A linear model of phase-dependent power correlations in neuronal oscillations

Recently, it has been suggested that effective interactions between two neuronal populations are supported by the phase difference between the oscillations in these two populations, a hypothesis referred to as "communication through coherence" (CTC). Experimental work quantified effective interactions by means of the power correlations between the two populations, where power was calculated on the local field potential and/or multi-unit activity. Here, we present a linear model of interacting oscillators that accounts for the phase dependency of the power correlation between the two populations and that can be used as a reference for detecting non-linearities such as gain control. In the experimental analysis, trials were sorted according to the coupled phase difference of the oscillators while the putative interaction between oscillations was taking place. Taking advantage of the modeling, we further studied the dependency of the power correlation on the uncoupled phase difference, connection strength, and topology. Since the uncoupled phase difference, i.e., the phase relation before the effective interaction, is the causal variable in the CTC hypothesis we also describe how power correlations depend on that variable. For uni-directional connectivity we observe that the width of the uncoupled phase dependency is broader than for the coupled phase. Furthermore, the analytical results show that the characteristics of the phase dependency change when a bidirectional connection is assumed. The width of the phase dependency indicates which oscillation frequencies are optimal for a given connection delay distribution. We propose that a certain width enables a stimulus-contrast dependent extent of effective long-range lateral connections.

The double electrostatic ion ring experiment: a unique cryogenic electrostatic storage ring for merged ion-beams studies

We describe the design of a novel type of storage device currently under construction at Stockholm University, Sweden, using purely electrostatic focussing and deflection elements, in which ion beams of opposite charges are confined under extreme high vacuum cryogenic conditions in separate "rings" and merged over a common straight section. The construction of this double electrostatic ion ring experiment uniquely allows for studies of interactions between cations and anions at low and well-defined internal temperatures and centre-of-mass collision energies down to about 10 K and 10 meV, respectively. Position sensitive multi-hit detector systems have been extensively tested and proven to work in cryogenic environments and these will be used to measure correlations between reaction products in, for example, electron-transfer processes. The technical advantages of using purely electrostatic ion storage devices over magnetic ones are many, but the most relevant are: electrostatic elements which are more compact and easier to construct; remanent fields, hysteresis, and eddy-currents, which are of concern in magnetic devices, are no longer relevant; and electrical fields required to control the orbit of the ions are not only much easier to create and control than the corresponding magnetic fields, they also set no upper mass limit on the ions that can be stored. These technical differences are a boon to new areas of fundamental experimental research, not only in atomic and molecular physics but also in the boundaries of these fields with chemistry and biology. For examples, studies of interactions with internally cold molecular ions will be particular useful for applications in astrophysics, while studies of solvated ionic clusters will be of relevance to aeronomy and biology.

Greenhouse and field cultivations of antigen-expressing potatoes focusing on the variability in plant constituents and antigen expression

The production of plant-derived pharmaceuticals essentially requires stable concentrations of plant constituents, especially recombinant proteins; nonetheless, soil and seasonal variations might drastically interfere with this stability. In addition, variability might depend on the plant organ used for production. Therefore, we investigated the variability in plant constituents and antigen expression in potato plants under greenhouse and field growth conditions and in leaves compared to tubers. Using potatoes expressing VP60, the only structural capsid protein of the rabbit haemorrhagic disease virus (RHDV), CTB, the non-toxic B subunit (CTB) of the cholera toxin (CTA-CTB(5)) and the marker protein NPTII (neomycinphosphotransferase) as a model, we compare greenhouse and field production of potato-derived antigens. The influence of the production organ turned out to be transgene specific. In general, yield, plant quality and transgene expression levels in the field were higher than or similar to those observed in the greenhouse. The variation (CV) of major plant constituents and the amount of transgene-encoded protein was not influenced by the higher variation of soil properties observed in the field. Amazingly, for specific events, the variability in the model protein concentrations was often lower under field than under greenhouse conditions. The changes in gene expression under environmental stress conditions in the field observed in another event do not reduce the positive influence on variability since events like these should excluded from production. Hence, it can be concluded that for specific applications, field production of transgenic plants producing pharmaceuticals is superior to greenhouse production, even concerning the stability of transgene expression over different years. On the basis of our results, we expect equal or even higher expression levels with lower variability of recombinant pharmaceuticals in the field compared to greenhouse production combined with approximately 10 times higher tuber yield in the field.

