17.1 mU/L (range, 6.8-27), and normal free T(4) and T(3) estimates) LT(4) treatment resulted in 6% reduction in supine MAP (p < 0.01), 14% increase in upright CO (p < 0.05), and 13%-20% decrease in SVR (supine and upright position, respectively) (p < 0.05). Plasma norepinephrine as well as epinephrine decreased during LT(4) treatment (p < 0.05). These changes were qualitatively similar but quantitatively less pronounced than in 15 women with overt hypothyroidism, also studied. Taking the two groups together (n = 31), pretreatment thyroid function (expressed as either TSH or free T(4) estimate) correlated to CO and SVR as well as the changes induced by LT(4) (p < 0.05), i.e., the lower the thyroid function the lower the CO and the higher the SVR, and the greater the response to LT(4). We conclude, that LT(4) treatment in SH results in changes in hemodynamic parameters of potentially beneficial character. SH and overt hypothyroidism should be regarded as a continuum, and our data favor earlier and more aggressive treatment of SH.

A new, efficient glycosylation method for oligosaccharide synthesis under neutral conditions: preparation and use of new DISAL donors

Efficient, stereoselective glycosylation methods are required for the synthesis of complex oligosaccharides as tools in glycobiology. All glycosylation methods, which have found wide acceptance, rely on Lewis acid activation of glycosyl donors prior to glycosylation. Here, we present a new and efficient method for glycosylation under neutral or mildly basic conditions. Glycosides of methyl 2-hydroxy-3,5-dinitrobenzoate (DISAL) and its para regioisomer, methyl 4-hydroxy-3,5-dinitrobenzoate, were prepared by nucleophilic aromatic substitution. In a first demonstration of their potential as glycosyl donors, stereospecific glycosylation of methanol was achieved. In the glycosylation of more hindered alcohols, the beta-donor proved more reactive, and alpha-glucosides were predominantly formed. Glycosylation of protected monosaccharides, with free 6-OH or 3-OH, proceeded smoothly in 1-methyl-2-pyrrolidinone (NMP) at 40-60 degrees C in the absence of Lewis acids and bases in good to excellent yields. Glycosylation of 3-OH gave the alpha-linked disaccharide only.

Serotype and genotype diversity and hatchery transmission of Campylobacter jejuni in commercial poultry flocks

We investigated the genotype and serotype diversity of Campylobacter coli and C. jejuni in two parent flocks of adult hens and their offspring over two rotations in order to evaluate the role of hatchery mediated transmission and/or vertical transmission of campylobacters in broiler flocks. In total, 314 C. jejuni and 32 C. coli isolates from parent and broiler flocks and from the surroundings of broiler houses were typed by flagellin gene PCR/RFLP (fla-typing), and selected isolates were also typed by serotyping and macrorestriction profiling using PFGE (MRP/PFGE). The combined typing results showed that the broiler flocks could be colonised by 1-3 different Campylobacter clones and parent flocks could be colonised by 2-6 different clones. C. coli was isolated from up to 36% of birds in one parent flock, whereas only C. jejuni was isolated from broiler flocks. C. jejuni clones from different flocks were clearly discriminated by fla-typing as well as by MRP/PFGE, except for a few cases where individual isolates belonging to two different clones were found to have altered fla-types. Similarly, one C. coli clone showed pronounced fla-type variation. The present results lead to the conclusion that vertical transmission or horizontal transmission via the hatchery are not significant transmission routes of C. jejuni to broiler chickens under Danish conditions. In the cases where more than one Campylobacter clone simultaneously colonised flocks, we found that the different clones coexisted in flocks rather than excluding each other.

Making effective use of tumor registries for cancer survivorship research

BACKGROUND

The growing number of cancer survivors has created an increased need for survivorship research; however, the identification and recruitment of cancer survivors present some challenges. This report describes how two hospital cancer registries were used to recruit a large sample of breast cancer survivors (BCS) for a study examining the late reproductive effects of breast cancer treatments. Limitations and opportunities associated with this type of recruitment strategy are described, and the overall success of recruitment using this approach is presented.

