What does "Advanced" mean in 2023? reflecting on 10 years of the ESTRO advanced Skills in modern radiotherapy course

The roles and responsibilities of radiation therapists (RTTs) are many and varied. Professional expectations are influenced by the technology available, as well as the level of autonomy RTTs have in their daily practice. This professional range requires RTTs to possess a unique set of ever evolving skills, posing challenges from an educational perspective. Teaching these "advanced skills" has been the ambition the ESTRO Advanced Skills in Modern Radiotherapy course. In the 10th year of this course, the Faculty look back and reflect on how our programme has evolved and what it has achieved.

Unsupervised construction of computational graphs for gene expression data with explicit structural inductive biases

MOTIVATION

Gene expression data are commonly used at the intersection of cancer research and machine learning for better understanding of the molecular status of tumour tissue. Deep learning predictive models have been employed for gene expression data due to their ability to scale and remove the need for manual feature engineering. However, gene expression data are often very high dimensional, noisy and presented with a low number of samples. This poses significant problems for learning algorithms: models often overfit, learn noise and struggle to capture biologically relevant information. In this article, we utilize external biological knowledge embedded within structures of gene interaction graphs such as protein-protein interaction (PPI) networks to guide the construction of predictive models.

RESULTS

We present Gene Interaction Network Constrained Construction (GINCCo), an unsupervised method for automated construction of computational graph models for gene expression data that are structurally constrained by prior knowledge of gene interaction networks. We employ this methodology in a case study on incorporating a PPI network in cancer phenotype prediction tasks. Our computational graphs are structurally constructed using topological clustering algorithms on the PPI networks which incorporate inductive biases stemming from network biology research on protein complex discovery. Each of the entities in the GINCCo computational graph represents biological entities such as genes, candidate protein complexes and phenotypes instead of arbitrary hidden nodes of a neural network. This provides a biologically relevant mechanism for model regularization yielding strong predictive performance while drastically reducing the number of model parameters and enabling guided post-hoc enrichment analyses of influential gene sets with respect to target phenotypes. Our experiments analysing a variety of cancer phenotypes show that GINCCo often outperforms support vector machine, Fully Connected Multi-layer Perceptrons (MLP) and Randomly Connected MLPs despite greatly reduced model complexity.

AVAILABILITY AND IMPLEMENTATION

https://github.com/paulmorio/gincco contains the source code for our approach. We also release a library with algorithms for protein complex discovery within PPI networks at https://github.com/paulmorio/protclus. This repository contains implementations of the clustering algorithms used in this article.

SUPPLEMENTARY INFORMATION

Supplementary data are available at Bioinformatics online.

Variational Autoencoders for Cancer Data Integration: Design Principles and Computational Practice

International initiatives such as the Molecular Taxonomy of Breast Cancer International Consortium are collecting multiple data sets at different genome-scales with the aim to identify novel cancer bio-markers and predict patient survival. To analyze such data, several machine learning, bioinformatics, and statistical methods have been applied, among them neural networks such as autoencoders. Although these models provide a good statistical learning framework to analyze multi-omic and/or clinical data, there is a distinct lack of work on how to integrate diverse patient data and identify the optimal design best suited to the available data.In this paper, we investigate several autoencoder architectures that integrate a variety of cancer patient data types (e.g., multi-omics and clinical data). We perform extensive analyses of these approaches and provide a clear methodological and computational framework for designing systems that enable clinicians to investigate cancer traits and translate the results into clinical applications. We demonstrate how these networks can be designed, built, and, in particular, applied to tasks of integrative analyses of heterogeneous breast cancer data. The results show that these approaches yield relevant data representations that, in turn, lead to accurate and stable diagnosis.

Associations between maternal physical activity in early and late pregnancy and offspring birth size: remote federated individual level meta-analysis from eight cohort studies

OBJECTIVE

Evidence on the impact of leisure time physical activity (LTPA) in pregnancy on birth size is inconsistent. We aimed to examine the association between LTPA during early and late pregnancy and newborn anthropometric outcomes.

DESIGN

Individual level meta-analysis, which reduces heterogeneity across studies.

SETTING

A consortium of eight population-based studies (seven European and one US) comprising 72 694 participants.

METHODS

Generalised linear models with consistent inclusion of confounders (gestational age, sex, parity, maternal age, education, ethnicity, BMI, smoking, and alcohol intake) were used to test associations between self-reported LTPA at either early (8-18 weeks gestation) or late pregnancy (30+ weeks) and the outcomes. Results were pooled using random effects meta-analyses.

