Circulating soluble fibroblast activation protein (FAP) levels are independent of cardiac and extra-cardiac FAP expression determined by targeted molecular imaging in patients with myocardial FAP activation.

INTRODUCTION: Tissue Fibroblast Activation Protein alpha (FAP) is overexpressed in various types of acute and chronic cardiovascular disease. A soluble form of FAP has been detected in human plasma, and low circulating FAP concentrations are associated with increased risk of death in patients with acute coronary syndrome. However, little is known about the regulation and release of FAP from fibroblasts, and whether circulating FAP concentration is associated with tissue FAP expression. This study characterizes the release of FAP in human cardiac fibroblasts (CF) and analyzes the association of circulating FAP concentrations with in vivo tissue FAP expression in patients with acute (ST-segment elevation myocardial infarction, STEMI) and chronic (severe aortic stenosis, AS) myocardial FAP expression. METHODS AND RESULTS: FAP was released from CF in a time- and concentration-dependent manner. FAP concentration was higher in supernatant of TGFß-stimulated CF, and correlated with cellular FAP concentration. Inhibition of metallo- and serine-proteases diminished FAP release in vitro. Median FAP concentrations of patients with acute (77 ng/mL) and chronic (75 ng/mL, p = 0.50 vs. STEMI) myocardial FAP expression did not correlate with myocardial nor extra-myocardial nor total FAP volume (P ≥ 0.61 in all cases) measured by whole-body FAP-targeted positron emission tomography. CONCLUSION: We describe a time- and concentration dependent, protease-mediated release of FAP from cardiac fibroblasts. Circulating FAP concentrations were not associated with increased in vivo tissue FAP expression determined by molecular imaging in patients with both chronic and acute myocardial FAP expression. These data suggest that circulating FAP and tissue FAP expression provide complementary, non-interchangeable information.

Hepatitis E virus blood donor NAT screening: as much as possible or as much as needed?

BACKGROUND: The cost-benefit question of general screening of blood products for the hepatitis E virus (HEV) is currently being discussed. One central question is the need for individual nucleic acid amplification techniques (NAT) screening (ID-NAT) versus minipool NAT screening (MP-NAT) approaches to identify all relevant viremias in blood donors. Here, the findings of ID-NAT versus MP-NAT in pools of 96 samples were compared. STUDY DESIGN AND METHODS: From November 2017 to January 2018, a total of 10,141 allogenic blood donations from 7650 individual German blood donors were screened for the presence of HEV RNA using MP-NAT (96 samples) (RealStar HEV RT-PCR Kit) compared to ID-NAT (cobas HEV assay) on the fully automated cobas 6800 platform. RESULTS: Parallel screening of MP (n = 122, 96 samples/MP) using both methods detected seven reactive pools. After pool resolution, 8 HEV RNA-positive donations were identified by the in-house detection method, whereas 17 HEV RNA-positive donations were identified by ID-NAT with the cobas HEV assay. This resulted in an incidence of 1:1268 donations (0.079%) for MP-NAT screening and 1:597 donations (0.168%) for ID-NAT screening. CONCLUSIONS: The detection frequency of HEV RNA was approximately 50% higher if ID-NAT was used compared to MP-NAT. However, viral loads of ID-NAT-only samples were below 25 IU/mL and will often not result in transfusion-transmitted HEV (TT-HEV) infection, taking into account the currently known infectious dose of 5.0E + 04 IU inevitably resulting in TT-HEV infection. The clinical relevance and need for identification of these low-level HEV-positive donors still require further investigation.

[Description of a Multidimensional Health Program for Informal Caregivers]. / Beschreibung eines mehrdimensionalen Gesundheitsprogramms für pflegende Angehörige.

The aim of this study is to describe the concept of a prevention program for informal caregivers and its fit into stress theory and quality criteria. The program combines a 4-day group intervention outside the home with individual professional care in familiar domestic surroundings (family health care for persons with high burden, home training for specific care aspects). The program applies strategies focusing on problems and emotions. The program can be financed by social security funds. The 4-day respite service closes a gap in health services for informal caregivers.