Detection of tumor DNA at the margins of colorectal cancer liver metastasis

PURPOSE

Defining an adequate resection margin of colorectal cancer liver metastases is essential for optimizing surgical technique. We have attempted to evaluate the resection margin through a combination of histopathologic and genetic analyses.

EXPERIMENTAL DESIGN

We evaluated 88 samples of tumor margins from 12 patients with metastatic colon cancer who each underwent partial hepatectomy of one to six liver metastases. Punch biopsies of surrounding liver tissue were obtained at 4, 8, 12, and 16 mm from the tumor border. DNA from these biopsies was analyzed by a sensitive PCR-based technique, called BEAMing, for mutations of KRAS, PIK3CA, APC, or TP53 identified in the corresponding tumor.

RESULTS

Mutations were identified in each patient's resected tumor and used to analyze the 88 samples circumscribing the tumor-normal border. Tumor-specific mutant DNA was detectable in surrounding liver tissue in 5 of these 88 samples, all within 4 mm of the tumor border. Biopsies that were 8, 12, and 16 mm from the macroscopic visible margin were devoid of detectable mutant tumor DNA and of microscopically visible cancer cells. Tumors with a significant radiologic response to chemotherapy were not associated with any increase in mutant tumor DNA in beyond 4 mm of the main tumor.

CONCLUSIONS

Mutant tumor-specific DNA can be detected beyond the visible tumor margin, but never beyond 4 mm, even in patients whose tumors were larger prior to chemotherapy. These data provide a rational basis for determining the extent of surgical excision required in patients undergoing resection of liver metastases.

Formation of Heterogeneous Thickness Modulations During Epitaxial Growth of LPCVD-Si1−xGex/Si Quantum Well Structures

Transmission electron microscopy and photoluminescence studies were performed to determine the critical thickness for generation of misfit dislocations in Sil-xGex layers grown by low pressure chemical vapor deposition. Above a certain Ge content the transition from two dimensional to three-dimensional growth occurs before generation of misfit dislocations. For instance, for x ∼0.3 and a substrate temperature around 700°C island formation was observed to start at 1.8 nm. The formation of islands is attributed to the preferential growth of SiGe in areas with less lattice strain. Islands were observed to broaden the exciton photoluminescence of the quantum well structures.

Highly conserved serine residue 40 in HIV-1 p6 regulates capsid processing and virus core assembly

Background

The HIV-1 p6 Gag protein regulates the final abscission step of nascent virions from the cell membrane by the action of two late assembly (L-) domains. Although p6 is located within one of the most polymorphic regions of the HIV-1 gag gene, the 52 amino acid peptide binds at least to two cellular budding factors (Tsg101 and ALIX), is a substrate for phosphorylation, ubiquitination, and sumoylation, and mediates the incorporation of the HIV-1 accessory protein Vpr into viral particles. As expected, known functional domains mostly overlap with several conserved residues in p6. In this study, we investigated the importance of the highly conserved serine residue at position 40, which until now has not been assigned to any known function of p6.

Results

Consistently with previous data, we found that mutation of Ser-40 has no effect on ALIX mediated rescue of HIV-1 L-domain mutants. However, the only feasible S40F mutation that preserves the overlapping pol open reading frame (ORF) reduces virus replication in T-cell lines and in human lymphocyte tissue cultivated ex vivo. Most intriguingly, L-domain mediated virus release is not dependent on the integrity of Ser-40. However, the S40F mutation significantly reduces the specific infectivity of released virions. Further, it was observed that mutation of Ser-40 selectively interferes with the cleavage between capsid (CA) and the spacer peptide SP1 in Gag, without affecting cleavage of other Gag products. This deficiency in processing of CA, in consequence, led to an irregular morphology of the virus core and the formation of an electron dense extra core structure. Moreover, the defects induced by the S40F mutation in p6 can be rescued by the A1V mutation in SP1 that generally enhances processing of the CA-SP1 cleavage site.

Conclusions

Overall, these data support a so far unrecognized function of p6 mediated by Ser-40 that occurs independently of the L-domain function, but selectively affects CA maturation and virus core formation, and consequently the infectivity of released virions.

