Detection and viability of tumor cells in peripheral blood stem cell collections from breast cancer patients using immunocytochemical and clonogenic assay techniques [see comments]

Although peripheral blood stem cell collections (PBSC) are thought to have less tumor involvement than bone marrow (BM), the incidence of circulating tumor cells in patients with breast cancer has not been widely investigated. We prospectively investigated the incidence and viability of tumor cell involvement in PBSC and BM collections from breast cancer patients undergoing high-dose chemotherapy/hematopoietic stem cell transplantation. Paired samples of PBSC and BM from 48 patients were analyzed using an immunocytochemical technique that detects one epithelial-derived tumor cell per 5 x 10(5) mononuclear cells. Immunostained tumor cells were detected in 9.8% (13/133) PBSC specimens from 9/48 (18.7%) patients and in 62.3% (38/61) BM specimens from 32/48 (66.7%) patients, a significantly higher rate than in PBSC (P < .005). The geometric mean concentration of tumor cells in contaminated PBSC specimens was 0.8/10(5) mononuclear cells (range 0.33 to 2.0/10(5)) compared with 22.9/10(5) mononuclear cells in BM (range 1 to 3,000/10(5), P < .0001). In culture experiments, clonogenic tumor colonies grew in 21/26 immunocytochemically positive specimens. No tumor colony growth was detected in 30/32 immunocytochemically negative specimens. Immunocytochemical detection of tumor involvement in BM and PBSC correlated significantly with in vitro clonogenic growth (P < .0001). We conclude that PBSC contain fewer tumor cells than paired BM specimens from patients with advanced breast cancer and that these tumor cells appear to be capable of clonogenic growth in vitro.     

Nutritional status and serum zinc and selenium levels in Iranian HIV infected individuals

Background  

Human immunodeficiency virus infected individuals are prone to malnutrition due to increased energy requirements, enteropathy and increased catabolism. Trace elements such as zinc and selenium have major role in maintaining a healthy immune system. This study was designed to evaluate the nutritional status of Iranian subjects who were newly diagnosed with human immunodeficiency virus infection and to compare serum level of zinc and selenium in these patients with those of the sex and aged match healthy subjects.     

WONCA研究论文摘要汇编——基层抑郁症风险患者的连续性服务

背景目前已开展了对重性精神病患者进提供连续性服务的研究。目的探讨基层对有抑郁症风险患者提供连续性服务的水平,并与对心力衰竭患者的服务水平进行对比。方法采用抑郁症风险患者与心力衰竭患者对比的探索性研究。采用患者问卷评估服务的持续性,包含如下内容:(1)联系的服务提供者数(个人连续性);(2)诊所内服务提供者之间的合作(团队连续性)(6个项目,分数1~5分);(3)诊所外全科医师与服务提供者之间的合作(跨界连续性)(4个项目,分数1~5分)。结果大多数抑郁症风险患者在过去1年中寻遍整个服务提供界联系了几个服务提供者,曾遇到过高水平团队连续性服务及低水平跨界连续性服务。在诊所中可接触到的不同服务提供者要明显多于心力衰竭患者服务提供者(P<0.01)。抑郁症风险患者的服务提供者之间的合作更好一些,每项平均得分4.3分,心力衰竭患者得分为4.0分(P=0.03)。然而,跨界连续性服务方面正好相反:抑郁症风险患者每项平均得分3.5分,心力衰竭患者得分为4.0分(P=0.01)。结论抑郁症风险患者与心力衰竭患者之间的探索性对比显示:体验服务连续性方面的差距不大。对此还应行进一步分析。     

Evaluation of knowledge and behavior of workers in Prince Mohammed International Airport in Western Saudi Arabia regarding public health emergency measures applied during Hajj season 2014

Objectives:

To evaluate the knowledge and behavior of workers at a Saudi airport regarding public health emergency measures applied during Hajj season.

Methods:

This study is a cross-sectional study conducted at the Prince Mohammed International Airport in Al-Madinah Al-Munawwarah, Saudi Arabia between August and September 2014. Data were collected by semi-structured questionnaires during personal interviews. Non-random purposive sampling was conducted to target workers at higher risk of acquiring infection from travellers.

