Colonisation with Staphylococcus aureus and Streptococcus pyogenes in New Zealand preschool children.

AIM: To describe colonisation patterns of Staphylococcus aureus (S. aureus) and Streptococcus pyogenes (S. pyogenes) among pre-school children in New Zealand. METHOD: Anterior nasal, oropharyngeal, and antecubital fossa swabs were collected from a diverse sample of 139 New Zealand children aged 4 years. Swabs were cultured for S. aureus and S. pyogenes. S. aureus isolates were tested for antibiotic susceptibility. RESULTS: S. aureus colonisation was more prevalent than S. pyogenes colonisation; 54% of the children were colonised with S. aureus whereas only 16% were colonised with S. pyogenes, at one or more sampling sites (P<0.0001). S. aureus was present in a larger proportion of swabs obtained from the anterior nasal (39%, P<0.0001) or oropharynx (32%, P=0.0002) than from the antecubital fossa (14%). S. pyogenes was present in a larger proportion of swabs obtained from the oropharynx (16%) than either the anterior nasal (4%, P=0.001) or the antecubital fossa (2%, P<0.0001). CONCLUSION: S. aureus and S. pyogenes are prevalent at superficial sites in preschool children in NZ, with S. aureus colonisation more prevalent than S. pyogenes colonisation. Colonisation frequency varies by site for both pathogens; S. aureus is more prevalent in the anterior nares and oropharynx while S. pyogenes is more prevalent in the oropharynx.

Tumor and normal tissue dosimetry changes during MR-guided pulsed-dose-rate (PDR) brachytherapy for cervical cancer.

BACKGROUND AND PURPOSE: To analyze systematic changes in tumor and normal tissue anatomy and dosimetry using serial MR imaging during pulsed dose rate brachytherapy (PDR BT) for cervical cancer. MATERIAL AND METHODS: Forty-three patients with cervical cancer underwent MR-guided PDR BT using an intrauterine applicator alone after external beam radiotherapy. MR imaging was repeated on days 2 and 3 of treatment and the day 1 plan was applied to the re-contoured volumes. RESULTS: The mean uterine volume and mean HR CTV increased during treatment. This resulted in a decrease in the mean HR CTV D90 relative to the day 1 planned dose. There was no change in the mean bladder volume during treatment but the mean rectal volume increased. This correlated with an increase in the mean rectal dose. There were four local recurrences. There was no apparent relationship between either the planned or the delivered HR CTV D90 and local recurrence. There was only one case of late bladder toxicity but nine patients developed late rectal toxicity. The cumulative rectal dose during treatment was a better predictor of late rectal toxicity than the planned dose. CONCLUSIONS: Significant changes in tumor and normal tissue anatomy and dosimetry can occur during PDR BT and should be tracked and corrected using serial imaging and plan adaptation, especially when the day 1 tumor or normal tissue doses are close to the planning constraints.

Beyond tamoxifen: extended and late extended endocrine therapy in postmenopausal early breast cancer.

Breast cancer is a leading cause of cancer death among women worldwide. The majority of cases are oestrogen receptor- or progesterone receptor-positive and, therefore, potentially sensitive to endocrine therapy. A significant risk of recurrence and death persists following initial diagnosis, with over one half of all recurrences and two thirds of breast cancer-related deaths reported to occur following completion of standard adjuvant tamoxifen therapy. There is a need for effective protection against recurrence beyond the initial 5 years of adjuvant treatment for women with hormone-responsive cancer. Extended adjuvant endocrine therapy with letrozole following completion of adjuvant tamoxifen treatment is well tolerated and reduces recurrence risk by 42% and the risk of developing distant metastases by 40% when compared with placebo. Extended adjuvant letrozole therapy confers protection against late relapses and should be considered for women completing adjuvant tamoxifen therapy. The MA.17 trial was unblinded early because of a statistically significant benefit in disease-free survival with letrozole, and patients receiving placebo were allowed to receive letrozole. MA.17 post-unblinding results show that women originally randomised to placebo who then chose to receive letrozole at the time of trial unblinding experienced a significant improvement in all outcomes (disease-free survival and distant disease-free survival), including a significant survival advantage when compared with women in the placebo arm who chose to continue with no further treatment. Physicians should consider late extended adjuvant therapy for women who have been off tamoxifen for some time, as it may offer benefit in outcomes, and this option should be discussed.

Celiac disease.

Clinically, celiac disease has always been regarded as a wasting, malabsorptive disorder due to disease of the small intestinal mucosa. It has been difficult for clinicians to recognize that this condition is primarily due to sensitization of mesenteric T lymphocytes to wheat protein (gluten) in genetically predisposed (DQ2+) individuals. On contact with dietary-derived gluten in the upper intestine, these sensitized T lymphocytes are activated leading to inflammation of and morphologically altered mucosal architecture: the latter reverts to normal with a gluten-free diet. The circulation of sensitized T lymphocytes to other parts of the intestinal mucosa explains why identical immunopathological inflammation can be induced in ileal and rectal mucosa. It appears, then, that in predisposed DQ2+ subjects, mesenteric T lymphocytes recognize gluten as foreign (non-self) antigen, thereby inducing mucosal pathology secondary to the initiating lymphocyte-protein interaction, analogously to the mucosal lesions that typify graft-vs-host reactions, or nematode or Giaraia infestations. Today, as this article describes, we recognize that celiac disease often exists in a subclinical, or "compensated-latent," form, or with symptoms that do not immediately suggest an origin in the gastrointestinal tract.