METHODS

Tumor registries from a comprehensive cancer center and a community hospital were used to identify BCS who met the study screening criteria. Invitations and response forms were mailed to all potentially eligible women, and those who did not respond by mail also were contacted by telephone. Women who indicated interest and met the study requirements were asked to give written consent, were enrolled in the study, and were sent a self-report questionnaire.

RESULTS

Seventy percent of the eligible women (n = 733 women) responded to the mailing. Seventy-seven percent of the 512 respondents indicated a willingness to participate and were sent a questionnaire. Of these, 78% (n = 368 women) completed questionnaires. BCS recruited from the cancer center registry were more likely than those from the community hospital registry to respond to the invitation form (P = 0.033) and were more likely to return a completed questionnaire (P = 0.001). However, the community hospital provided access to a more ethnically diverse sample of survivors.

CONCLUSIONS

The two participating cancer registries were an excellent source for identifying a large sample of long-term BCS, and the different types of registries provided greater sample size and diversity. Although there are some limitations to this approach, including nonresponse of a significant number of BCS, tumor registries represent an important resource for the rapid identification of cancer survivors for research studies. Findings from this study suggest several enhancements for future studies that may increase the yield from registry recruitment.

Making effective use of tumor registries for cancer survivorship research

BACKGROUND

The growing number of cancer survivors has created an increased need for survivorship research; however, the identification and recruitment of cancer survivors present some challenges. This report describes how two hospital cancer registries were used to recruit a large sample of breast cancer survivors (BCS) for a study examining the late reproductive effects of breast cancer treatments. Limitations and opportunities associated with this type of recruitment strategy are described, and the overall success of recruitment using this approach is presented.

METHODS

Tumor registries from a comprehensive cancer center and a community hospital were used to identify BCS who met the study screening criteria. Invitations and response forms were mailed to all potentially eligible women, and those who did not respond by mail also were contacted by telephone. Women who indicated interest and met the study requirements were asked to give written consent, were enrolled in the study, and were sent a self-report questionnaire.

RESULTS

Seventy percent of the eligible women (n = 733 women) responded to the mailing. Seventy-seven percent of the 512 respondents indicated a willingness to participate and were sent a questionnaire. Of these, 78% (n = 368 women) completed questionnaires. BCS recruited from the cancer center registry were more likely than those from the community hospital registry to respond to the invitation form (P = 0.033) and were more likely to return a completed questionnaire (P = 0.001). However, the community hospital provided access to a more ethnically diverse sample of survivors.

CONCLUSIONS

The two participating cancer registries were an excellent source for identifying a large sample of long-term BCS, and the different types of registries provided greater sample size and diversity. Although there are some limitations to this approach, including nonresponse of a significant number of BCS, tumor registries represent an important resource for the rapid identification of cancer survivors for research studies. Findings from this study suggest several enhancements for future studies that may increase the yield from registry recruitment.

Evidence that certain clones of Campylobacter jejuni persist during successive broiler flock rotations

Through the national surveillance program for Campylobacter spp., nine broiler chicken farms that were infected with Campylobacter jejuni in at least five rotations in 1998 were identified. One additional farm, located at the island of Bornholm where divided slaughter is used extensively, was also selected. Twelve broiler houses located on 10 farms were included in the study. The C. jejuni isolates collected from the selected houses during the surveillance were typed using fla typing and macrorestriction profiling (MRP), and a subset of the isolates, representing each of the identified clones, was serotyped according to the Penner scheme. Pulsed-field gel electrophoresis typing using SmaI and KpnI revealed that the majority of houses (11 of 12) carried identical isolates in two or more broiler flocks. Such persistent clones were found in 63% of all flocks (47 of 75). The majority of persistent clones (7 of 13) had fla type 1/1, but MRPs distinguished between isolates from different houses, and fla type 1/1 clones belonged to different serotypes. Seven houses carried persistent clones that covered an interval of at least four broiler flock rotations, or at least one half year. The dominant fla type (1/1) was represented by 44% of isolates, or by at least one isolate from 31 of 62 broiler flocks. This significantly exceeded the prevalence of fla type 1/1 C. jejuni isolates that we have estimated from other studies and suggests that isolates carrying this fla type are overrepresented in flocks with recurrent Campylobacter problems. The MRPs of clones belonging to fla type 1/1 serotype O:2 isolated from persistently infected flocks shared a high percentage of bands compared to the remaining isolates, indicating that some clones that have the ability to cause persistent infections in broiler farms are highly related to each other.