MAIN OUTCOME MEASURES

Birth weight, large-for-gestational age (LGA), macrosomia, small-for-gestational age (SGA), % body fat, and ponderal index at birth.

RESULTS

Late, but not early, gestation maternal moderate to vigorous physical activity (MVPA), vigorous activity, and LTPA energy expenditure were modestly inversely associated with BW, LGA, macrosomia, and ponderal index, without heterogeneity (all: I2  = 0%). For each extra hour/week of MVPA, RR for LGA and macrosomia were 0.97 (95% CI: 0.96, 0.98) and 0.96 (95% CI: 0.94, 0.98), respectively. Associations were only modestly reduced after additional adjustments for maternal BMI and gestational diabetes. No measure of LTPA was associated with risk for SGA.

CONCLUSIONS

Physical activity in late, but not early, pregnancy is consistently associated with modestly lower risk of LGA and macrosomia, but not SGA.

TWEETABLE ABSTRACT

In an individual participant meta-analysis, late pregnancy moderate to vigorous physical activity modestly reduced birth size outcomes.

Metagenome, metatranscriptome, and metaproteome approaches unraveled compositions and functional relationships of microbial communities residing in biogas plants

The production of biogas by anaerobic digestion (AD) of agricultural residues, organic wastes, animal excrements, municipal sludge, and energy crops has a firm place in sustainable energy production and bio-economy strategies. Focusing on the microbial community involved in biomass conversion offers the opportunity to control and engineer the biogas process with the objective to optimize its efficiency. Taxonomic profiling of biogas producing communities by means of high-throughput 16S rRNA gene amplicon sequencing provided high-resolution insights into bacterial and archaeal structures of AD assemblages and their linkages to fed substrates and process parameters. Commonly, the bacterial phyla Firmicutes and Bacteroidetes appeared to dominate biogas communities in varying abundances depending on the apparent process conditions. Regarding the community of methanogenic Archaea, their diversity was mainly affected by the nature and composition of the substrates, availability of nutrients and ammonium/ammonia contents, but not by the temperature. It also appeared that a high proportion of 16S rRNA sequences can only be classified on higher taxonomic ranks indicating that many community members and their participation in AD within functional networks are still unknown. Although cultivation-based approaches to isolate microorganisms from biogas fermentation samples yielded hundreds of novel species and strains, this approach intrinsically is limited to the cultivable fraction of the community. To obtain genome sequence information of non-cultivable biogas community members, metagenome sequencing including assembly and binning strategies was highly valuable. Corresponding research has led to the compilation of hundreds of metagenome-assembled genomes (MAGs) frequently representing novel taxa whose metabolism and lifestyle could be reconstructed based on nucleotide sequence information. In contrast to metagenome analyses revealing the genetic potential of microbial communities, metatranscriptome sequencing provided insights into the metabolically active community. Taking advantage of genome sequence information, transcriptional activities were evaluated considering the microorganism's genetic background. Metaproteome studies uncovered enzyme profiles expressed by biogas community members. Enzymes involved in cellulose and hemicellulose decomposition and utilization of other complex biopolymers were identified. Future studies on biogas functional microbial networks will increasingly involve integrated multi-omics analyses evaluating metagenome, transcriptome, proteome, and metabolome datasets.

Metagenome, metatranscriptome, and metaproteome approaches unraveled compositions and functional relationships of microbial communities residing in biogas plants

