Vaccine effectiveness against influenza hospitalisation in adults during the 2022/2023 mixed season of influenza A(H1N1)pdm09, A(H3N2) and B circulation, Europe: VEBIS SARI VE hospital network

We conducted a multicentre hospital-based test-negative case-control study to measure vaccine effectiveness (VE) against PCR-confirmed influenza in adult patients with severe acute respiratory infection (SARI) during the 2022/2023 influenza season in Europe. Among 5547 SARI patients ≥18 years, 2963 (53%) were vaccinated against influenza. Overall VE against influenza A(H1N1)pdm09 was 11% (95% CI: -23-36); 20% (95% CI: -4-39) against A(H3N2) and 56% (95% CI: 22-75) against B. During the 2022/2023 season, while VE against hospitalisation with influenza B was >55%, it was ≤20% for influenza A subtypes. While influenza vaccination should be a priority for future seasons, improved vaccines against influenza are needed.

Effectiveness of the adapted bivalent mRNA COVID-19 vaccines against hospitalisation in individuals aged ≥ 60 years during the Omicron XBB lineage-predominant period: VEBIS SARI VE network, Europe, February to August, 2023

We conducted a multicentre hospital-based test-negative case-control study to measure the effectiveness of adapted bivalent COVID-19 mRNA vaccines against PCR-confirmed SARS-CoV-2 infection during the Omicron XBB lineage-predominant period in patients aged ≥ 60 years with severe acute respiratory infection from five countries in Europe. Bivalent vaccines provided short-term additional protection compared with those vaccinated > 6 months before the campaign: from 80% (95% CI: 50 to 94) for 14-89 days post-vaccination, 15% (95% CI: -12 to 35) at 90-179 days, and lower to no effect thereafter.

Influenza vaccine effectiveness in Europe: Results from the 2022-2023 VEBIS (Vaccine Effectiveness, Burden and Impact Studies) primary care multicentre study

Background

Influenza A(H3N2) viruses dominated early in the 2022-2023 influenza season in Europe, followed by higher circulation of influenza A(H1N1)pdm09 and B viruses. The VEBIS primary care network estimated the influenza vaccine effectiveness (VE) using a multicentre test-negative study.

Materials and Methods

Primary care practitioners collected information and specimens from patients consulting with acute respiratory infection. We measured VE against any influenza, influenza (sub)type and clade, by age group, by influenza vaccine target group and by time since vaccination, using logistic regression.

Results

We included 38 058 patients, of which 3786 were influenza A(H3N2), 1548 influenza A(H1N1)pdm09 and 3275 influenza B cases. Against influenza A(H3N2), VE was 36% (95% CI: 25-45) among all ages and ranged between 30% and 52% by age group and target group. VE against influenza A(H3N2) clade 2b was 38% (95% CI: 25-49). Overall, VE against influenza A(H1N1)pdm09 was 46% (95% CI: 35-56) and ranged between 29% and 59% by age group and target group. VE against influenza A(H1N1)pdm09 clade 5a.2a was 56% (95% CI: 46-65) and 79% (95% CI: 64-88) against clade 5a.2a.1. VE against influenza B was 76% (95% CI: 70-81); overall, 84%, 72% and 71% were among 0-14-year-olds, 15-64-year-olds and those in the influenza vaccination target group, respectively. VE against influenza B with a position 197 mutation of the hemagglutinin (HA) gene was 79% (95% CI: 73-85) and 90% (95% CI: 85-94) without this mutation.

Conclusion

The 2022-2023 end-of-season results from the VEBIS network at primary care level showed high VE among children and against influenza B, with lower VE against influenza A(H1N1)pdm09 and A(H3N2).

Vaccine effectiveness against COVID-19 hospitalisation in adults (≥ 20 years) during Alpha- and Delta-dominant circulation: I-MOVE-COVID-19 and VEBIS SARI VE networks, Europe, 2021

IntroductionTwo large multicentre European hospital networks have estimated vaccine effectiveness (VE) against COVID-19 since 2021.AimWe aimed to measure VE against PCR-confirmed SARS-CoV-2 in hospitalised severe acute respiratory illness (SARI) patients ≥ 20 years, combining data from these networks during Alpha (March-June)- and Delta (June-December)-dominant periods, 2021.MethodsForty-six participating hospitals across 14 countries follow a similar generic protocol using the test-negative case-control design. We defined complete primary series vaccination (PSV) as two doses of a two-dose or one of a single-dose vaccine ≥ 14 days before onset.ResultsWe included 1,087 cases (538 controls) and 1,669 cases (1,442 controls) in the Alpha- and Delta-dominant periods, respectively. During the Alpha period, VE against hospitalisation with SARS-CoV2 for complete Comirnaty PSV was 85% (95% CI: 69-92) overall and 75% (95% CI: 42-90) in those aged ≥ 80 years. During the Delta period, among SARI patients ≥ 20 years with symptom onset ≥ 150 days from last PSV dose, VE for complete Comirnaty PSV was 54% (95% CI: 18-74). Among those receiving Comirnaty PSV and mRNA booster (any product) ≥ 150 days after last PSV dose, VE was 91% (95% CI: 57-98). In time-since-vaccination analysis, complete all-product PSV VE was > 90% in those with their last dose < 90 days before onset; ≥ 70% in those 90-179 days before onset.ConclusionsOur results from this EU multi-country hospital setting showed that VE for complete PSV alone was higher in the Alpha- than the Delta-dominant period, and addition of a first booster dose during the latter period increased VE to over 90%.