Occurrence of natural radioactivity in public water supplies in Germany: (238)U, (234)U, (235)U, (228)RA, (226)RA, (222)RN, (210)PB, (210)PO and gross alpha activity concentrations

The Federal Office for Radiation Protection performed a representative survey on the radiological quality of drinking water in Germany. The aim of this study was to determine regional variations of natural radionuclide concentrations and to estimate radiation exposures caused by drinking water consumption. The study includes analyses of the natural radionuclides (238)U, (234)U, (235)U, (228)Ra, (226)Ra, (222)Rn, (210)Pb, (210)Po and of gross alpha activity concentrations in drinking water from 564 public water supplies. This represents 3 % of all German water supplies providing about 37 Mio. inhabitants. Results on ranges, medians and distributions of radionuclide concentrations of drinking water as well as age-dependent ingestion and inhalation doses estimated for members of the public are presented. Generally, the dose due to uranium isotopes is negligibly low. Radiation exposures are predominantly caused by (222)Rn, (228)Ra, (210)Po and (210)Pb. The ingestion dose deduced for adults (>17 a) and infants (0-1 a) is dominated by (222)Rn and (228)Ra, respectively. A gross alpha activity analysis procedure using liquid scintillation counting has been tested. Measured gross alpha activities values were found to be well related to the summarised activities of (238)U, (234)U, (226)Ra and (210)Po.

Synthesis of 2a,8b-Dihydrocyclobuta[a]naphthalene-3,4-diones

On irradiation (λ = 350 nm) in neat hex-1-yne, naphthalene-1,2-dione monoacetals 1 afford mixtures of pentacyclic photodimers and up to 25% (isolated yield) of mixed photocycloadducts 2. Careful acidic hydrolysis of the acetal function of 2 gives the title compounds 3, the overall sequence representing a first approach to a (formal) [2 + 2] photocycloadduct of a 1,2-naphthoquinone to an alkyne.

The Anesthesia Preoperative Evaluation Clinic (APEC): a prospective randomized controlled trial assessing impact on consultation time, direct costs, patient education and satisfaction with anesthesia care

AIM

Anesthetic preoperative evaluation clinics (APECs) are relatively new institutions. Although cost effective, APECs have not been universally adopted in Europe. The aim of this study was to compare preoperative anesthetic assessment in wards with an APEC, assessing time, information gain, patient satisfaction and secondary costs.

METHODS

Two hundred and seven inpatients were randomized to be assessed at the APEC or on the ward by the same two senior anesthetists. The outcomes measured were the length of time for each consultation, the amount of information passed on to patients and the level of patient satisfaction. The consultation time was used to calculate impact on direct costs. A multivariate analysis was conducted to detect confounding variables.

RESULTS

Ninety-four patients were seen in the APEC, and 78 were seen on the ward. The total time for the consultation was shorter for the APEC (mean 8.4 minutes [P<0.01]), and we calculated savings of 6.4 Euro per patient. More information was passed on to the patients seen in the APEC (P<0.01). The general satisfaction scores were comparable between groups. A multivariate analysis found that the consultation time was significantly influenced by the type of anesthesia, the magnitude of the operation and the location of the consultation. Gain in information was significantly influenced by age, education and the location of the visit.

CONCLUSION

The APEC reduced consultation times and costs and had a positive impact on patient education. The cost savings are related to personnel costs and, therefore, are independent of other potential savings of an APEC, whereas global patient satisfaction remains unaltered.

Investigations into the antibacterial activities of phytotherapeutics against Helicobacter pylori and Campylobacter jejuni

The prevalence of gastric diseases is increasing with H. pylori, the causative agent of acute and chronic gastritis, being a major predisposing factor for peptic ulcer disease and gastric carcinoma. C. jejuni is the most common cause of enteric infections, particularly among children, resulting in severe diarrhoea. Increasing drug resistance of these bacteria against standard antibiotics, and the more widespread use of herbal medicines, favours investigations into additional anti-Helicobacter and anti-Campylobacter effects of phytotherapeutics that are already used for their beneficial effects on bowel and digestive functions. Twenty-one hydroethanol herbal extracts and four essential oils were screened for antibacterial activity using a modification of a previously described micro-dilution assay and compared with the inhibitory effects of antibiotics. The herbal extracts showing the highest growth inhibition of C. jejuni were Calendula officinalis, Matricaria recutita, Zingiber officinale, Salvia officinalis, Foeniculum vulgare and Silybum marianum. Agrimonia eupatoria, Hydrastis canadensis, Filipendula ulmaria and Salvia officinalis were the most active herbal extracts in inhibiting the growth of H. pylori. This study provides evidence for additional beneficial effects of phytotherapeutics marketed for their gastrointestinal effects and identifies new beneficial antibacterial effects for some herbal medicines not currently recommended for gastrointestinal problems.