The production of biogas by anaerobic digestion (AD) of agricultural residues, organic wastes, animal excrements, municipal sludge, and energy crops has a firm place in sustainable energy production and bio-economy strategies. Focusing on the microbial community involved in biomass conversion offers the opportunity to control and engineer the biogas process with the objective to optimize its efficiency. Taxonomic profiling of biogas producing communities by means of high-throughput 16S rRNA gene amplicon sequencing provided high-resolution insights into bacterial and archaeal structures of AD assemblages and their linkages to fed substrates and process parameters. Commonly, the bacterial phyla Firmicutes and Bacteroidetes appeared to dominate biogas communities in varying abundances depending on the apparent process conditions. Regarding the community of methanogenic Archaea, their diversity was mainly affected by the nature and composition of the substrates, availability of nutrients and ammonium/ammonia contents, but not by the temperature. It also appeared that a high proportion of 16S rRNA sequences can only be classified on higher taxonomic ranks indicating that many community members and their participation in AD within functional networks are still unknown. Although cultivation-based approaches to isolate microorganisms from biogas fermentation samples yielded hundreds of novel species and strains, this approach intrinsically is limited to the cultivable fraction of the community. To obtain genome sequence information of non-cultivable biogas community members, metagenome sequencing including assembly and binning strategies was highly valuable. Corresponding research has led to the compilation of hundreds of metagenome-assembled genomes (MAGs) frequently representing novel taxa whose metabolism and lifestyle could be reconstructed based on nucleotide sequence information. In contrast to metagenome analyses revealing the genetic potential of microbial communities, metatranscriptome sequencing provided insights into the metabolically active community. Taking advantage of genome sequence information, transcriptional activities were evaluated considering the microorganism's genetic background. Metaproteome studies uncovered enzyme profiles expressed by biogas community members. Enzymes involved in cellulose and hemicellulose decomposition and utilization of other complex biopolymers were identified. Future studies on biogas functional microbial networks will increasingly involve integrated multi-omics analyses evaluating metagenome, transcriptome, proteome, and metabolome datasets.

Biphasic Study to Characterize Agricultural Biogas Plants by High-Throughput 16S rRNA Gene Amplicon Sequencing and Microscopic Analysis

Process surveillance within agricultural biogas plants (BGPs) was concurrently studied by high-throughput 16S rRNA gene amplicon sequencing and an optimized quantitative microscopic fingerprinting (QMF) technique. In contrast to 16S rRNA gene amplicons, digitalized microscopy is a rapid and cost-effective method that facilitates enumeration and morphological differentiation of the most significant groups of methanogens regarding their shape and characteristic autofluorescent factor 420. Moreover, the fluorescence signal mirrors cell vitality. In this study, four different BGPs were investigated. The results indicated stable process performance in the mesophilic BGPs and in the thermophilic reactor. Bacterial subcommunity characterization revealed significant differences between the four BGPs. Most remarkably, the genera Defluviitoga and Halocella dominated the thermophilic bacterial subcommunity, whereas members of another taxon, Syntrophaceticus, were found to be abundant in the mesophilic BGP. The domain Archaea was dominated by the genus Methanoculleus in all four BGPs, followed by Methanosaeta in BGP1 and BGP3. In contrast, Methanothermobacter members were highly abundant in the thermophilic BGP4. Furthermore, a high consistency between the sequencing approach and the QMF method was shown, especially for the thermophilic BGP. The differences elucidated that using this biphasic approach for mesophilic BGPs provided novel insights regarding disaggregated single cells of Methanosarcina and Methanosaeta species. Both dominated the archaeal subcommunity and replaced coccoid Methanoculleus members belonging to the same group of Methanomicrobiales that have been frequently observed in similar BGPs. This work demonstrates that combining QMF and 16S rRNA gene amplicon sequencing is a complementary strategy to describe archaeal community structures within biogas processes.

Genomics and prevalence of bacterial and archaeal isolates from biogas-producing microbiomes

BACKGROUND

To elucidate biogas microbial communities and processes, the application of high-throughput DNA analysis approaches is becoming increasingly important. Unfortunately, generated data can only partialy be interpreted rudimentary since databases lack reference sequences.

RESULTS

Novel cellulolytic, hydrolytic, and acidogenic/acetogenic Bacteria as well as methanogenic Archaea originating from different anaerobic digestion communities were analyzed on the genomic level to assess their role in biomass decomposition and biogas production. Some of the analyzed bacterial strains were recently described as new species and even genera, namely Herbinix hemicellulosilytica T3/55^T, Herbinix luporum SD1D^T, Clostridium bornimense M2/40^T, Proteiniphilum saccharofermentans M3/6^T, Fermentimonas caenicola ING2-E5B^T, and Petrimonas mucosa ING2-E5A^T. High-throughput genome sequencing of 22 anaerobic digestion isolates enabled functional genome interpretation, metabolic reconstruction, and prediction of microbial traits regarding their abilities to utilize complex bio-polymers and to perform specific fermentation pathways. To determine the prevalence of the isolates included in this study in different biogas systems, corresponding metagenome fragment mappings were done. Methanoculleus bourgensis was found to be abundant in three mesophilic biogas plants studied and slightly less abundant in a thermophilic biogas plant, whereas Defluviitoga tunisiensis was only prominent in the thermophilic system. Moreover, several of the analyzed species were clearly detectable in the mesophilic biogas plants, but appeared to be only moderately abundant. Among the species for which genome sequence information was publicly available prior to this study, only the species Amphibacillus xylanus, Clostridium clariflavum, and Lactobacillus acidophilus are of importance for the biogas microbiomes analyzed, but did not reach the level of abundance as determined for M. bourgensis and D. tunisiensis.