A collaborative, computer-assisted, psychoeducational intervention for depressed patients with chronic disease at primary care: protocol for a cluster-randomized controlled trial

Introduction

Depression treatment recommendations seldom include chronic illness comorbidity.

Objectives

To describe the rationale and methods for a cluster-randomized trial (CRT) in primary care clinics (PCC) comparing a computer-assisted psychoeducational (CAPE) intervention to usual care (UC) for depressed patients with hypertension or diabetes.

Methods

Two-arm, single-blind CRT in Santiago, Chile. Eight PCC will be randomly assigned to the intervention or UC. A total of 360 depressed individuals aged 18 or older PHQ-9 scores ≥ 15 and hypertension or diabetes will be recruited. Patients with alcohol/substance abuse; current treatment for depression, bipolar disorder, or psychosis; illiteracy; severe impairment; and residents in long-term care facilities will be excluded. Patients in the intervention will receive eight CAPE sessions by trained therapists, structured telephone calls to track progress, and usual medical care for chronic diseases. Psychologists and psychiatrists will regularly supervise therapists. To ensure continuity of care, the PCC team will meet monthly with a research team member. Patients in UC will receive standard medical and depression treatment. Three, six, and twelve months after enrollment, outcomes will be assessed. The primary outcome will be a 50% reduction in baseline PHQ-9 scores at six months. Intention-to-treat analyses will be used.

Results

A previous, small-scale pilot study provided valuable insights for study design.

Conclusions

This study will provide first-hand evidence on the effectiveness of a CAPE for depressed patients with chronic diseases at PCC in a Latin American country.

Disclosure

No significant relationships.

Effectiveness of complete primary vaccination against COVID-19 at primary care and community level during predominant Delta circulation in Europe: multicentre analysis, I-MOVE-COVID-19 and ECDC networks, July to August 2021

IntroductionIn July and August 2021, the SARS-CoV-2 Delta variant dominated in Europe.AimUsing a multicentre test-negative study, we measured COVID-19 vaccine effectiveness (VE) against symptomatic infection.MethodsIndividuals with COVID-19 or acute respiratory symptoms at primary care/community level in 10 European countries were tested for SARS-CoV-2. We measured complete primary course overall VE by vaccine brand and by time since vaccination.ResultsOverall VE was 74% (95% CI: 69-79), 76% (95% CI: 71-80), 63% (95% CI: 48-75) and 63% (95% CI: 16-83) among those aged 30-44, 45-59, 60-74 and ≥ 75 years, respectively. VE among those aged 30-59 years was 78% (95% CI: 75-81), 66% (95% CI: 58-73), 91% (95% CI: 87-94) and 52% (95% CI: 40-61), for Comirnaty, Vaxzevria, Spikevax and COVID-19 Vaccine Janssen, respectively. VE among people 60 years and older was 67% (95% CI: 52-77), 65% (95% CI: 48-76) and 83% (95% CI: 64-92) for Comirnaty, Vaxzevria and Spikevax, respectively. Comirnaty VE among those aged 30-59 years was 87% (95% CI: 83-89) at 14-29 days and 65% (95% CI: 56-71%) at ≥ 90 days between vaccination and onset of symptoms.ConclusionsVE against symptomatic infection with the SARS-CoV-2 Delta variant varied among brands, ranging from 52% to 91%. While some waning of the vaccine effect may be present (sample size limited this analysis to only Comirnaty), protection was 65% at 90 days or more between vaccination and onset.