The ability of Fla-typing schemes to discriminate between strains of Campylobacter jejuni

AIMS

The aim of this investigation was to compare the usefulness of two previously published flagellin PCR-RFLP typing (Fla-typing) techniques for the subtyping of Campylobacter jejuni strains, in terms of ease of use and discriminatory power.

METHODS AND RESULTS

Six groups of isolates, which were epidemiologically unrelated but with similar Fla-types, and five groups of epidemiologically related poultry isolates, with similar PFGE profiles, were used in the comparison. The Fla-typing methods used varied in the number and length of fla-genes amplified and the restriction enzymes used. In addition, the use of separately amplified PCR fragments of both the flaA and flaB genes to generate RFLP profiles was investigated.

CONCLUSION

The results clearly demonstrated that both previously published methods exhibit some advantages over the other. However, optimal discrimination was obtained by the use of separately amplified PCR fragments of both fla-genes.

SIGNIFICANCE AND IMPACT OF THE STUDY

The subtyping of Camp. jejuni isolates is considered essential for epidemiological purposes. Genotyping methods are now more frequently used but have yet to be standardized. Fla-typing is a rapid and easy to use method with acceptable discriminatory power. However, the discriminatory power of the currently published Fla-typing techniques may be further improved by incorporating RFLP profiles of both fla-genes.

Comparison of genotypes and serotypes of Campylobacter jejuni isolated from Danish wild mammals and birds and from broiler flocks and humans

The incidence of human infection with Campylobacter jejuni is increasing in most developed countries and the reason for this is largely unknown. Although poultry meat is considered to be a major source, it is evident that other reservoirs exist, possibly common to humans and poultry. Environmental sources are believed to be important reservoirs of Campylobacter infection in broiler chicken flocks. We investigated the potential importance of wildlife as a source of infection in commercial poultry flocks and in humans by comparing the serotype distributions, fla types, and macrorestriction profiles (MRPs) of C. jejuni isolates from different sources. The serotype distribution in wildlife was significantly different from the known distributions in broilers and humans. Considerable sero- and genotype diversity was found within the wildlife collection, although two major groups of isolates within serotype O:12 and the O:4 complex were found. Common clonal lines among wildlife, chicken, and/or human isolates were identified within serotype O:2 and the O:4 complex. However, MRPs of O:12 and O:38 strains isolated from wildlife and other sources indicated that some clonal lines propagated in a wide selection of animal species but were not detected in humans or broilers in this study. The applied typing methods successfully identified different clonal groups within a strain collection showing large genomic diversity. However, the relatively low number of wildlife strains with an inferred clonal relationship to human and chicken strains suggests that the importance of wildlife as a reservoir of infection is limited.

Factors related to sexual function in postmenopausal women with a history of breast cancer

BACKGROUND

The normal life expectancy of survivors of early-stage breast cancer (BCS) underscores the need to address long-term quality of life issues in these women. Sexual dysfunction persists after breast cancer treatment, despite recovery in other domains.

OBJECTIVE

To examine associations between a broad array of characteristics and sexuality in BCS.

PARTICIPANTS

Sixty-one postmenopausal BCS who were participants in a randomized, controlled trial of nonhormonal interventions for menopause symptoms and who had a partnered, intimate relationship.

METHODS

Cross-sectional analysis of baseline trial data. Outcomes were standardized scales of sexual interest, dysfunction, and satisfaction. Candidate predictors included demographic, anatomical, medical, psychological, sociocultural, and hormonal characteristics. Forward, stepwise regression was used.

RESULTS

Relationship quality, vaginal discomfort, education, and hot flashes were each associated with two of the three domains of sexuality assessed. Ten other factors entered predictive models: age, time since diagnosis, breast conservation, comorbidity, urinary incontinence, perceived health, body image, bioavailable testosterone, luteinizing hormone, and sex hormone binding globulin. Each of these 10 factors was associated with only one sexuality domain.

