Evaluation of the amplicor HCV test: Experiences after 1 year of routine use in a diagnostic laboratory

Summary To evaluate the usefulness of a standardized commercial amplification assay for detection of hepatitis C virus (HCV) RNA, Amplicor® HCV Test (Roche), a total of 1,204 serum samples from 888 patients was examined. Seven out of 443 anti-HCV-negative samples, 638 out of 729 anti-HCV-positive samples and four out of 32 anti-HCV-indeterminate samples tested HCV RNA positive by Amplicor® in initial testing. One false-negative and five false-positive Amplicor® results were found in initial testing, giving an overall sensitivity and specificity of the Amplicor® HCV Test of 99.8% and 99.1%, respectively. Our study confirmed that the Amplicor® HCV Test is a practical, rapid, sensitive and specific assay for detection of HCV RNA. However, the results must be interpreted with some caution and with the patient's anti-HCV status and clinical data in mind.

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Evaluierung des HCV-Amplicor®-Tests: Erfahrungen aus einjähriger Anwendung im Routinelabor

Zusammenfassung Ein standardisierter kommerzieller Amplifikationsassay zum Nachweis von Hepatitis C Virus (HCV)-RNA, der Amplicor® HCV Test (Roche) wurde an 1.204 Serumproben von 888 Patienten auf seine Brauchbarkeit geprüft. Sieben von 443 anti-HCV-negativen Proben und 638 von 729 anti-HCV positiven Proben sowie vier von 32 anti-HCV unbestimmten Proben ware mit Amplicor® positiv bei erster Testung. Die Ergebnisse der ersten Testung erwiesen sich in einem Fall als falsch negativ und in fünf Fällen als falsch positiv. Für den Amplicor® HCV-Test ergibt sich daraus eine Sensitivität von 99,8% und eine Spezifität von 99,1%. Unsere Studie bestätigte, daß der Amplicor® HCV-Test ein praktischer, rasch durchführbarer, sensitiver und spezifischer Test für den Nachweis von HCV RNA ist. Die Ergebnisse müssen jedoch mit Vorsicht bewertet werden, wobei immer der anti-HCV Status des Patienten und seine klinischen Daten herangezogen werden sollten.

     

Deletion of the activating NK cell receptor NKG2D accelerates rejection of cardiac allografts

It has already been shown that neutralization of the activating NK cell receptor NKG2D in combination with co‐stimulation blockade prolongs graft survival of vascularized transplants. In order to clarify the underlying cellular mechanisms, we transplanted complete MHC‐disparate BALB/c‐derived cardiac grafts into C57BL/6 wildtypes or mice deficient for NKG2D (Klrk1^?/?). Although median survival was 8 days for both recipient groups, we detected already at day 5 posttransplantation significantly greater intragraft frequencies of NKp46⁺ NK cells in Klrk1^?/? recipients than in wildtypes. This was followed by a significantly greater infiltration of CD4⁺, but a lesser infiltration of CD8⁺ T cell frequencies. Contrary to published observations, co‐stimulation blockade with CTLA4‐Ig resulted in a significant acceleration of cardiac rejection by Klrk1^?/? recipients, and this result was confirmed by applying a neutralizing antibody against NKG2D to wildtypes. In both experimental setups, grafts derived from Klrk1^?/? recipients were characterized by significantly higher levels of interferon‐γ mRNA, and both CD4⁺ and CD8⁺ T cells displayed a greater capacity for degranulation and interferon‐γ production. In summary, our results clearly illustrate that NKG2D expression in the recipient is important for cardiac allograft survival, thus supporting the hypothesis that impairment of NK cells prevents the establishment of graft acceptance.     

Investigating acculturation orientations of patients with an immigration background and doctors in Canada: implications for medical advice adherence

Background

Increased immigration requires successful interaction of different cultures in various life domains, such as health. This study investigates acculturation orientation (AO) of immigrant patients and doctors native to the country, as a potential factor related to perceived medical advice adherence.

Data and methods

N = 171 immigrant patients (M = 54.38 years, SD = 17.94, range = 23–96, 74.3 % female) and their N = 12 doctors (M = 38.88 years, SD = 13.42, range = 27–66, 83 % female) from a hospital in Montreal, Canada, participated in a paper-based survey to assess AOs, patients’ perceived expectations of their doctor (regarding adopting the new culture or keeping their previous culture), doctors’ actual expectations, perceived quality of care and perceived adherence.

Results

AO of patients significantly related to perceived adherence, via a path model involving perceptions of doctors’ expectations and perceived quality of care. Integration was positively related to perceived adherence, while Marginalization was negatively related to it. Doctors’ AOs were not significant.

Conclusion

Patient perceptions seem to be a significant factor to be considered when striving to improve immigrant medical advice adherence.

     

Severe heart failure and the need for mechanical circulatory support and heart transplantation in pediatric patients with myocarditis: Results from the prospective multicenter registry “MYKKE”

Myocarditis represents an important cause for acute heart failure. MYKKE, a prospective multicenter registry of pediatric patients with myocarditis, aims to gain knowledge on courses, diagnostics, and therapy of pediatric myocarditis. The role of mechanical circulatory support (MCS) in children with severe heart failure and myocarditis is unclear. The aim of this study was to determine characteristics and outcome of patients with severe heart failure requiring MCS and/or heart transplantation. The MYKKE cohort between September 2013 and 2016 was analyzed. A total of 195 patients were prospectively enrolled by 17 German hospitals. Twenty‐eight patients (14%) received MCS (median 1.5 years), more frequently in the youngest age group (0‐2 years) than in the older groups (P < 0.001; 2‐12 and 13‐18 years). In the MCS group, 50% received a VAD, 36% ECMO, and 14% both, with a survival rate of 79%. The weaning rate was 43% (12/28). Nine (32%) patients were transplanted, one had ongoing support, and six (21%) died. Histology was positive for myocarditis in 63% of the MCS group. Patients within the whole cohort with age <2 years and/or ejection fraction <30% had a significantly worse survival with high risk for MCS, transplantation, and death (P < 0.001). Myocarditis represents a life‐threatening disease with an overall mortality of 4.6% in this cohort. The fulminant form more often affected the youngest, leading to significantly higher rate of MCS, transplantation, and mortality. MCS represents an important and life‐saving therapeutic option in children with myocarditis with a weaning rate of 43%.     

Health-related quality of life of carfilzomib- and daratumumab-based therapies in patients with relapsed/refractory multiple myeloma,based on German benefit assessment data

Quality of Life Research - Carfilzomib and daratumumab are licensed in relapsed/refractory multiple myeloma (RRMM), but no head-to-head trials have been conducted. We used data from dossiers...