Translation of genomics-guided RNA-based personalised cancer vaccines: towards the bedside.

Cancer is a disease caused by DNA mutations. Cancer therapies targeting defined functional mutations have shown clinical benefit. However, as 95% of the mutations in a tumour are unique to that single patient and only a small number of mutations are shared between patients, the addressed medical need is modest. A rapidly determined patient-specific tumour mutation pattern combined with a flexible mutation-targeting drug platform could generate a mutation-targeting individualised therapy, which would benefit each single patient. Next-generation sequencing enables the rapid identification of somatic mutations in individual tumours (the mutanome). Immunoinformatics enables predictions of mutation immunogenicity. Mutation-targeting RNA-based vaccines can be rapidly and affordably synthesised as custom GMP drug products. Integration of these cutting-edge technologies into a clinically applicable process holds the promise of a disruptive innovation benefiting cancer patients. Here, we describe our translation of the individualised RNA-based cancer vaccine concept into clinic trials.

Autologous blood donor screening indicated a lower prevalence of viral hepatitis in East vs West Germany: epidemiological benefit from established health resources.

Prevalence data concerning viral hepatitis and human immunodeficiency virus (HIV) in the general population are usually scarce. We aimed for a large cohort representative of the general population that required little funding. Autologous blood donors are relatively representative of the general population, and are tested for viral hepatitis and HIV in many countries. However, frequently these data are not captured for epidemiologic purposes. We analysed data from well over 35,000 autologous blood donors as recorded in 21 different transfusion centres for anti-hepatitis C virus (HCV), HBsAg and anti-HIV, as well as TPHA if available. We found a lower prevalence of hepatitis B virus and HCV in East vs West Germany, 0.2%vs 0.32% and 0.16%vs 0.32% respectively, which confirms earlier data in smaller cohorts, thus supporting the value of our approach. HIV was too rare to disclose significant differences, 0.01%vs 0.02%. TPHA was higher in East (0.34%) vs West Germany (0.29%) without significant differences. HCV was more frequent in women vs men. Transfusion institutes managing autologous blood donations should be used as a resource for epidemiological data relating to viral hepatitis and HIV, if such testing is performed routinely. This approach generates data relating to the general population with special emphasis on undiagnosed cases.

Hormonal counterregulation during severe hypoglycaemia under everyday conditions in patients with type 1 and insulin-treated type 2 diabetes mellitus.

AIM: To determine the counterregulatory hormonal responses to severe hypoglycaemia (SH) in type 1 versus insulin-treated type 2 diabetic patients under everyday conditions. METHODS: Counterregulatory hormones were determined in 28 consecutive type 1 and thirteen insulin-treated type 2 diabetic patients (age 54 +/- 18 vs. 75 +/- 13 yrs; diabetes duration 27 +/- 16 vs. 21 +/- 6 yrs) with SH requiring emergency treatment. Blood samples were taken prior to and after effective treatment of SH. SH was defined as an event with neuroglycopenic presentation requiring external intervention by administration of intravenous glucose or oral carbohydrates. 68 % (19/28) of type 1 diabetic patients but none of those with type 2 diabetes had reduced awareness of hypoglycaemia. RESULTS: Plasma glucose levels were 30 +/- 14 prior to and 179 +/- 82 mg/dl after treatment of SH; the time between the two measurements was 54 +/- 26 minutes. With the exception of higher levels of human growth hormone in type 1 patients - which were attributed to younger age - the other counterregulatory responses to SH showed no significant differences in type 1 vs. type 2 diabetic patients. In both groups glucagon responses were virtually absent while moderate catecholamine responses could be demonstrated. Treatment with beta-blockers did not affect hormonal counterregulation in type 1 diabetic patients. CONCLUSIONS: In patients approaching the insulin-deficient end of the spectrum of type 2 diabetes the hormonal responses to SH are comparable to those in patients with longstanding type 1 diabetes. Thus, in advanced type 2 diabetes the risk of developing SH may be similar to that in individuals with type 1 diabetes.