Osimertinib and anti-HER3 combination therapy engages immune dependent tumor toxicity via STING activation in trans

Over the past decade, immunotherapy delivered novel treatments for many cancer types. However, lung cancer still leads cancer mortality, and non-small-cell lung carcinoma patients with mutant EGFR cannot benefit from checkpoint inhibitors due to toxicity, relying only on palliative chemotherapy and the third-generation tyrosine kinase inhibitor (TKI) osimertinib. This new drug extends lifespan by 9-months vs. second-generation TKIs, but unfortunately, cancers relapse due to resistance mechanisms and the lack of antitumor immune responses. Here we explored the combination of osimertinib with anti-HER3 monoclonal antibodies and observed that the immune system contributed to eliminate tumor cells in mice and co-culture experiments using bone marrow-derived macrophages and human PBMCs. Osimertinib led to apoptosis of tumors but simultaneously, it triggered inositol-requiring-enzyme (IRE1α)-dependent HER3 upregulation, increased macrophage infiltration, and activated cGAS in cancer cells to produce cGAMP (detected by a lentivirally transduced STING activity biosensor), transactivating STING in macrophages. We sought to target osimertinib-induced HER3 upregulation with monoclonal antibodies, which engaged Fc receptor-dependent tumor elimination by macrophages, and STING agonists enhanced macrophage-mediated tumor elimination further. Thus, by engaging a tumor non-autonomous mechanism involving cGAS-STING and innate immunity, the combination of osimertinib and anti-HER3 antibodies could improve the limited therapeutic and stratification options for advanced stage lung cancer patients with mutant EGFR.

No effect modification of influenza virus vaccine effectiveness by age or chronic condition was observed in the 2010/11 to 2017/18 seasons

PURPOSE

Most European influenza vaccine strategies target individuals at higher risk of complications, which include, among others, individuals aged ≥65 years and with chronic conditions. These individuals not only have a high-risk of post-infection complications but also could have lower capacity of acquiring adequate vaccine-induced protection. As such, chronic conditions and age could modify the effect of vaccines. This study aimed at assessing the potential effect modification of influenza vaccine effectiveness (IVE) by age and chronic conditions.

METHODS

We used eight-season data from the Portuguese vaccine effectiveness study. Every season, physicians at primary care units recruited patients with influenza-like illness. Clinical data and swabs were collected for Reverse Transverse Polymerase Chain Reaction (RT-PCR) detection of influenza. Trivalent inactivated IVE was estimated as 1 - odds ratio (OR) of being vaccinated in cases (RT-PCR positive for influenza) versus negative controls. ORs were obtained using a multivariable conditional logistic regression model, paired by week of onset within each season. Confounders were assessed by designing a specific causal diagram. Age (< 65 or ≥65 years) and chronic conditions (diabetes, cardiovascular disease, chronic renal disease, chronic hepatic disease, obesity, chronic respiratory disease, and congenital or acquired immunodeficiency) were studied as effect modifiers by including an interaction term in the regression models. Significance was established at 5%.

RESULTS

Point estimates indicate a higher IVE in the chronic condition strata compared to that in the no chronic condition strata. Regarding age, different results were obtained considering the virus type and (sub)type. When comparing the ≥65 years with the <65 years of age strata, we observed a higher IVE against A(H1N1)pdm09, an equal IVE against A(H3N2) and a lower IVE against B virus. However, all interaction terms were statistically insignificant, and this may be due to a small sample size.

CONCLUSION

The potential effect modification of age or chronic condition was not observed within our study.

Implementing an Influenza Vaccine Effectiveness Study in a Hospital Context in Portugal: The EVA Hospital Project

INTRODUCTION

The project 'Integrated Monitoring of Vaccines in Europe' aimed to measure seasonal influenza vaccine effectiveness against hospitalised adults, aged 65 years and over, with influenza. We describe the protocol implementation in Portugal.

MATERIAL AND METHODS

We implemented a test-negative design, targeting community-dwelling patients aged 65 years old and over hospitalised with severe acute respiratory illness. Patients were reverse transverse-polymerase chain reaction tested for influenza. Cases were those positive for influenza while others were controls. Most variables were collected using hospital medical records. Selection bias was evaluated by comparison with the laboratory influenza test requests database according to demographic characteristics. Crude, season-adjusted influenza vaccine effectiveness was estimated as = 1 - odds ratio, and 95% confidence intervals were obtained by conditional logistical regression, matched with the disease onset month.

RESULTS

The recruitment rate was 37.8%. Most participants (n = 368) were female (55.8%) and aged 80 years old and over (55.8%). This was similar to values for potentially eligible severe acute respiratory illness patients (80 years old and over: 56.8%, female: 56.2%). The proportion of missing values was below 2.5% for 20 variables and above 5% (maximum 11.6%) for six variables. Influenza vaccine effectiveness estimates were 62.1% against AH1pdm09 (95% confidence intervals: -28.1 to 88.8), 14.9% against A(H3N2) (95% confidence intervals: -69.6 to 57.3), 43.6% against B/Yam (95% confidence intervals: -66.2 to 80.8).

DISCUSSION

Given the non-existence of a coded admission database in either participating hospital the selection of severe acute respiratory illness due to clinical features was the feasible one. These results are only valid for the older adult population residing in the catchment area of the two participating hospitals who were admitted to a public hospital with severe influenza or SARI symptoms.

CONCLUSION

Despite the low participation rate, we observed comparable characteristics of participants and eligible severe acute respiratory illness patients. Data quality was high, and influenza vaccine effectiveness results were in accordance with the results of meta-analyses and European season-specific estimates. The final sample size was low, which inhibited obtaining estimates with good precision.