Epiflex(®) a new decellularised human skin tissue transplant: manufacture and properties

The manufacture and initial testing of a new human tissue transplant is described. Epiflex(®) is a human acellular dermis transplant that is manufactured from skin recovered from screened consenting donors according to validated and approved methods. The transplant is approved as a drug in Germany. The safety, stability and usability of the transplant are discussed with respect to the results of sterility, residual moisture content and rehydration tests. Histological and confocal laser scanning microscopy experiments and analysis of oxygen and water vapour permeability demonstrate that the native extracellular matrix structure and transport properties of human connective tissue are retained in the transplant. Results from initial clinical investigations suggest that Epiflex(®) can be used successfully in the treatment of burns, hypertrophic scars and as a transplant seeded with autologous dermal fibroblasts for soft-tissue regeneration in settings with wound healing problems following multi-modal treatments for sarcomas of the extremities.

Development of personalized tumor biomarkers using massively parallel sequencing

Clinical management of human cancer is dependent on the accurate monitoring of residual and recurrent tumors. The evaluation of patient-specific translocations in leukemias and lymphomas has revolutionized diagnostics for these diseases. We have developed a method, called personalized analysis of rearranged ends (PARE), which can identify translocations in solid tumors. Analysis of four colorectal and two breast cancers with massively parallel sequencing revealed an average of nine rearranged sequences (range, 4 to 15) per tumor. Polymerase chain reaction with primers spanning the breakpoints was able to detect mutant DNA molecules present at levels lower than 0.001% and readily identified mutated circulating DNA in patient plasma samples. This approach provides an exquisitely sensitive and broadly applicable approach for the development of personalized biomarkers to enhance the clinical management of cancer patients.

Compound heterozygous mutations in 2 siblings with Hermansky-Pudlak syndrome type 1 (HPS1)

BACKGROUND

Hermansky-Pudlak syndrome (HPS) is a rare autosomal recessive disorder causing oculocutaneous albinism, bleeding disorder and ceroid lipofuscinosis. Platelets from HPS patients are characterized by the absence of dense (delta)-bodies. There are eight known human HPS GENES (HPS1-HPS8), each leading to a particular clinical HPS subtype. Restrictive lung disease, granulomatous colitis and cardiomyopathy have been described in HPS1 patients.

PATIENTS

We identified HPS1 in Russian and in German siblings. All four patients show a typical HPS phenotype. The two older Russian patients demonstrate excessive bleeding after tooth extractions, recurrent epistaxis and hematomas. The two younger German patients suffer only from hematomas, so far.

METHODS/RESULTS

Patients' platelets showed severe pathological agglutination/aggregation. Flow cytometry analysis demonstrated absence of platelet delta-granule secretion. Three different mutations in the HPS1 gene were found in the two families. Two mutations, p.H119delC and p.Q397delC identified in the Russian siblings had been previously described. The German siblings presented with a novel frameshift mutation (p.Q32_S33delCAGT) and the known p.Q397delC mutation.

CONCLUSION

Patients with oculocutaneous albinism should be investigated for increased clinical bleeding symptoms. In case of increased bleeding symptoms, analyses of primary hemostasis should be initiated to confirm HPS. Molecular genetic investigations should be performed to distinguish the different subtypes of HPS which is important for therapy and prognosis.

Discrimination of endocardial electrogram disorganization using a signal regularity analysis

Measures from the theory of nonlinear dynamics were applied on complex fractionated atrial electrograms (CFAEs) in order to characterize their physiological dynamic behavior. The results were obtained considering 113 short term atrial electrograms (A-EGMs) which were annotated by three experts into four classes of fractionation according to A-EGMs signal regularity. The following measures were applied on A-EGM signals: General Correlation Dimension, Approximate Entropy, Detrended Fluctuation Analysis, Lempel-Ziv Complexity, and Katz-Sevcik, Variance and Box Counting Fractal Dimension. Assessment of disorganization was evaluated by a Kruskal Wallis statistical test. Except Detrended Fluctuation Analysis and Variance Fractal Dimension, the CFAE disorganization was found statistically significant even for low significant level alpha = 0.001. Moreover, the increasing complexity of A-EGM signals was reflected by higher values of General Correlation Dimension of order 1 and Approximate Entropy.

