Fever and neutropenia in cancer patients: the diagnostic role of cytokines in risk assessment strategies

Cancer patients treated with chemotherapy are susceptible to bacterial infections. Therefore, all neutropenic cancer patients with fever receive standard therapy consisting of broad-spectrum antibiotics and hospitalization. However, febrile neutropenia in cancer patients is often due to other causes than bacterial infections. Therefore, standard therapy should be re-evaluated and new treatment strategies for patients with variable risk for bacterial infection should be considered. This paper reviews the changing spectrum of microorganisms and resistance of microorganisms to antibiotics in infection during neutropenia and discusses new strategies for the selection of patients with low-risk for bacterial infection using clinical and biochemical parameters such as acute phase proteins and cytokines. These low-risk patients may be treated with alternative therapies such as oral antibiotics, early discharge from the hospital or outpatient treatment.     

Validity of the Hewlett-Packard actograph in detecting fetal movements.

OBJECTIVE: To detect fetal movements during non-stressed cardiotocography to evaluate the validity of the Hewlett-Packard Doppler ultrasound actograph in detecting fetal movements. METHODS: This was a prospective, observational study. Thirty healthy pregnant women were divided into two gestational age groups (Group I, 31 + 0 to 34 + 0 weeks, n = 15; Group II, 37 + 0 to 40 + 0 weeks, n = 15). A Hewlett-Packard M-1350-A actocardiograph was used to make recordings of 45 min for each woman. Fetal movements were also detected sonographically by an observer and they were recorded independently by the pregnant woman. Ninety consecutive 30-s periods were analyzed to study agreement between the three techniques. RESULTS: The mean total agreement for fetal activity plus quiescence between ultrasound and the actograph was 63.7% for Group I, and 72.2% for Group II. In cases of fetal activity only, these values were 45.8% and 47.6%, respectively. Total agreements between ultrasound and the pregnant woman were 74.0% and 79.0%, respectively, for Groups I and II. Cohen's kappa values for total agreement between ultrasound and actograph were 0.31 (95% CI, 0.27-0.36), indicating 'fair' agreement in Group I, and 0.43 (95% CI, 0.38-0.47), indicating 'moderate' agreement in Group II. CONCLUSIONS: Use of the Hewlett-Packard actograph may offer some additional information during routine cardiotocography. However, our results were disappointing; the technique appears not to be suitable for detailed recordings of fetal behavior, and may even be misleading when difficult cardiotocographic patterns have to be interpreted.     

Insufficient protection against infection with HIV in general and orthopedic surgeons

In a study of the content of occupational health care for hospital workers we carried out a separate study to measure the professional protection used to prevent contamination with HIV or hepatitis B virus. Therefore we carried out a study among Dutch general and orthopaedic surgeons. A questionnaire was sent to a representative sample of this population. The conclusions are that the respondents are relatively poorly informed about HIV and (or) hepatitis risks. A relatively small part of the respondents used protecting instruments; 40 (operating rooms) and 83% (emergency departments) of the respondents did not use safety glasses. The availability of protecting instruments is higher in operating rooms than in emergency departments, but this availability does not imply use of these instruments. The information on occupational contamination risks, the individual safety measures and the quality of the safety glasses are subject to criticism.     

特应性皮炎患者CD4^＋T淋巴细胞中皮肤归巢、增殖和凋亡相关基因的表达差异

CD4 T淋巴细胞在变态性疾病中,包括在受累组织和全身均起着重要作用。本研究旨在通过分析未激活CD4 T淋巴细胞的基因表达谱来研究特应性皮炎(A D)患者外周血CD4 T淋巴细胞在体内的激活状态。使用寡核苷酸微阵列检测分析5例特应性皮炎患者和7例健康对照外周血CD4 T淋巴细胞的M R     

Transabdominal cerclage

The procedure of the transabdominal cerclage (TAC) is outlined. Sixteen cases of TAC are described in detail. The fetal salvage rate increased from 36% before to 96% after the operation. Caesarean section has to be performed at term after TAC has been applied. The transabdominal method of cerclage seems to be very promising, especially for women with severely damaged or practically absent cervices.     

Gender Differences in Work Modifications and Changed Job Characteristics During the Return-To-Work Process: A Prospective Cohort Study

Objectives To describe gender differences in work modifications and changed job characteristics during return-to-work after sickness absence. Methods A 13 month prospective cohort study was performed among 119 employees (54 women and 65 men) who had reported sick for more than 1 month due to mental or musculoskeletal disorders. Men and women were of comparable ages and educational levels, worked in similar sectors, at corresponding functional levels, and were experiencing the same types of health disorders. They were interviewed bi-monthly. Work modifications and job characteristics were assessed at return-to-work. Job characteristics were also assessed upon the employee’s inclusion in the study. Results Work modifications occurred in 77.4% of the return-to-work attempts (no gender differences); reduced working hours, reduced work pace, or task reassignments were most frequent. Compared to men, reduced hours and pace were more often used for women between 12 and 20 weeks of absence (P > 0.001 and 0.01 < P < 0.001 respectively) and reduced hours also during the whole period (0.01 < P < 0.001). Applying reduced hours related to type of disorder in men and applying different time-schedules in women. Upon return to work both women and men reported increased job autonomy and emotional demands (P < 0.001); women reported more job satisfaction (P < 0.001). Conclusions Work modifications were widely applied during the return-to-work process and predominantly aimed at reduction of pressure at work. Women had a few more work modifications. The marginal gender differences may be due to male and female respondents having similar characteristics. Upon return to work some job characteristics improved.