Low-level viraemia of hepatitis B virus in an anti-HBc- and anti-HBs-positive blood donor.

summary In many countries, screening of hepatitis B virus (HBV) in blood donors is limited to HBsAg testing. However, if anti-HBc testing and sensitive HBV nucleic acid amplification testing (NAT) for routine screening are not prescribed, HBV viraemia might remain unrecognized. A clinically inconspicuous HBsAg-negative 35-year-old female blood donor was detected with anti-HBc antibodies following the introduction of anti-HBc screening of donors. Based on her history, she had seroconverted to anti-HBs positive (titre >7000 IU/L) after vaccination. Blood donations were routinely tested HBV-DNA negative by minipool NAT. The individual donor samples were reinvestigated by an ultrasensitive NAT with a lower detection limit of 3.8 IU/mL. Intermittent HBV viraemia was detected over a 7-year period from this donor, with a concentration ranging from 8 to 260 IU/mL. In the subsequent donor-directed lookback study, no post-transfusion hepatitis was detected. Low-level HBV viraemia in simultaneous anti-HBc- and anti-HBs-positive blood donors could only be identified with enhanced sensitivity individual polymerase chain reaction assays and is not detectable by pool HBV NAT.

Hormonal counterregulation and consecutive glimepiride serum concentrations during severe hypoglycaemia associated with glimepiride therapy.

OBJECTIVE: To examine the release of counterregulatory hormones and consecutive glimepiride serum concentrations during severe hypoglycaemia (SH) associated with glimepiride therapy. METHODS: In nine type-2 diabetic patients [age 81+/-9 (65-93) years; diabetes duration 9+/-4 (3-15) years; initial blood glucose 33+/-16 (10-54) mg/dl (1.8+/-0.9 mmol/l); HbA1c 7.2+/-1.1 (5.6-8.7)%; creatinine clearance 49+/-33 (15-107) ml/min] who experienced SH associated with glimepiride therapy with neuroglucopenic presentation, insulin, C-peptide, glucagon, epinephrine, norepinephrine, cortisol, adenocorticotrophic hormone (ACTH), human growth hormone (HGH) and pancreatic polypeptide (PP) were determined in blood samples taken at 4-h intervals prior to and during treatment with glucose i.v. Serum from the same samples was screened for sulphonylurea-type oral antidiabetics. Glimepiride concentrations were determined by a validated atmospheric pressure chemical ionization liquid chromatographic-mass spectrometry (APCI-LC-MS) assay. RESULTS: Once treatment had begun, normoglycaemia was maintained; most glimepiride levels were below the limit of detection (LOD <0.01 mg/l) and further sulphonylureas could be excluded. The secretion of glucagon and epinephrine as counterregulatory hormonal responses was unaffected. In addition, protracted marked increases of cortisol and norepinephrine levels were demonstrated. Protracted stimulation of insulin and C-peptide occurred in a period of up to 24 h after SH. No significant protracted responses were observed for ACTH, HGH or PP. CONCLUSION: In SH associated with glimepiride therapy, no correlation between glimepiride serum concentrations and the protracted stimulation of insulin and C-peptide was observed. The secretion of glucagon and epinephrine as counterregulatory hormonal responses was unaffected. Protracted increased release of cortisol might be a medium-term indicator of glimepiride-associated SH.

Alanine aminotransferase cut-off values for blood donor screening using the new International Federation of Clinical Chemistry reference method at 37 degrees C.