Correction to the article "Implementing an Influenza Vaccine Effectiveness Study in a Hospital Context in Portugal: The EVA Hospital Project", Published on Acta Med Port 2021 Jan;34(1):20-27

On page 23, Figure 1, where it reads: "Controls 157 2015-2016 season = 47" (area circled in the image bellow) It should read: (see new Figure 1 on pag. 62). On page 25, Table 2, third line of the last column, under "p-value", where it reads: 1 (see Table 2 in page 63) It should read: 1.000 (see new Table 2, page 64) Article published with errors: https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13438.

Influenza burden estimates in Portugal: seasons 2013/14 to 2018/19

Background

Reliable influenza burden estimates are essential for a true understanding of the influenza epidemics' impact; informed decision-making and effective risk communication. This study aimed to estimate the influenza burden in Portugal in 2013/14 - 2018/19 seasons.

Methods

We estimated seasonal influenza burden, ranging from medically attended influenza cases in primary care to influenza-attributable deaths, using surveillance data. Data were collected for influenza like illness (ILI) epidemic periods, determined by the Moving Epidemic Method. Medically attended influenza cases were estimated by multiplying the number of ILI cases in primary care by the percentage of influenza-positive samples. Hospitalized severe acute respiratory infections (SARI) positive for influenza estimates were computed, multiplying the number of SARI by the percentage of influenza-positive samples. To determine influenza-attributable deaths, a Poisson regression model was used.

Results

The median number of medically attended influenza cases in primary care was 33,668 (325.8 cases per 10,000 population), ranging between 21,393 in 2017/18, [Influenza B and A(H1) co-dominance] and 61,768 in 2014/15 [Influenza B and A(H3) co-dominance]. The median number of SARI positive for influenza was 8,724 (84.4 cases per 10,000 population), ranging between 7,099 in 2013/14 [A(H1) and A(H3) co-dominance], and 9,125 in 2014/15. The median number of influenza-attributable deaths was 3,311 (32.0 cases per 10,000 population), ranging between 96 in 2015/16 [A(H1) dominance], and 5,224 in 2014/15.

Conclusions

Higher mortality, and higher rate of medically attended influenza cases, were found in seasons with A(H3) circulation. Little variability was observed in the number of influenza-positive SARI. The relationship between the number of SARI and the number of deaths requires further investigation. This work highlights the need of health surveillance systems for a better understanding of the influenza impact.

Key messages

Lower burden of influenza is found in seasons with A(H1) co-dominance. Higher burden of influenza is found in seasons with A(H3) circulation. Health surveillance systems are essential to provide data for a better understanding of the epidemiology and extent of seasonal influenza.

P1595 Prognostic role of late gadolinium enhancement for sudden cardiac death risk in non-ischemic dilated cardiomyopathy

OBJECTIVES

to evaluate the prognosis role of late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (cMRI) in patients with non-ischemic dilated cardiomyopathy (NIDM).

BACKGROUND

Risk stratification in NIDM needs to be improved.

METHODS

We included 210 patients with NIDM and cMRI from 2005 to 2018 in our study population. Outcomes were retrospectively assessed by medical records. The pattern of LGE was classified as mid-wall, sub-epicardial, or both patterns. Primary endpoint was sudden cardiac death (SCD) or aborted SCD. Secondary endpoints were global mortality and a composite endpoint of cardiovascular mortality and heart failure hospitalization.

Demographic and clinical parameters were also evaluated. Patients with LGE (LGE+) were more likely to be male (80,6% vs 66,7%, p= 0,03). No significant differences were observed between LGE+ and LGE- patients in comorbidities, NYHA class, left ventricular ejection fraction (LVEF), or neurohormonal treatment.

RESULTS

Of 210 patients (71,4% men, median age 59,8 years) with a median follow up of 5,6 years (3,24-8,15), 72 patients (34,3%) had non ischemic LGE (LGE+) on cMRI. Mean left ventricular ejection fraction (LVEF) was 34%.

SCD or aborted SCD occurred in 11 patients (5,2%): 6 patients (9,5%) with LGE+ vs 5 patients (4,07 %) of LGE- (p = 0,19).

Patients with LGE+ had a higher risk for the composite endpoint (cardiovascular mortality and heart failure hospitalization): OR 2,45, confidence interval (CI): 1,16-5,17, (p = 0,02).

LGE presence was not associated with global mortality.

The subepicardial pattern of LGE was associated with SCD or aborted SCD. 3 out of 11 patients (27%), with subepicardial pattern of LGE suffered from SCD or aborted SCD (p= 0,01).