Development of personalized tumor biomarkers using massively parallel sequencing

Clinical management of human cancer is dependent on the accurate monitoring of residual and recurrent tumors. The evaluation of patient-specific translocations in leukemias and lymphomas has revolutionized diagnostics for these diseases. We have developed a method, called personalized analysis of rearranged ends (PARE), which can identify translocations in solid tumors. Analysis of four colorectal and two breast cancers with massively parallel sequencing revealed an average of nine rearranged sequences (range, 4 to 15) per tumor. Polymerase chain reaction with primers spanning the breakpoints was able to detect mutant DNA molecules present at levels lower than 0.001% and readily identified mutated circulating DNA in patient plasma samples. This approach provides an exquisitely sensitive and broadly applicable approach for the development of personalized biomarkers to enhance the clinical management of cancer patients.

Modeling isotopomer distributions in biochemical networks using isotopomer mapping matrices

Within the last decades NMR spectroscopy has undergone tremendous development and has become a powerful analytical tool for the investigation of intracellular flux distributions in biochemical networks using (13)C-labeled substrates. Not only are the experiments much easier to conduct than experiments employing radioactive tracer elements, but NMR spectroscopy also provides additional information on the labeling pattern of the metabolites. Whereas the maximum amount of information obtainable with (14)C-labeled substrates is the fractional enrichment in the individual carbon atom positions, NMR spectroscopy can also provide information on the degree of labeling at neighboring carbon atom positions by analyzing multiplet patterns in NMR spectra or using 2-dimensional NMR spectra. It is possible to quantify the mole fractions of molecules that show a specific labeling pattern, i.e., information of the isotopomer distribution in metabolite pools can be obtained. The isotopomer distribution is the maximum amount of information that in theory can be obtained from (13)C-tracer studies. The wealth of information contained in NMR spectra frequently leads to overdetermined algebraic systems. Consequently, fluxes must be estimated by nonlinear least squares analysis, in which experimental labeling data is compared with simulated steady state isotopomer distributions. Hence, mathematical models are required to compute the steady state isotopomer distribution as a function of a given set of steady state fluxes. Because 2(n) possible labeling patterns exist in a molecule of n carbon atoms, and each pattern corresponds to a separate state in the isotopomer model, these models are inherently complex. Model complexity, so far, has restricted usage of isotopomer information to relatively small metabolic networks. A general methodology for the formulation of isotopomer models is described. The model complexity of isotopomer models is reduced to that of classical metabolic models by expressing the 2(n) isotopomer mass balances of a metabolite pool in a single matrix equation. Using this approach an isotopomer model has been implemented that describes label distribution in primary carbon metabolism, i.e., in a metabolic network including the Embden-Meyerhof-Parnas and pentose phosphate pathway, the tricarboxylic acid cycle, and selected anaplerotic reaction sequences. The model calculates the steady state label distribution in all metabolite pools as a function of the steady state fluxes and is applied to demonstrate the effect of selected anaplerotic fluxes on the labeling pattern of the pathway intermediates.