CONCLUSIONS

Isolation of key anaerobic digestion microorganisms and their functional interpretation was achieved by application of elaborated cultivation techniques and subsequent genome analyses. New isolates and their genome information extend the repository covering anaerobic digestion community members.

Unraveling the microbiome of a thermophilic biogas plant by metagenome and metatranscriptome analysis complemented by characterization of bacterial and archaeal isolates

BACKGROUND

One of the most promising technologies to sustainably produce energy and to mitigate greenhouse gas emissions from combustion of fossil energy carriers is the anaerobic digestion and biomethanation of organic raw material and waste towards biogas by highly diverse microbial consortia. In this context, the microbial systems ecology of thermophilic industrial-scale biogas plants is poorly understood.

RESULTS

The microbial community structure of an exemplary thermophilic biogas plant was analyzed by a comprehensive approach comprising the analysis of the microbial metagenome and metatranscriptome complemented by the cultivation of hydrolytic and acido-/acetogenic Bacteria as well as methanogenic Archaea. Analysis of metagenome-derived 16S rRNA gene sequences revealed that the bacterial genera Defluviitoga (5.5 %), Halocella (3.5 %), Clostridium sensu stricto (1.9 %), Clostridium cluster III (1.5 %), and Tepidimicrobium (0.7 %) were most abundant. Among the Archaea, Methanoculleus (2.8 %) and Methanothermobacter (0.8 %) were predominant. As revealed by a metatranscriptomic 16S rRNA analysis, Defluviitoga (9.2 %), Clostridium cluster III (4.8 %), and Tepidanaerobacter (1.1 %) as well as Methanoculleus (5.7 %) mainly contributed to these sequence tags indicating their metabolic activity, whereas Hallocella (1.8 %), Tepidimicrobium (0.5 %), and Methanothermobacter (<0.1 %) were transcriptionally less active. By applying 11 different cultivation strategies, 52 taxonomically different microbial isolates representing the classes Clostridia, Bacilli, Thermotogae, Methanomicrobia and Methanobacteria were obtained. Genome analyses of isolates support the finding that, besides Clostridium thermocellum and Clostridium stercorarium, Defluviitoga tunisiensis participated in the hydrolysis of hemicellulose producing ethanol, acetate, and H2/CO2. The latter three metabolites are substrates for hydrogentrophic and acetoclastic archaeal methanogenesis.

CONCLUSIONS

Obtained results showed that high abundance of microorganisms as deduced from metagenome analysis does not necessarily indicate high transcriptional or metabolic activity, and vice versa. Additionally, it appeared that the microbiome of the investigated thermophilic biogas plant comprised a huge number of up to now unknown and insufficiently characterized species.

Dual investigation of methanogenic processes by quantitative PCR and quantitative microscopic fingerprinting

Monitoring of methanogenic communities in anaerobic digesters using molecular-based methods is very attractive but can be cost-intensive. A new and fast quantification method by microscopic image analysis was developed to accompany molecular-based methods. This digitalized method, called quantitative microscopic fingerprinting (QMF), enables quantification of active methanogenic cells (N mL(-1)) by their characteristic auto-fluorescence based on coenzyme F420 . QMF was applied to analyze the methanogenic communities in three biogas plant samples, and the results were compared with the relative proportion of gene copy numbers obtained with the quantitative PCR (qPCR). Analysis of QMF demonstrated dominance of Methanomicrobiales and Methanobacteriales in relation to the total methanogenic community in digesters operating at high ammonia concentrations, which corresponded to the results established by qPCR. Absolute microbial counts by QMF and the numbers obtained by qPCR were not always comparable. On the other hand, the restricted morphological analysis by QMF was enhanced by the capability of qPCR to identify microbes. Consequently, dual investigations of both methods are proposed to improve monitoring of anaerobic digesters. For a rough estimation of the methanogenic composition in anaerobic digesters, the QMF method seems to be a promising approach for the rapid detection of microbial changes.