CONCLUSIONS

In our cohort of 210 patients with NIDM, LGE was not significatively associated with SCD or aborted SCD, probably because of a low event rate (5,2%) in a relatively small and well treated population, despite a long follow-up (5,6 years). On the other hand, LGE presence was associated with a higher risk for the composite endpoint of cardiovascular mortality and heart failure hospitalization. Finally, the subepicardial pattern of LGE identified a group of patients at high risk of SCD and aborted SCD.

P994Association of late gadolinium enhancement with prognosis and sudden cardiac death risk in non-ischemic dilated cardiomyopathy

Objectives

to evaluate the association between late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (cMRI) and prognosis in patients with non-ischemic dilated cardiomyopathy (NIDM).

Background

Risk stratification in NIDM needs to be improved.

Methods

A total of 210 patients with NIDM and cMRI from 2005 to 2018 were included in our population. Outcomes were retrospectively assessed by medical records. The pattern of LGE was classified as midwall, subepicardial, or both patterns. Primary endpoint was sudden cardiac death (SCD) and aborted SCD. Secondary endpoints were global mortality and a composite endpoint of cardiovascular mortality and heart failure hospitalization. Demographic and clinical parameters were also evaluated. Patients with LGE (LGE+) were more likely to be male (80,6% vs 66,7%, p=0,03). No significant differences were observed between LGE+ and LGE− patients in comorbidities, NYHA class, left ventricular ejection fraction (LVEF), left bundle branch block or neurohormonal treatment.

Results

Of 210 patients (71,4% men, median age 59,8 years) with a median follow up of 5,6 years (3,24–8,15), 72 patients (34,3%) had non ischemic LGE (LGE+). Mean LVEF was 34%.

SCD or aborted SCD occurred in 11 patients (5,2%). 6 patients (9,5%) with LGE+ reached the primary endpoint vs 5 (4,07%) of LGE− patients (p=0,19).

The adjusted OR for the presence of LGE in the composite endpoint (cardiovascular mortality and heart failure hospitalization) was 2,45, confidence interval (CI): 1,16–5,17, (p=0,02).

LGE presence was not associated with global mortality.

The subepicardial pattern of LGE was associated with SCD and aborted SCD: 3 out of 11 patients (27, 1%) with subepicardial pattern of LGE suffered from SCD or aborted SCD (p=0,02).

Conclusions

In our cohort of 210 patients with NIDM, LGE presence was not associated with SCD and aborted SCD, probably because of low event rate in a relatively small population. However, LGE presence was associated with the composite endpoint of cardiovascular mortality and heart failure hospitalization. The subepicardial pattern of LGE identified patients at high risk of SCD and aborted SCD.

Energy transduction and signal averaging of fluctuating electric fields by a single protein ion channel

A biological ion channel is used to charge a conventional capacitor from an external fluctuating electrical noise.

Designing voltage multipliers with nanofluidic diodes immersed in aqueous salt solutions

Novel networks composed of asymmetric membranes operate as voltage multipliers and suggest opportunities for the monitoring of sensors and actuators.

Voltage-controlled current loops with nanofluidic diodes electrically coupled to solid state capacitors

Nanofluidic diodes electrically coupled to solid state capacitors show electrical properties reminiscent of a resistor with memory.

Machine perfusion: initial results in an expanded criteria donor kidney transplant program

BACKGROUND

Delayed graft function (DGF) negatively impacts graft survival. Expanded criteria donors (ECD) show a higher rate of DGF. Hypothermic machine perfusion (HMP) has shown a DGF decrease and an increase of survival at 1 year. Several authors found that renal resistance (RR) at the end of machine perfusion was an independent risk factor for the development of DGF and poorer graft survival. The objective of this study was to analyze HMP results in the context of an ECD program and assess the impact of donor parameters and resistance index (RI) during perfusion in graft survival after kidney transplantation.

METHODS

Donor age, terminal creatinine, machine perfusion time, percentage of glomerulosclerosis, and RI at the end of the perfusion were considered as risk predictors. Univariate and multivariate Cox regression analysis was constructed to find independent risk factors of DGF. Finally, diagnostic validity for RR was determined by sensitivity, specificity, and positive and negative predictive values.

RESULTS

Twenty-three percent of patients developed DGF. We found no difference in the ability of flow or RI to predict the development of DGF. The predictive accuracy of RI for DGF by receiver operator characteristic curve was poor, with a c-statistic of 0.66 (95% CI, 0.50-0.81; P = .046). Our analysis did not identify risk factors that predicted graft survival at 1 year. Patient and graft survival were 98.8% and 89.7%, respectively.

CONCLUSIONS

HMP has reduced the rate of DGF in our cohort of recipients of ECD grafts compared with historical data (23.3% vs 38.0%). Analysis did not identify risk pretransplant factors for graft survival at 1 year.