BACKGROUND AND OBJECTIVES: Serum alanine aminotransferase (ALT) determination is recommended, or even required by law, in the screening of blood donors in many countries, and donors with an increased catalytic activity of ALT are excluded from blood donation. In most countries, the ALT cut-off value for blood donor screening for men and women is twice the upper limit of the normal range. The introduction, in 2002, of the new International Federation of Clinical Chemistry (IFCC) reference method, performed at 37 degrees C, required new ALT reference values to be established for healthy individuals and a new cut-off point to be determined for blood donor screening. MATERIALS AND METHODS: We compared ALT values of donor blood units using the previous German standard method, which measures ALT values at 25 degrees C, and the new IFCC reference procedure, where ALT levels are measured at 37 degrees C. RESULTS: We found a linear correlation between the ALT values obtained by the method at 25 degrees C and the new IFCC reference method (37 degrees C) (r = 0.983), and a gender- and age-independent ratio of 0.523. Using this ratio we calculated the new ALT cut-off for blood donations and now propose a new upper limit of 132 U/l (2.20 microkat/l) for men and 86 U/l (1.43 microkat/l) for women. Only 220 of 151 678 blood donations collected over a period of 5 years showed an ALT value higher than the cut-off. None were hepatitis C virus (HCV) positive in serological or nucleic acid amplification technology (NAT) assays. Only 0.006% of all blood donations were positive for antibody to HCV and thus excluded. CONCLUSIONS: With the implementation of the new IFCC reference method for ALT determination at 37 degrees C, we propose a new ALT cut-off for blood donor screening, which, for men, is about three times the upper limit of the normal range and for women about 2.5 times. Our results show that a lower cut-off would probably not yield a higher safety of blood products in terms of detecting viral infections, but would result in a loss of approximately 0.75% of suitable blood donors.

Analysis of cigarette mainstream smoke for 1,1-dimethylhydrazine and vinyl acetate by gas chromatography-mass spectrometry.

1,1-Dimethylhydrazine, also known as unsymdimethylhydrazine (UDMH) and vinyl acetate (VA), are both classified by the International Agency for Research on Cancer as 2B carcinogens (possibly carcinogenic to humans) and listed as cigarette smoke constituents; however, there is little or no quantitative data available on them. For UDMH in cigarette smoke, neither a yield nor a method has been published. For VA, the most recent information on yields dates back to 1965. To bridge this gap, we have developed new gas chromatographic-mass spectrometric methods for both compounds to determine their yields in cigarette smoke. UDMH is determined by derivatization with 2-nitrobenzaldehyde in methanol and is not found in cigarette smoke at levels above the detection limit of 19 ng/cig. In further experiments, when UDMH is added to the smoke stream or air stream of lit or unlit cigarettes, the derivative 2-nitrobenzaldehyde-2,2-dimethylhydrazone is found only in the air stream of the unlit cigarettes. From this, we conclude that UDMH is either not formed during smoking at all or, if it is, it reacts immediately and quantitatively with other smoke constituents (e.g., aldehydes) and is therefore not detectable in cigarette smoke. VA is determined by trapping in acetone at -78 degrees C and is found at a concentration of 270 ng/cig for a standard reference cigarette with a cellulose acetate filter (the reference cigarette 1 R4F). In the literature, VA is reported at concentrations of 1.6 microg/cig for a cigarette with a cellulose acetate/charcoal filter and 4 microg/cig for a cigarette with a cellulose acetate filter and for an unfiltered cigarette.

PMN granulocyte elastase--an early indicator of postoperative spondylodiscitis?

The diagnosis of spondylodiscitis after lumbar disc surgery has been based so far on clinical abnormalities, non-specific changes in chemical laboratory parameters [erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)] and radiological examinations such as MRI. Such techniques do not enable any clear diagnosis to be made before the 3rd postoperative week. The PMN elastase released from stimulated polymorphonuclear granulocytes has been proved to be a good laboratory parameter by which it is possible to prognosticate bacterial and abacterial organ complications in surgical patients with a high degree of probability. Under investigation were 12 patients with spondylodiscitis out of 1162 operations on herniated lumbar discs. PMN elastase was determined on the 7th postoperative day. In patients with spondylodiscitis and a mean value of 110.5 micrograms/l, the elastase was on average higher by a factor of 2.6 as compared to 88 randomly selected control patients. Since spondylodiscitis is a rare complication, this results in a positive value of only 7%, which does not allow a reliable diagnosis of spondylodiscitis by the elastase assay. But because the negative predictive value is 100%, it is possible to exclude a postoperative spondylodiscitis already on the 7th postoperative day, if the elastase value is normal.