State of Iron in the Archaebacterium Methanosarcina barkeri Grown on Different Carbon Sources as Studied by Mössbauer Spectroscopy

Cells of the archaebacterium Methanosarcina barkeri were grown strictly anaerobic in defined media. 57Fe-Mössbauer Spectroscopy of methanol grown cells oxidized in the presence of air demonstrated only the state of Fe3+ whereas active cells under reducing conditions offered spectra of two additional iron sites in the Fe2+ state. Furthermore the 57Fe hyperfine interaction data at different temperatures gave evidence that cells cultivated with methanol or acetate as substrate contained ferredoxin like compounds.

[Medical indoor environment counsellor (MIEC) in Burgundy: evaluation by physicians and patients]

Since December 2009, chest physicians and allergologists in Burgundy have been able to call upon a medical indoor environment counsellor (MIEC). The consultations are free for the patient and are undertaken following a medical referal after systematic cutaneous prick tests.

AIMS

To describe the indications, the distribution of prescriptions and to measure the impact of the counsellor's visits on the first 100 patients at 6 months and on the physicians at 18 months.

METHOD

Telephone interviews with the 67 physicians (whether prescribers or not) concerning their motivation and/or expectations, and with the first 100 patients concerning follow up of the recommendations.

RESULTS

Seventy percent of the physicians replied (n=47). The satisfaction of prescribers (n=22) was 8.42/10. The indications were rhinitis and a poorly controlled asthma. The requests concerned the search for dust mite (50%) and moulds (46%). Eighty-four percent of the physicians discussed the MIEC's report with the patients. The patients' symptoms were rhinitis (79%), asthma (57%) and conjunctivitis (33%). The Acarex test(®), performed in cases of positive prick tests to house dust mites (n=72), was strongly positive for 67 patients. Sixteen mould samples out of 21 were above the standard concentrations. Sixty-nine patients had followed the recommendations of the MIEC.

CONCLUSION

The impact of the MIEC visits was perceived as positive by the physicians and the patients. The medico-economic impact warrants further evaluation.

Randomised multicentre trial on safety and efficacy of rivastigmine in cognitively impaired multiple sclerosis patients

BACKGROUND

Cognitive decline has been recognised as a frequent symptom in multiple sclerosis (MS). Cholinesterase inhibitors (ChEIs) are employed for the treatment of Alzheimer's disease, but there is some evidence that ChEIs might also be effective in MS patients with cognitive deficits, particularly deficits of memory function.

OBJECTIVE

The aim of this study was to evaluate efficacy on memory function and safety of the ChEI rivastigmine in MS patients with cognitive deficits as measured by the change from baseline of the total recall score of the selective reminding test (SRT) after 16 weeks of treatment.

METHODS

Efficacy and safety of rivastigmine were analysed in a 16-week, multicentre, double-blind, randomised, placebo-controlled study, followed by an optional one-year open-label treatment phase. Effects of rivastigmine and placebo were compared by an analysis of covariance.

RESULTS

In total, 86 patients were enrolled. Patients who received rivastigmine (n = 43) showed a non-significant increase in total recall score (sum of all words immediately recalled over all six trials) over placebo (n = 38) after 16 weeks of treatment (p = 0.2576). Other outcome measures provided no evidence supporting benefits of rivastigmine. Treatment with rivastigmine was well tolerated.

CONCLUSIONS

With the results of this study, the need for an effective therapy in cognitively impaired MS patients is still required. Thus, intensive and continued clinical research is required to explore therapeutic options for cognitive deficits in MS patients.

Potential impact of process parameters upon the bacterial diversity in the mesophilic anaerobic digestion of beet silage

The impact of the process parameters hydraulic retention time (HRT), organic loading rate (OLR) and substrate upon bacterial diversity was analyzed. Therefore, a controlled anaerobic fermentation (1755 days) of beet silage, only initially inoculated with manure, was monitored by the amplified "ribosomal DNA" restriction analysis. More than 85% of detected operational taxonomic units (OTUs) could not be assigned to described Bacteria. In contrast to studies analyzing the digestion of energy crops in the presence of manure, Chloroflexi were detected, whereas Clostridia and Chloroflexi were identified as persistent groups. Both groups are known as potential hydrogen producers or users. Species distribution patterns for Firmicutes, Bacteroidetes, Synergistetes and Thermotogae were not clearly linked to process parameters. The presence of Planctomycetes, Actinobacteria and Alcaligenaceae was related to long HRTs and short OLRs, while Acidobacteria were governed by short HRTs and high OLRs, respectively. The impact of substrate variations on diversity was minute.