Population structure among mycobacterium tuberculosis isolates from pulmonary tuberculosis patients in Colombia

Background

Phylogeographic composition of M. tuberculosis populations reveals associations between lineages and human populations that might have implications for the development of strategies to control the disease. In Latin America, lineage 4 or the Euro-American, is predominant with considerable variations among and within countries. In Colombia, although few studies from specific localities have revealed differences in M. tuberculosis populations, there are still areas of the country where this information is lacking, as is a comparison of Colombian isolates with those from the rest of the world.

Principal Findings

A total of 414 M. tuberculosis isolates from adult pulmonary tuberculosis cases from three Colombian states were studied. Isolates were genotyped using IS6110-restriction fragment length polymorphism (RFLP), spoligotyping, and 24-locus Mycobacterial interspersed repetitive units variable number tandem repeats (MIRU-VNTRs). SIT42 (LAM9) and SIT62 (H1) represented 53.3% of isolates, followed by 8.21% SIT50 (H3), 5.07% SIT53 (T1), and 3.14% SIT727 (H1). Composite spoligotyping and 24-locus MIRU- VNTR minimum spanning tree analysis suggest a recent expansion of SIT42 and SIT62 evolved originally from SIT53 (T1). The proportion of Haarlem sublineage (44.3%) was significantly higher than that in neighboring countries. Associations were found between M. tuberculosis MDR and SIT45 (H1), as well as HIV-positive serology with SIT727 (H1) and SIT53 (T1).

Conclusions

This study showed the population structure of M. tuberculosis in several regions from Colombia with a dominance of the LAM and Haarlem sublineages, particularly in two major urban settings (Medellín and Cali). Dominant spoligotypes were LAM9 (SIT 42) and Haarlem (SIT62). The proportion of the Haarlem sublineage was higher in Colombia compared to that in neighboring countries, suggesting particular conditions of co-evolution with the corresponding human population that favor the success of this sublineage.

Non-invasive monitoring of hypoxia-inducible factor activation by optical imaging during antiangiogenic treatment in a xenograft model of ovarian carcinoma

Targeting the hypoxia response pathway and angiogenesis are two promising therapeutic strategies for cancer treatment. Their use as single strategies has important limitations. Thus, development of combined regimens has become an important step toward improving therapeutic efficacy. Also, non-invasive monitoring of the response to targeted biological therapies, as well as determination of the optimal schedule for combination regimens has become an active field of research over the last five years, with relevance for both preclinical and clinical settings. Here, we used an optical imaging method to non-invasively monitor the functional changes in HIF activity in response to antiangiogenic treatment in a xenograft model of human ovarian carcinoma. A bioluminescent reporter construct containing nine copies of the hypoxia response element upstream of the luciferase gene (9xHRE-luciferase) was characterized in vitro in a panel of tumor cell lines and in vivo in a subcutaneous xenograft model of ovarian carcinoma by means of optical imaging. We showed that in OVCAR-3 subcutaneous xenografts, the most abrupt change in the HIF functional reporter occurs before the onset of massive tumor growth. However, this system failed to detect hypoxia induced upon antiangiogenic treatment due to the compensating effects of increased hypoxia and decreased tumor cell viability caused by imbalanced neovascularization vs. tumor expansion. Therefore, the readout based on HIF functional reporter could be conditioned by the dynamics of tumor growth and angiogenesis, which is highly variable depending on the tumor type, tumor model and stage of progression.

Assessment of mycobacteremia detection as a complementary method for the diagnosis of tuberculosis in HIV-infected patients

The purpose of this investigation was to assess the usefulness of mycobacteremia detection in human immunodeficiency virus (HIV) patients with suspected tuberculosis. The study included 47 patients with suspected tuberculosis and confirmed HIV infection. A first blood sample was incubated in a BACTEC 9050 MB system, while white blood cells isolation was performed on a second blood specimen before incubation in a BACTEC MGIT 960 system. The third specimen was taken from the affected organs of each patient according to their clinical profile. Twelve (25.5%) patients were positive for mycobacterial infection identified by any of the methods used. Ten (21.2%) were positive for Mycobacterium tuberculosis and 2 (4.3%) for M. avium. Six patients were diagnosed by the culture of specimen from affected organs only, whilst three other patients were positive exclusively for blood cultures. Three additional patients were diagnosed by both methods. Four patients with negative cultures were ultimately diagnosed with tuberculosis by measuring the adenosine deaminase levels. Mycobacteremia detection can be used to increase the sensitivity of the diagnosis of tuberculosis and other mycobacteria in patients with HIV. However, it cannot be used as the sole diagnostic method. Clinical specimen cultures do not provide 100% diagnostic accuracy and it is, therefore, critical to further improve the mycobacteria detection sensitivity.