Tuber-specific cphA expression to enhance cyanophycin production in potatoes

The production of biodegradable polymers that can be used to substitute petrochemical compounds in commercial products in transgenic plants is an important challenge for plant biotechnology. Nevertheless, it is often accompanied by reduced plant fitness. To decrease the phenotypic abnormalities of the sprout and to increase polymer production, we restricted cyanophycin accumulation to the potato tubers by using the cyanophycin synthetase gene (cphA(Te)) from Thermosynechococcus elongatus BP-1, which is under the control of the tuber-specific class 1 promoter (B33). Tuber-specific cytosolic (pB33-cphA(Te)) as well as tuber-specific plastidic (pB33-PsbY-cphA(Te)) expression resulted in significant polymer accumulation solely in the tubers. In plants transformed with pB33-cphA(Te), both cyanophycin synthetase and cyanophycin were detected in the cytoplasm leading to an increase up to 2.3% cyanophycin of dry weight and resulting in small and deformed tubers. In B33-PsbY-cphA(Te) tubers, cyanophycin synthetase and cyanophycin were exclusively found in amyloplasts leading to a cyanophycin accumulation up to 7.5% of dry weight. These tubers were normal in size, some clones showed reduced tuber yield and sometimes exhibited brown sunken staining starting at tubers navel. During a storage period over of 32 weeks of one selected clone, the cyanophycin content was stable in B33-PsbY-cphA(Te) tubers but the stress symptoms increased. However, all tubers were able to germinate. Nitrogen fertilization in the greenhouse led not to an increased cyanophycin yield, slightly reduced protein content, decreased starch content, and changes in the amounts of bound and free arginine and aspartate, as compared with control tubers were observed.

Hosts as ecological traps for the vector of Lyme disease

Vectors of infectious diseases are generally thought to be regulated by abiotic conditions such as climate or the availability of specific hosts or habitats. In this study we tested whether blacklegged ticks, the vectors of Lyme disease, granulocytic anaplasmosis and babesiosis can be regulated by the species of vertebrate hosts on which they obligately feed. By subjecting field-caught hosts to parasitism by larval blacklegged ticks, we found that some host species (e.g. opossums, squirrels) that are abundantly parasitized in nature kill 83-96% of the ticks that attempt to attach and feed, while other species are more permissive of tick feeding. Given natural tick burdens we document on these hosts, we show that some hosts can kill thousands of ticks per hectare. These results indicate that the abundance of tick vectors can be regulated by the identity of the hosts upon which these vectors feed. By simulating the removal of hosts from intact communities using empirical models, we show that the loss of biodiversity may exacerbate disease risk by increasing both vector numbers and vector infection rates with a zoonotic pathogen.

Statistical aspects of environmental risk assessment of GM plants for effects on non-target organisms

Previous European guidance for environmental risk assessment of genetically modified plants emphasized the concepts of statistical power but provided no explicit requirements for the provision of statistical power analyses. Similarly, whilst the need for good experimental designs was stressed, no minimum guidelines were set for replication or sample sizes. Furthermore, although substantial equivalence was stressed as central to risk assessment, no means of quantification of this concept was given. This paper suggests several ways in which existing guidance might be revised to address these problems. One approach explored is the ;bioequivalence' test, which has the advantage that the error of most concern to the consumer may be set relatively easily. Also, since the burden of proof is placed on the experimenter, the test promotes high-quality, well-replicated experiments with sufficient statistical power. Other recommendations cover the specification of effect sizes, the choice of appropriate comparators, the use of positive controls, meta-analyses, multivariate analysis and diversity indices. Specific guidance is suggested for experimental designs of field trials and their statistical analyses. A checklist for experimental design is proposed to accompany all environmental risk assessments.

Sensitive digital quantification of DNA methylation in clinical samples

Analysis of abnormally methylated genes is increasingly important in basic research and in the development of cancer biomarkers. We have developed methyl-BEAMing technology to enable absolute quantification of the number of methylated molecules in a sample. Individual DNA fragments are amplified and analyzed either by flow cytometry or next-generation sequencing. We demonstrate enumeration of as few as one methylated molecule in approximately 5,000 unmethylated molecules in DNA from plasma or fecal samples. Using methylated vimentin as a biomarker in plasma samples, methyl-BEAMing detected 59% of cancer cases. In early-stage colorectal cancers, this sensitivity was four times more than that obtained by assaying serum-carcinoembryonic antigen (CEA). With stool samples, methyl-BEAMing detected 41% of cancers and 45% of advanced adenomas. In addition to diagnostic and prognostic applications, this digital quantification of rare methylation events should be applicable to preclinical assessment of new epigenetic biomarkers and quantitative analyses in epigenetic research.