Results:

One hundred and eighty-six participants were recruited of whom 92.5% were males. The study participants were workers in 8 different sectors. Twenty-six percent of the participants were health workers. Non-health workers were more likely to be concerned on acquiring infection while working at the airport compared with health workers (p=0.023). The most commonly feared disease was Ebola viral disease (EBV) among 30% of health workers, and 47% of non-health workers. Approximately 47% of non-health workers reported no knowledge of the procedures implemented during public health emergencies. The proportion of participants who received public health related training among non-health workers was significantly lower compared with health workers (p<0.00001).

Conclusion:

More emphasis should be given to educating airport workers on the potential health threats at the airport. Specific guidelines for public health emergencies at the airport should be established and communicated with airport sectors.Airports are frontier gates where proper public health measures are likely to reduce the possibility of allowing the entrance of communicable disease to a country. According to the World Health Organization (WHO) International Health Regulations mandate WHO member states to ensure that every designated point of entry is equipped with staff and instruments enabling smooth movements of the travellers while maintaining appropriate public health measures.1 Maintaining such regulations is likely to enhance proper travellers’ movement during public health emergencies by reducing possible interference between application of preventive public health measures, and the ability of travellers to access the designated points of entry. Additionally, ensuring the application of public health measures might aid in preventing the occurrence of any public health emergencies. A public health emergency is defined as any situation with health consequences that are likely to overwhelm the community’s routine capability of addressing them. A health situation can be considered as an emergency if there is a risk due to timing, such as facing emerging diseases threats during Hajj season, scale, as with an overwhelming number of causalities, or due to the unpredictability of the situation. Defining the nature of potential public health emergencies is crucial to allow competent development of preparedness plans.2 Having a large number of passengers arriving at a particular point of entry during a limited time is a burden on the available health services. A meticulous state of readiness is required to respond to any risk of spreading a communicable disease. The state of readiness is maintained by several steps including preparation of staff, equipment, and buildings.3,4 The burden of not maintaining effective public health event response measures is aggravated if an epidemic is announced in a particular region of the globe where travellers form these areas are scheduled to arrive in the country. During the Hajj season of 2014, the Ebola Virus Disease (EVD), which is a viral hemorrhagic disease, was announced as an epidemic disease in Guinea, Liberia, and Sierra Leone in West Africa. Additionally, a localized spread of the virus was announced in certain areas of Nigeria.5 The Saudi Arabian government, as a preventive measure, decided to prevent citizens of EVD-affected countries from entering the country. However, nationals of Nigeria were exempt as no extended transmission of EVD was announced.6,7 Nonetheless, several procedures were applied to prevent the transmission of Ebola virus among thousands of Nigerian pilgrims arriving in the country. These measures were mainly related to exit screening of travellers in Nigeria,8 and entry screening at points of entry in Saudi Arabia. Additionally, the Ministry of Health in Saudi Arabia produced response plans for infectious diseases (Middle East Respiratory Syndrome [MERS] and EVD) to be implemented during Hajj.9 There are many potential sources of infectious disease transmission from a single infected individual. The presence of infected travellers, such as an EVD infection, on an aircraft increases the risk of transmitting infection to neighboring passengers and flight crew. Airport workers, such as ground workers handling cleaning of aircrafts and lavatories, are at risk of the infection, especially with the presence of spilled infectious materials. Airport workers handling the flow of passengers during busy times are at risk of acquiring infection such as immigration, customs, security, and healthcare workers. Therefore, all of these individuals have to be aware of the potential health threats at the airport, should be aware of preventive methods, how to use preventive methods, and know what to do when facing a public health emergency event in the airport. Prince Mohammed Airport (Al-Madinah, Saudi Arabia) workers’ level of knowledge of the potential health threat at the airport is currently not known. Additionally, the attitude and practice of the staff when a public health emergency is announced in the airport is not measured. The significance of this study stems from the ability to investigate the degree to which airport workers, at the time of dealing with travellers during Hajj season, were able to deal with potential urgent infectious cases, and to adhere to the relevant protective guidelines.