[Laboratory testing including CD4 T-cell count and determination of viral load to evaluate the impact of first line antiretroviral treatment at 6 months in adults in Benin]

The purpose of this study was to determine lymphocyte CD4 T-cell count and circulating HIV-1 RNA load in HIV-infected adults starting first line antiretroviral treatment according to the revised 2006 WHO recommendations in Cotonou, Benin. A total of 1209 adults treated mainly by lamivudine/stavudine/nevirapine, were prospectively included between November 2006 and June 2007. CD4 T-cell counts and HIV viral load (measured by branched DNA assay, Siemens, Tarytown, New York, USA) were evaluated at 6 months of treatment. Mean CD4 T-cell count showed a marked increase at six months of treatment (93/mm3 at baseline versus 387/mm3 at 6 months) with 65.2% of patients reaching a CD4 T-cell level higher than 200/mm3 and 34.8% showing CD4 T-cell counts lower than 200/mm3. At 6 months, HIV 1 viral load was undetectable (<2.70 log10 copies/ml) in only 54 patients (16.7%), detectable but lower than 3.0 log10 copies/ml in 522 (73%) patients, and high, i.e., still greater than 3.7 log10 copies/ml in 188 (27%) patients. After 18 months of follow up, 499 patients (41.3%) had undetectable circulating viral load. The three main findings of this study are that at 6 months of antiretroviral treatment i) one-third of patients remained at risk for opportunistic infection (CD4<200/mm3), ii) one-fourth met criteria for virological failure (> 5000 copies/ml), and iii) concordance between immunological and virological responses was frequent but discordance responses were observed in more than 10% of patients. Taken together, these findings underline the need to improve compliance and laboratory follow-up in patients undergoing antiretroviral therapy in Africa.

[Retrospective study--pregnancy after assisted medical reproduction from 2001 to 2009 at the Central Hospital of Luxembourg (first section)]

Retrospective study on a nine year ART practice focusing on pregnancy outcomes and multiple pregnancies, their complications, the gestational duration, delivery options, the new born weights and health statements til the age of two. Post ART pregnancies seem to have an increased complication rate; multiple births are more frequent than with spontaneous conception. The first chapter deals with the entire group. The second chapter analyses several sub-groups according to the ART method employed. The results are compared to publications in PubMed and Medline.

[Retrospective studies of pregnancies after assisted medical reproduction from 2001-2009 and Central Hospital in Luxembourg (part 2)]

The first chapter analyses the ART methods of the Centre Hospitalier of Luxembourg, in the department of reproductive medicine between 2001 and 2009. The second chapter examines the techniques individually, their influence on pregnancy outcomes, the complications on offsprings and their health. The results coincide with literature in that risks are acceptable as long as good medical and biological conditions are maintained. Multiple pregnancies remain the most frequent complication, particularly once out of IVF. These are analysed separately as well as the pregnancies after egg and semen donation.

Monitoring gene therapy by external imaging of mRNA: pilot study on murine erythropoietin

Gene therapy is anticipated as being an important medical development. Essential to its effectiveness is the appropriate activity (protein expression) in the expected target cells. A noninvasive diagnostic procedure of successful gene expression will be of paramount importance to validate its use or its misuse (eg, sports gene doping). Externally detectable labeled oligonucleotide hybridizing with the messenger RNA generated by the transferred gene has been proposed as a possibility to monitor successful gene therapy. The authors selected the erythropoietin gene (Epo) for a pilot study on erythropoietin protein expression in mouse muscle. Oligonucleotides of peptide nucleic acid (PNA) type capable of antisense binding to unique murine Epo-mRNA sequences were synthesized by solid phase methods, and elongated at the N-terminus with the HIV Tat (48-60) cell penetrating peptide. They were labeled with fluorescence and radioactive tags to verify penetration and longer half-life properties in Epo gene transfected C2C12 mouse muscle cells as compared with corresponding wild-type cells. Downregulation of newly expressed erythropoietin protein in such cells additionally confirmed the penetration and hybridizing properties of the selected labeled oligonucleotide. I-labeled Tat-PNAs were intravenously injected into mice that had previously received the Epo gene into the right tibialis muscle by DNA electrotransfer. Preferential accumulation of radioactivity in the transferred limb as compared with the contralateral limb was ascertained, especially for I-Tat-CTA CGT AGA CCA CT (labeled Tat-PNA 1). This study provides experimental data to support the potential use of external noninvasive image detection to monitor gene therapy. The extension of the approach to more sensitive methods for whole-body external detection such as positron emission tomography appears feasible.