Impact of bioaugmentation by compost on the performance and ecology of an anaerobic digester fed with energy crops

The influence of compost as inoculum during continuous anaerobic digestion of fodder beet silage was studied over 330 days. Two simultaneously driven mesophilic fermentors (Inoc-1/Inoc-2) were inoculated with manure and sewage sludge. Only the digester Inoc-2 was inoculated additionally with compost. After 160 days fermentor Inoc-2 reached a hydraulic retention time (HRT) around 15 days whereas Inoc-1 remained at a HRT of 40d. After changing the substrate feed from one to three times a day both digesters stabilised at a shorter HRT; Inoc-2 at 10 days and Inoc-1 around 20 days. An additional inoculation of fermentor Inoc-1 by compost shortened the HRT to 10 days and revealed a minor increased gas production of about 6%. Fluorescence in situ hybridization indicated that probably an archaeal population shift was responsible for the observed stimulations. An addition of compost induced a methanogenic community change towards hydrogenotrophic methanogens.

Application of a fuzzy logic control system for continuous anaerobic digestion of low buffered, acidic energy crops as mono-substrate

A fuzzy logic control (FLC) system was developed at the Hamburg University of Applied Sciences (HAW Hamburg) for operation of biogas reactors running on energy crops. Three commercially available measuring parameters, namely pH, the methane (CH4) content, and the specific gas production rate (spec. GPR = m(3)/kg VS/day) were included. The objective was to avoid stabilization of pH with use of buffering supplements, like lime or manure. The developed FLC system can cover most of all applications, such as a careful start-up process and a gentle recovery strategy after a severe reactor failure, also enabling a process with a high organic loading rate (OLR) and a low hydraulic retention time (HRT), that is, a high throughput anaerobic digestion process with a stable pH and CH4 content. A precondition for a high load process was the concept of interval feeding, for example, with 8 h of interval. The FLC system was proved to be reliable during the long term fermentation studies over 3 years in one-stage, completely stirred tank reactors (CSTR) with acidic beet silage as mono-input (pH 3.3-3.4). During fermentation of the fodder beet silage (FBS), a stable HRT of 6.0 days with an OLR of up to 15 kg VS/m(3)/day and a volumetric GPR of 9 m(3)/m(3)/day could be reached. The FLC enabled an automatic recovery of the digester after two induced severe reactor failures. In another attempt to prove the feasibility of the FLC, substrate FBS was changed to sugar beet silage (SBS), which had a substantially lower buffering capacity than that of the FBS. With SBS, the FLC accomplished a stable fermentation at a pH level between 6.5 and 6.6, and a volatile fatty acid level (VFA) below 500 mg/L, but the FLC had to interact and to change the substrate dosage permanently. In a further experiment, the reactor temperature was increased from 41 to 50 degrees C. Concomitantly, the specific GPR, pH and CH4 dropped down. Finally, the FLC automatically enabled a complete recovery in 16 days.

[Disclosure of diagnosis in ambulatory radiology practice: expectations of patients and referring physicians]

PURPOSE

To evaluate and compare the expectations of patients and referring physicians (RPH) regarding the disclosure of radiological diagnostic procedure (RDP) results.

MATERIALS AND METHODS

A written survey was performed among 594 consecutive patients (47% male, 53% female; average age 49.6 y +/- 17.2 y) undergoing diagnostic cross-sectional imaging at three different ambulatories. A separate questionnaire was sent to 149 non-radiologist RPHs (rate of return 43.6%). The Chi-square test (Pearson's) (alpha < or = 0.05) and the stepwise calculation of logistic regression were used for statistical evaluation.

RESULTS

We found that 284 (47.8%) of the patients and 38 (58.5%) of the RPHs favored the radiologist disclosing RDP results. The patients' preference was significantly influenced by age, sex and geographical location (p < or = 0.05). 428 (72.1%) of the patients expected immediate therapeutic recommendations. Most patients (214, 75.1%) expected to be told the diagnosis within 30 minutes, RPHs (40/61.5%) within 48 hours.

CONCLUSION

Patients have high expectations with respect to radiologists. Excellent organization is mandatory to fulfill these expectations. Unrealistic expectations should be corrected in advance by an improved information policy. Since only approximately half of the patients favored the radiologist disclosing the results of RDPs, radiologists should rethink their disclosure policy. The majority of RPHs preferred disclosure of the diagnosis by the radiologist. Timely reporting of RDP results is essential.