CONCLUSIONS

In this small sample of BCS, we found multiple correlates of sexuality. Most seem to impact uniquely on individual domains of sexual function. Several characteristics are modifiable and could be targets for intervention.

[Description of a group of psychiatric patients difficult to place]

INTRODUCTION

There are long-term patients in psychiatric hospitals, who are often referred to as new long-stay patients: the heavy users consumers of psychiatric services and difficult-to-place patients.

MATERIAL AND METHOD

Social characteristics, diagnosis, need for care, function, and admission patterns were compared in a group of heavy user patients (N = 39) and a group of difficult-to-place patients (N = 14).

RESULTS AND DISCUSSION

The difficult-to-place patients were more often men, more often had a diagnosis of schizophrenia, had a lower socio-economic status, and lower GAF scores. The difficult-to-place patients rated the same amount of need for care as did the heavy users, but were assessed by the staff to have a greater need for care. The results support the view that the difficult-to-place patients comprise a distinct group. Services for the difficult-to-place patients must combine highly differentiated care with few demands and greater tolerance with respect to problem behaviour.

Intramolecular glycosylation under neutral conditions for synthesis of 1,4-linked disaccharides

[structure: see text]. A new method for intramolecular glycosylation, in which the donor and acceptor were linked via a 3,5-dinitrosalicylic acid derivative, was developed. Simply dissolving the tethered glycoside in CH3NO2 and warming to 40-60 degrees C led to formation of 1,4-linked disaccharides under neutral, hence, exceptionally mild, conditions.

West Nile virus in the United States: guidelines for detection, prevention, and control

The epidemic/epizootic of West Nile (WN) encephalitis in the northeastern United States in the summer and fall of 1999 was an unprecedented event, underscoring the ease with which emerging infectious pathogens can be introduced into new geographic areas in today's era of rapid transportation and increased movement of people, animals, and commodities. This epidemic/epizootic and the increased frequency of other exotic pathogens being imported into the United States raises the issue of whether local, state, and national public health agencies are prepared to deal with epidemics/epizootics of vector-borne infectious diseases. The overwintering of WN virus and the epizootic transmission in the summer of 2000 reinforces the need to rebuild the public health infrastructure to deal with vector-borne diseases in this country. This article summarizes guidelines for surveillance, prevention, and control of WN virus that were drafted in December 1999 to help prepare state and local health departments for monitoring WN virus activity in the spring and summer of 2000 and also summarizes the data collected from those surveillance systems through September 2000.

Anchoring of organic molecules to a metal surface: HtBDC on Cu(110)

The interaction of largish molecules with metal surfaces has been studied by combining the imaging and manipulation capabilities of the scanning tunneling microscope (STM). At the atomic scale, the STM results directly reveal that the adsorption of a largish organic molecule can induce a restructuring of a metal surface underneath. This restructuring anchors the molecules on the substrate and is the driving force for a self-assembly process of the molecules into characteristic molecular double rows.

Changing epidemiology of Q fever in Germany, 1947-1999

The epidemiology of Q fever in Germany was examined by reviewing relevant studies since 1947 and by analyzing available surveillance data since 1962. The average annual Q fever incidence nationwide from 1979 to 1989 was 0.8 per million and from 1990 to 1999, 1.4 per million. The mean annual incidence from 1979 to 1999 ranged from a minimum of 0.1 per million in several northern states to 3.1 per million in Baden-Württemberg, in the South. We identified 40 documented outbreaks since 1947; in 24 of these sheep were implicated as the source of transmission. The seasonality of community outbreaks has shifted from predominantly winter- spring to spring-summer, possibly because of changes in sheep husbandry. The location of recent outbreaks suggests that urbanization of rural areas may be contributing to the increase in Q fever. Prevention efforts should focus on reducing sheep-related exposures, particularly near urban areas.