Glucose deprivation contributes to the development of KRAS pathway mutations in tumor cells

Tumor progression is driven by genetic mutations, but little is known about the environmental conditions that select for these mutations. Studying the transcriptomes of paired colorectal cancer cell lines that differed only in the mutational status of their KRAS or BRAF genes, we found that GLUT1, encoding glucose transporter-1, was one of three genes consistently up-regulated in cells with KRAS or BRAF mutations. The mutant cells exhibited enhanced glucose uptake and glycolysis and survived in low-glucose conditions, phenotypes that all required GLUT1 expression. In contrast, when cells with wild-type KRAS alleles were subjected to a low-glucose environment, very few cells survived. Most surviving cells expressed high levels of GLUT1, and 4% of these survivors had acquired KRAS mutations not present in their parents. The glycolysis inhibitor 3-bromopyruvate preferentially suppressed the growth of cells with KRAS or BRAF mutations. Together, these data suggest that glucose deprivation can drive the acquisition of KRAS pathway mutations in human tumors.

[Patient satisfaction--a potential cornerstone of hospital management]

BACKGROUND

Hospitals consider themselves to be exposed to intense competition for patient admissions. Yet their competitive performance is only rarely assessed in terms of patient satisfaction.

METHODS

Following agreed guidelines, formulated on the basis of interdisciplinary research, the University Clinical Centre (2,500 beds, 10,000 employees) of Schleswig Holstein, Germany's most northerly Bundesland, developed and distributed standardized questionnaires on patient satisfaction and collected them after completion.

RESULTS

18,711 completed questionnaires were collected from a population of 71,000 treated patients (rate of return: 26%; males 50,6%; females 49,4%). Two-thirds of admissions were elective whereas the remainder were emergencies. The quarterly evaluation revealed quality of food and cleanliness as the main areas of complaint. Patients' dissatisfactions was the greater the longer the stay in hospital. Other differences between patients on statutory or private health insurance, respectively, were voiced regarding "respectful treatment" and "professional ability" (especially by private patients). Furthermore, patient satisfaction related to the duration of doctors' rotation (i.e. how long they were on duty), satisfaction being greater the longer the period of rotation.

CONCLUSION

The study has provided information on patient satisfaction as a measure of effective hospital management.

Long-term adherence to intensified conventional insulin therapy

All diabetic patients of the outpatient clinic of the University of Frankfurt/Main, who started intensified conventional insulin therapy (ICT) between 1980 and 1991, and who could be followed for at least one year (n = 141) were evaluated retrospectively. Fourteen patients changed from ICT to continuous subcutaneous insulin infusion (CSII). No patient changed back permanently to conventional insulin therapy. Mean glycosylated hemoglobin-levels (HbA1) decreased significantly in the first year from 9.3% to 8.5% and remained at a near normal level in the following years. HbA1-levels were found not to be associated with age, age at diagnosis, weight gain, frequency of visits to the outpatient clinic, number of consultations with the dietician as well as the frequency of attendance at special seminars for ICT. These results demonstrate that ICT lowered blood glucose levels permanently, that patients were highly compliant, and that ICT was practicable and safe for long-term treatment under routine conditions without initial hospitalization and with an acceptable expenditure of time for patients and medical staff.

Coping styles and psychological outcomes in men with advanced cancer

e20521

Background: The psychological outcomes of men with advanced cancer may vary based upon their appraisal and response to the threat of cancer. Coping styles in other illnesses are influenced by gender and stage of disease, but little is known specifically about men with advanced cancer. Methods: We recruited 81 men with advanced cancer to complete surveys assessing coping (Mini-MAC), post-traumatic growth (PTGI), and psychological outcomes (Hospital Anxiety and Depression Scale). Psychological outcomes and coping styles were determined with means, and percentages above established cutoff points. Relationships were assessed using Pearson correlation coefficients. Results: The mean HADS anxiety and depression scores were 5.4 and 4.0, respectively. Fourteen men (17%) scored 8–10 and 8 (10%) scored ≥11 suggesting an anxiety state and disorder, respectively. Eight men (10%) had scores suggesting a depressive state and 4 (5%) a depressive disorder. Greater helplessness/hopelessness and anxious preoccupation scores were correlated with greater anxiety (r =.54, p<.0001; r =.66, p<.0001) and depression scores (r =.43, p<.0001; r=.47, p<.0001). Greater fighting spirit correlated with less anxiety (r =-.26, p=.018) and less depression (r = -.42, p < .0001) and with increased post-traumatic growth in the form of new possibilities (r = .26, p = .020), personal strength (r = .33, p = .003), and the total PTGI score (r = .23, p = .043). Greater fatalism was associated with lower total distress measured by the total HADS score (r = -.24, p = .032), and marginally so when assessed separately for anxiety (r = -.22, p = .052) and depression (r = -.21, p = .056). In addition, greater fatalism was significantly associated with greater post-traumatic growth in all five areas assessed by the PTGI subscales (.27 < r < .36; .001 p < .032). Conclusions: As expected men with advanced cancer report anxiety and depression. Coping styles were significantly associated with anxiety, depression, and post-traumatic growth.