Immunomodulating drugs in multiple sclerosis: compliance, satisfaction and adverse effects evaluation in a German multiple sclerosis population

OBJECTIVE

To assess the compliance, satisfaction and adverse effects of immunomodulating drugs in a German multiple sclerosis (MS) population.

RESEARCH DESIGN AND METHODS

A standardised, anonymous questionnaire was sent to the 1985 members with MS of the Berlin section of the German Multiple Sclerosis Association. Patients were questioned with regards to sociodemographic data, MS-related topics, therapy, adverse effects and compliance. The response rate was 51.1%, from which 681 patients were selected who were experienced in therapy with interferon beta 1a or 1b or glatiramer acetate.

RESULTS

Most participants were treated with beta-interferons and only one-third with glatiramer acetate. Patients were moderately satisfied with their medication. Approximately 75.5% of patients had used the medication for longer than 2 years, especially those with a relapsing-remitting course (RRMS). Around one-third of all participants had their immunomodulating drug changed, mostly only once. The main reasons for discontinuation of the therapy were adverse effects, physician's recommendation and lack of treatment effect. Mood-related adverse effects (e.g., depression), fever and pain were perceived as most disturbing. Regression analysis revealed that dependence on a wheelchair and a secondary progressive course predicted a low compliance to treatment.

CONCLUSION

Treating MS is a challenge and to positively influence the course of the disease it is necessary to administer medication in a constant manner. Our data showed a moderate compliance and satisfaction with the immunomodulating medication. Adverse effects and perceived lack of treatment effect were reasons for discontinuation of therapy. To increase compliance and satisfaction with treatment, adequate information about MS, the therapeutic options, handling of medication, side-effects and their management are necessary. Additionally, realistic therapeutic aims should be discussed with the patients.

The Faces Symbol Test, a newly developed screening instrument to assess cognitive decline related to multiple sclerosis: first results of the Berlin Multi-Centre FST Validation Study

Reliable, language-independent, short screening instruments to test for cognitive function in patients with multiple sclerosis (MS) remain rare, despite the high number of patients affected by cognitive decline. We developed a new, short screening instrument, the Faces Symbol Test (FST), and compared its diagnostic test characteristics with a composite of the Digit Symbol Substitution Test (DSST) and the Paced Auditory Serial Addition Test (PASAT), in 108 MS patients and 33 healthy controls. An Informant-Report Questionnaire, a Self-Report Questionnaire, and a neurologist's estimation of the Every Day Life Cognitive Status were also applied to the MS patients. The statistical analyses comprised of a receiver operating characteristic analysis for test accuracy and for confounding variables. The PASAT and DSST composite score estimated that 36.5% of the MS patients had cognitive impairment. The FST estimated that 40.7% of the MS patients were cognitively impaired (sensitivity 84%; specificity 85%). The FST, DSST and PASAT results were significantly correlated with the patients' physical impairment, as measured by the Expanded Disability Status Scale (EDSS). The results suggest that the FST might be a culture-free, sensitive, and practical short screening instrument for the detection of cognitive decline in patients with MS, including those in the early stages. Multiple Sclerosis 2007; 13: 402-411. http://msj.sagepub.com

Genetic study of the CD36 gene in a French diabetic population

OBJECTIVES

CD36 is a multifunctional membrane receptor widely expressed in different tissues which binds and internalizes oxidized low-density lipoprotein. In rodents, CD36 gene variations modulate glucose homeostasis and contribute to metabolic syndrome associated with type 2 diabetes but the effects in human are unknown.

METHODS

We screened the entire coding sequence of the CD36 gene in 272 individuals and we genotyped both rare and frequent variants in 454 T2D subjects and 221 controls.

RESULTS

We detected five mutations, P191P and N247S were only found each in one family and did not segregate with diabetes, the three others (A/C-178 in the promoter, A/G-10 in intron 3 and (GGGTTGAGA) insertion in intron 13) being equally frequent in diabetic subjects and in controls. However, adiponectin levels, a marker for insulin sensitivity, were significantly associated with the -178 A/C promoter variant allele (p=0.003, p corrected for multiple testing=0.036), possibly reflecting association with insulin-resistance in the French population.

CONCLUSION

Thus, the -178 A/C SNP promoter mutation in the CD36 gene represents a putative genetic marker for insulin-resistance in the French population, although it does not appear to contribute to the genetic risk for T2D.