Residual fructose and osmolality affect the levels of pneumocandins B0 and C0 produced by Glarea lozoyensis

A high total pneumocandin titer (B0 + C0) with a low percentage of the structural isomer pneumocandin C0 was achieved by carrying out fermentations of Glarea lozoyensis at a high residual fructose concentration (125 g/l initial). When the fermentation was carried out at a low residual fructose concentration (40 g/l initial), pneumocandin production increased by 34%. However, a disproportionate increase in the level of pneumocandin C0 synthesized (250% increase vs 30% increase for pneumocandin B0) was observed. Midcycle addition of 150 mM NaCl or 116 mM Na2SO4 to low residual fructose fermentations returned the titer and isomer levels to those seen for the high residual fructose fermentation. The increase in pneumocandin C0 synthesis under low residual fructose conditions appears to be linked to the increase in the synthesis of trans-4 hydroxyproline, with the synthesis of trans-3 hydroxyproline remaining unaffected. This suggests that the formation of pneumocandin C0 is the result of a misincorporation of trans-4 hydroxyproline instead of trans-3 hydroxyproline by the pneumocandin peptide synthetase, and that the amount of trans-4 hydroxyproline formed dictates the frequency of this misincorporation.

Evaluation of phenotypic and genotypic methods for subtyping Campylobacter jejuni isolates from humans, poultry, and cattle

Six methods for subtyping of Campylobacter jejuni were compared and evaluated with a collection of 90 isolates from poultry, cattle, and sporadic human clinical cases as well as from a waterborne outbreak. The applied methods were Penner heat-stable serotyping; automated ribotyping (RiboPrinting); random amplified polymorphic DNA typing (RAPD); pulsed-field gel electrophoresis (PFGE); restriction fragment length polymorphisms of the flagellin gene, flaA (fla-RFLP); and denaturing gradient gel electrophoresis of flaA (fla-DGGE). The methods were evaluated and compared on the basis of their abilities to identify isolates from one outbreak and discriminate between unrelated isolates and the agreement between methods in identifying clonal lines. All methods identified the outbreak strain. For a collection of 80 supposedly unrelated isolates, RAPD and PFGE were the most discriminatory methods, followed by fla-RFLP and RiboPrinting. fla-DGGE and serotyping were the least discriminative. All isolates included in this study were found to be typeable by each of the methods. Thirteen groups of potentially related isolates could be identified using a criterion that at least four of the methods agreed on clustering of isolates. None of the subtypes could be related to only one source; rather, these groups represented isolates from different sources. Furthermore, in two cases isolates from cattle and human patients were found to be identical according to all six methods.

An outbreak of Salmonella blockley infections following smoked eel consumption in Germany

In June 1998, an increased number of persons with Salmonella blockley infection were reported from one German state. Because S. blockley is extremely uncommon in Germany, a case-control study was performed in order to find the source. A total of 13 patients met the case definition. Nine of 12 cases and 2 of 21 controls with food consumption histories reported eating smoked eel (OR 28.5; 95% CI 3.9-235.3). The consumed eel came from four different local smokeries, but could be traced back to fish farms in Italy. This outbreak indicates that eel may be a vehicle for salmonella infection and that the smoking process may not eliminate bacterial contamination from raw fish.

Managing menopausal symptoms in breast cancer survivors: results of a randomized controlled trial

BACKGROUND

Menopausal symptoms (e.g., hot flashes, vaginal dryness, and stress urinary incontinence) are very common in breast cancer survivors and cannot be managed with standard estrogen replacement therapy (ERT) in these patients. The purpose of this study was to test the efficacy of a comprehensive menopausal assessment (CMA) intervention program in achieving relief of symptoms, the improvement in quality of life (QOL), and sexual functioning in breast cancer survivors.

METHODS

Using a two-group, randomized controlled design, we assigned 76 postmenopausal breast cancer survivors with at least one severe target symptom either to the intervention group or to a usual-care group. Seventy-two women were evaluable at the end of the study period. The CMA intervention, delivered by a nurse practitioner, focused on symptom assessment, education, counseling and, as appropriate, specific pharmacologic and behavioral interventions for each of the three target symptoms. Psychosocial symptoms were assessed with the use of a self-report screening instrument, and distressed women were referred for counseling if needed. The intervention took place over a 4-month period. Outcomes measured were scores on a composite menopausal symptom scale, the RAND Short Form Health Survey Vitality Scale, and the Cancer Rehabilitation Evaluation System (CARES) Sexual Functioning Scale at baseline and at 4-month follow-up. All statistical tests were two-sided and were performed at the alpha =. 05 significance level.