Readability of American Cancer Society patient education literature.

American Cancer Society (ACS) literature commonly used to inform patients about cancer-detection methods, life-style risks, and treatment modalities was examined for readability. Fifty-one booklets obtained from a regional ACS office were evaluated. According to the SMOG formula, the reading level estimates of the booklets ranged from grade 5.8-15.6 (SD = 2.2), with a mean reading level of grade 11.9. The sampled cancer materials may be too difficult for many Americans to read and understand since most of the booklets (55%) were written for individuals with grade 12 or higher reading skills. Only one booklet was written at less than a grade six reading level. Booklets produced since 1985 were written at significantly lower reading levels (p less than 0.05) than those published in earlier years. The nurse's role in cancer education encompasses awareness of patients' diverse reading skills and formulation of a systematic method to develop materials that meet the needs of low-literacy groups.

A survey of nursing students' knowledge of cancer pain control.

The World Health Organization estimates that approximately 3.5 million people suffer daily from cancer pain. Recently, a Midwestern state was named by the World Health Organization to lead worldwide efforts in controlling the pain experienced by cancer patients. As part of this effort, the Nursing Education Committee conducted a statewide study of first year and final year nursing students from 19 nursing programs. The purpose of this study was to determine nursing students' perceptions and knowledge about cancer pain control. After the deans and directors of the nursing programs were contacted to obtain their agreement to participate, questionnaires composed of 26 items were mailed to each nursing school and distributed to students. Nine hundred thirty-eight questionnaires were returned to the researchers, realizing a 40% return rate. Data analysis reflects poor knowledge about the prevalence of cancer pain and its management. Using the student's t-test, significant differences between the scores of first year and last year students were found with last year students achieving higher mean scores. It was concluded that more information about how to manage cancer pain needs to be provided in nursing curricula. It is recommended that faculty members frequently update their knowledge and skills about cancer pain management.

The effect of social learning intervention on metabolic control of insulin-dependent diabetes mellitus in adolescents.

This paper reports the results of an experimental study modeled after a study conducted by Kaplan et al. The hypothesis tested was: Adolescents who receive a social learning intervention (SLI) will show greater improvement in metabolic control of their diabetes than will adolescents who receive only traditional diabetes instruction. Thirty-four adolescents between the ages of 12 and 16 who attended a midwestern camp were randomly divided into two groups. Both groups attended a daily 1-hour teaching session about diabetes. Later each day, the experimental group received an SLI consisting of role modeling to help the subjects circumvent peer pressure. To determine metabolic control, HbA1 values were determined before and 3 1/2 months after the intervention. The control group showed no significant difference in HbA1 values, while the experimental group showed a decrease in metabolic control.

Cancer pain control: one state's experience.

The World Health Organization estimates that approximately 3.5 million people suffer daily from cancer pain. Approximately 30% to 40% of people with intermediate stages of cancer and 55% to 90% of patients with advanced or terminal disease have pain. A multidisciplinary effort is under way in Wisconsin to improve cancer pain management. In recognition of the state's initiative, the World Health Organization has designated Wisconsin a demonstration state for cancer pain management. Support for staffing is provided by the United States Public Health Service Interagency Committee on Pain and Analgesia. In December 1986, 65 people representing 50 health organizations met to develop a comprehensive plan of action to improve pain management in people with cancer. In this article the various statewide activities focused at improving cancer pain management are discussed.