No significant financial relationships to disclose.

Effect of coping styles on the psychological impact of discussing life expectancy for men with advanced cancer

9615

Background: Discussions of life expectancy between men and oncologists are limited, in part, because of the potential adverse effect on psychological outcomes. However, appraisal of the cancer threat may enhance coping and improve psychological outcomes for some men with advanced cancer. Methods: We recruited 81 men with advanced cancer to complete surveys including coping (Mini-MAC), post-traumatic growth (PTGI), psychological outcomes (Hospital Anxiety and Depression Scale). Men and oncologists rated extent of discussions about life expectancy. Moderation was assessed with regression interactions and follow-up within group Pearson correlations. Results: Men reported a full (33%), brief (41%), or no (26%) discussion of life expectancy. Concordance was low. Only 23 (28%) agreed with oncologists about the extent of discussion. Among the 34 oncologists who reported having a full discussion, 16 (47%) of their patients reported having a brief discussion and 8 (24%) reported no discussion. Men who reported having a full discussion had significantly lower depression scores (mean = 2.8) than those who reported a brief or no discussion (mean = 4.6; p=.018). As expected, the extent of discussion moderated some of the relationships between coping style and outcomes. Helpless-hopeless coping was associated with greater depression only among patients who reported a full or brief discussion of life expectancy (n=61, r=.56, p<.0001). Interestingly, greater fatalism was associated with greater PTGI spiritual change among men who reported no or brief discussions (n = 54, r = .39, p = .004) and greater PTGI personal strength (n = 20, r = .63, p = .003) and PTGI appreciation of life (n = 20, r = .62, p = .003) among men who reported no discussion compared to men with full and brief or full discussion, respectively. Conclusions: Most men and oncologists reported discussions of life expectancy but there was little agreement on extent. Full discussions were not associated with depression; however this effect was moderated by coping styles.

No significant financial relationships to disclose.

Relationships among patient-level factors, religious coping, use of complementary and alternative medicine, and psychological outcomes in men with advanced cancer

e20652

Background: Religious coping and complementary and alternative medicine (CAM) are two resources frequently used to manage distress associated with advanced cancer. However, the relationships among these coping strategies and psychological outcomes in men with advanced cancer are not well studied. We hypothesized that patient-level factors (e.g., demographics, personality) would predict religious coping and CAM use, which would then predict psychological outcomes. Methods: 81 men with advanced cancer were recruited from oncology clinics for this cross-sectional study. Patients completed surveys which included demographic questions, personality measures (Adult Hope Scale, Life Orientation Test-Revised), CAM use, religious coping (Brief R-COPE), and psychological outcomes (Hospital Anxiety and Depression Scale, Post-Traumatic Growth Inventory). Hierarchical regression analyses were conducted with anxiety, depression, and post-traumatic growth as the criterion variables. Results: Higher anxiety scores were predicted by more negative RC (β = 0.50, p = .002), hope-pathways (β = 0.37, p = .033), and less hope-agency (β = -0.55, p = .002). Depression was predicted by lower hope-agency (β = -0.48, p = .021) and less education (β = -0.37, p = .044). Greater post-traumatic growth was predicted by greater positive RC (β = 0.54, p = .003). CAM use did not predict any psychological outcomes. Greater positive RC was predicted by less education (β = -0.39, p = .025). More negative RC was predicted by lower optimism (β = -0.43, p = .006). CAM use was predicted by greater hope-pathways (β = 0.42, p = .046). Conclusions: Religious coping, but not CAM use, was associated with psychological outcomes. Positive RC predicted greater growth, whereas negative RC predicted greater anxiety. Psychological outcomes were related to patient-level factors including hope and education. However, the two dimensions of trait hope had opposite effects. Higher hope-agency predicted less anxiety and depression, whereas higher hope-pathways predicted greater anxiety. These relationships merit further investigation.

No significant financial relationships to disclose.