RESULTS

Patients receiving the intervention demonstrated statistically significant improvement (P =.0004) in menopausal symptoms but no significant change in vitality (P =.77). Sexual functioning was statistically significantly improved (P =.04) in the treatment group compared with the usual-care group.

CONCLUSIONS

A clinical assessment and intervention program for menopausal symptom management in breast cancer survivors is feasible and acceptable to patients, leading to reduction in symptoms and improvement in sexual functioning. Measurable improvement in a general QOL measure was not demonstrated.

Efficacy of flagellin gene typing for epidemiological studies of Campylobacter jejuni in poultry estimated by comparison with macrorestriction profiling

Thirty isolates of Campylobacter jejuni isolated from 29 different Danish broiler flocks were chosen for the evaluation of PCR-Fla typing as a genotyping tool. Except for two isolates that originated from the same broiler flock, the isolates were clearly distinguishable on basis of their macrorestriction profiles using the restriction endonucleases SmaI and KpnI. PCR-Fla typing of the 30 isolates yielded 16 distinct genotypes, whereas one isolate was untypeable by this method. The dominant PCR-Fla type (1/1) was shared by eight isolates, and five additional Fla groups containing two or three isolates were obtained. The PCR-Fla type of one isolate changed spontaneously after five subcultures, illustrating the relative plasticity of the gene locus. Comparison of MRPs within and between Fla-types support the view that some PCR-Fla types may be conserved within clonal lines. It is concluded that PCR-Fla typing is useful as a genotyping tool in large-scale epidemiological studies but that additional analyses with other methods are required to properly define interstrain relationships.

Listeria spp. in broiler flocks: recovery rates and species distribution investigated by conventional culture and the EiaFoss method

The occurrence of Listeria monocytogenes in samples from broiler houses and cloacal swabs taken at the abattoir was investigated. An automated immunobased method (EiaFoss) was used, and 42 samples were also analysed by conventional culture; both methods were based on a two-step selective enrichment using CHR.4.17; Fraser and Fraser broths. L. monocytogenes was isolated from two of 71 broiler flocks, yielding an estimated flock prevalence of 3%. The flock prevalence of L. inocua was estimated to 13%, and it was speculated that the potential of this apathogenic bacteria to grow faster than L. monocytogenes in enrichment broths may lead to an underestimation of the prevalence of L. monocytogenes. Furthermore, as L. inocua was also detected by the EiaFoss method, a significant amount of bacterial confirmation work had to be done. Of 42 samples analysed by conventional culture, four yielded L. inocua, of which two were not positive by EiaFoss.

[The staff's knowledge of patients' social function and needs--in connection with discharge planning]

The aim of the study was to assess the staff's knowledge about the social functioning and needs of the patients. A cross-sectional study interviewing 48 staff members using the Camberwell Assessment of Need--CAN was carried out. In nine of CAN's 26 areas more than 5% of the staff did not know if the patient had a problem. Among the patients with a problem more than 5% of the staff could not assess the need for care in four areas. The staff generally had a good knowledge concerning the patients' need for care. CAN seem to be a relevant instrument for the purpose of discharge planning.

Serogroup C meningococcal disease outbreak associated with discotheque attendance during carnival

In the week following a carnival during 19-24 February 1998, an outbreak of meningococcal disease occurred in a rural German county. The available isolates belonged to phenotype C:2a:P1.2,5 and were clonally related by pulsed-field gel electrophoresis. A case-control study was done to identify risk factors for the outbreak and to define possible vaccination target groups. Five persons aged 13-16 years who fell ill during 24-27 February were included in the study. Four of 5 cases and 10 of 32 controls visited local discotheques (OR = 8.8; P = 0.06). Cases also visited discotheques more frequently than controls (chi2 for trend, P = 0.0002). Multiple discotheques during the carnival may have been predominant locations of transmission in this outbreak. Because this risk factor was limited in time, a mass community vaccination campaign was not initiated.