Relapse of chronic myeloid leukemia after allogeneic stem cell transplantation: outcome and prognostic factors: the Chronic Myeloid Leukemia Subcommittee of the GETH (Grupo Español de Trasplante Hemopoyético)

In order to analyze the outcome of patients with chronic myeloid leukemia (CML) who relapse after allogeneic stem cell transplantation (SCT), we investigated data from 107 patients reported to the Spanish Registry, GETH. In all, 93 (87%) patients were treated after relapse; 36 out of 49 that failed to achieve a response received a second relapse-treatment, and seven a third one. At the last follow-up, the number of patients in molecular or cytogenetic remission was 29 and 13, respectively. Overall survival and progression-free survival after relapse were 53.6% (95% CI: 42.9--64.2) and 52% (95% CI: 41-63) at 5 years, respectively. In multivariate analysis, survival was significantly related to CML phase at relapse (cytogenetic or chronic phase vs advanced phases) and time from transplant to relapse (<1 vs >or=1 year). Patients with no adverse factors had a better survival compared with patients with one or two adverse features (65 vs 35 vs 0%, respectively). We conclude that a significant proportion of CML patients that relapse after transplantation can regain complete and long-lasting remissions with one or more salvage therapies. Disease stage at relapse and time from transplant to relapse should be taken into account when comparing results of different salvage treatments.

Influence of laparoscopic live donor nephrectomy in ischemia-reperfusion syndrome and renal function after kidney transplantation: an experimental study

The increase of intra-abdominal pressure during laparoscopic techniques provokes oliguria and reduction of the renal blood flow (RBF). The aim of this study is to evaluate this effect during living donor nephrectomy and its influence in the ischemia-reperfusion syndrome and renal function after kidney transplantation. Autotransplantation was performed using 22 pigs (15 after conventional open nephrectomy and 7 after laparoscopic nephrectomy). During donor nephrectomy a significant reduction in RBF was observed in the laparoscopic group (70 mL/min) vs the open group (260 mL/min) (P<.05). After a cold ischemia period of 24 hours an autotransplantation was performed. During the first hour after revascularization RBF was lower for the laparoscopic than for the open group: 60 vs 180 mL/s at 1 minute and 160 vs 400 mL/s at 60 minutes (P<.05). The decrease of creatinine was slower for the laparoscopic than for the open group during the first posttransplant week (2 vs 1.3 mg/dL on the first day and 1.4 vs 0.8 mg/dL on the seventh day posttransplant, respectively) (P<.05).

Use of curanderismo in a public health care system

BACKGROUND

Curanderismo ("the healing") is a centuries-old synthesis of Mexican Indian culture and beliefs.

OBJECTIVE

To evaluate the rate of use of curanderismo among Hispanic subjects seeking medical care at the Denver Health Medical Center, Denver, Colo.

METHODS

We conducted a survey of 405 Hispanic subjects attending outpatient primary and urgent care clinics at Denver Health Medical Center, the public hospital system for Denver. The main outcome measure was independent predictors of use of curanderos.

RESULTS

Of the 405 subjects, 118 (29.1%) (95% confidence interval, 20.9-37.3) had been to a curandero at some time in their lives. Of all the subjects, 91.3% knew what a curandero was. Univariate analyses demonstrated an association between those who had been to a curandero and level of income, level of education, and whether the subject was bilingual. The results of fitting a stepwise logistic regression model revealed an independent association with subjects who had been to a curandero and level of household income (>$20 000 vs <$10 000), with an odds ratio of 2.19 (95% confidence interval, 1.20-4.01) (P =.01), and level of education (post--high school vs elementary school), with an odds ratio of 3.16 (95% confidence interval, 1.45-6.86) (P =.004).

CONCLUSIONS

Many Hispanic patients who receive their health care at a public hospital system use the services of curanderos. This potentially has important implications for their health care.

Sarcoidosis after antiretroviral therapy in a patient with acquired immunodeficiency syndrome

A 53-year-old man with acquired immunodeficiency syndrome (AIDS) developed clinical and radiological features compatible with sarcoidosis 14 months after starting highly active antiretroviral therapy (HAART). The CD4 lymphocyte count had increased from 5 cells/mm(3) to 235 cells/mm(3) with HAART. Transbronchial lung biopsy showed nonnecrotizing granulomas. All studies for an infectious etiology were negative. His condition improved after treatment with corticosteroids. To our knowledge, this is the fifth case report of sarcoidosis occurring after initiation of antiretroviral therapy for AIDS.

Fitness of Botrytis cinerea Associated with Dicarboximide Resistance

ABSTRACT Fitness costs in Botrytis cinerea associated with dicarboximide resistance were studied. Spearman rank correlation coefficients were calculated between resistance to iprodione and survival ability both outside and inside the greenhouse, measured on isolates randomly chosen from a collection done in a survey of commercial greenhouses in Southeastern Spain in 1992. Survival was measured at 47, 83, and 110 days as percentage of surviving mycelia in a sample of artificially inoculated tomato stem pieces and as percentage of viable sclerotia from a sample of sclerotia produced on potato dextrose agar. Resistance to iprodione was measured by the fungicide concentration that reduces fungal growth by 50% (EC(50) values). Significant (P < 0.05) negative correlation coefficients between survival of sclerotia and resistance to iprodione were found for some samplings dates, which indicates that sclerotia of resistant isolates survive less well than sclerotia from sensitive isolates. For mycelia, no relationship between survival and resistance was found.