Normierung der Brief Repeatable Battery of Neuropsychological Tests (BRB-N) f�r den deutschsprachigen Raum

The Brief Repeatable Battery of Neuropsychological Tests (BRB-N) is a neuropsychological screening battery, often applied in multiple sclerosis (MS) patients. It is almost exclusively administered in trials and not in the daily practice routine because of the lack of normative values. Using a stepwise linear regression analysis, the dependence of test results on age, gender, and education of 241 healthy control subjects was investigated. Z-values of -1.68 or less were considered pathological. Based on the normative values, the proportions of cognitively impaired patients with relapsing-remitting MS (RRMS, n=43) and secondary progressive MS patients (SPMS, n=60) were calculated. The regression model explained 2.7-25.0% of the variance of test performances. Cognitive impairment occurred in 38% and in 47% of the RRMS and the SPMS groups, respectively. In both groups attention and concentration impairment was prominent, while in the SPMS group memory was also frequently affected. The proportion of cognitively impaired MS patients reflected the figures that could be found in the literature.

Wirkungen einer „Slow Stroke”-Massage als komplementäre Therapie bei stationären depressiven Patienten

BACKGROUND AND OBJECTIVE

Among methods of complementary treatment of depression, massage plays an important role, at least in the U.S.A. Although there are some pointers to the antidepressive and anxiolytic action of slow-stroke massage in various randoms studies of patient cohorts, there have been no controlled trials of depressed hospitalized patients.

PATIENTS AND METHODS

32 depressed patients (24 women, 8 men; average 48 years - coveringthe entire spectrum of affective disorders listed in the ICD but without comorbidity in axis 2) with a minimum BRMS score of 16,7 - were included in the study. The randomized cross-over trial involved three massage sessions at set times (M) and sessions in two control groups (C) (relaxation and perception) lasting for 60 min 2-3 days apart. Under the control conditions there was no touching. The effects of depression-specific variables (e.g. mood, drive, abnormal cognition, as well as typical progress variables of the slow-stroke massage (bodily awareness, general state of health, etc.) were measured by both the patients' own assessment and that of an independent observer.

RESULTS

Under condition of both M and C, comparison of before and after effects, there was not only the primarily postulated mood-enhancing effect, but also some very marked changes in almost all dimension, the mean improvement ratio under M often being stronger than under C. After Bonferroni correction for multiple tests, the statistical significance there remained the stronger effect of M in four dimensions (global tenseness, restlessness, depressed mood, neck/shoulder tension). The intensive effect of M compared with C was confirmed by both female and male patients regarding the answers to various open questions.

CONCLUSIONS

Slow-stroke massage is suitable for adjuvant acute treatment of patients with depression. It is very readily accepted also by very ill patients. In relation to the skin as an organ that aids identity, non-hedonic depressed patients are able to recognize the sensory quality of therapeutic touching as a positive stimulus. In view of the latent period of many weeks and the only moderate efficacy of antidepressants, the described complementary method, which does not require physiotherapeutic training, should be more often applied in both a hospital and general practice setting.

[IgE allergy due to formaldehyde paste during endodontic treatment. Apropos of 4 cases: 2 with anaphylactic shock and 2 with generalized urticaria]

We report 4 cases of allergic reaction to formaldehyde-containing root canal sealant after endodontic care: 2 anaphylactic shocks and 2 local reactions with generalized urticaria. Allergic IgE mediated mechanisms were suggested by the clinical presentation, skin tests and high levels of anti-formaldehyde IgE. These infrequent but potentially severe reactions after canal treatment led us to examine the involved mechanisms, the diagnostic procedure and the possibility of prevention in odontostomatology.

Alternate finger tapping test in patients with migraine

Migraine patients are thought to show some cognitive dysfunction and slight structural abnormalities in the white matter of the brain, whereas most patients with multiple sclerosis (MS) are known to have numerous white matter lesions, often affecting the corpus callosum. To demonstrate psychomotor dysfunction, an alternate finger tapping task (a-FTT) on a PC was administered to controls (n = 41), migraine patients (n = 25), and multiple sclerosis patients (n = 22). Five MS patients with secondary callosal atrophy detected by MRI were also investigated as a separate group. Significant slowing was demonstrated in migraine (P = 0.0005) and MS (P<0.0001). The poorest test results were found in patients with callosal atrophy. In summary, a-FTT on a PC is able to detect minimal psychomotor dysfunction in migraine.