Closer to the goal: efforts in measles elimination in Germany 2010

Increasing 2-dose vaccination coverage has led to an interruption of endemic measles virus circulation in Germany. However, outbreaks after virus importation still occur and contribute to international transmission chains. Between 2003 and 2009, annual measles incidence ranged between 0.2 and 2.8 per 100,000 population. Immunization gaps have been identified especially in secondary-school students and young adults, which is also reflected by a shift in age distribution of reported measles cases toward older age groups. Stronger political commitment and standardized guidelines for outbreak containment were put in place in Germany in the past years, but the last step toward measles elimination cannot be made until the number of susceptible individuals has been further reduced. In addition to routine childhood vaccination, supplementary immunization activities are needed targeting school students and young adults to close critical immunization gaps. Intensification of public awareness and sound information on vaccinations are necessary to convince skeptics and remind the forgetful.     

Plasticity of two structural proteins: alpha-collagen and beta-keratin

Although the microstructures of Type-I collagen in bone and F-keratin in avian feathers are very different, their plastic behaviour is similar. In both plasticity is thermally activated, with the activation enthalpy H=1.1 eV in bone and 1.75 eV in feather. The activation volumes are v=0.6 nm3 in bone and v=0.83 nm3 in feather. This indicates that the rate controlling process in both is the breaking of electrostatic bonds.     

IRINI: random group allocation of multiple prognostic factors

Statistically sound experimental design in pharmacology studies ensures that the known prognostic factors, if any, are equally represented across investigational groups to avoid bias and imbalance which could render the experiment invalid or lead to false conclusions. Complete randomization can be effective to reduce bias in the created groups especially in large sample size situations. However, in small studies which involve only few treatment subjects, as in preclinical trials, there is a high chance of imbalance. The effects of this imbalance may be removed through covariate analysis or prevented with stratified randomization, however small studies limit the number of covariates to be analyzed this way. The problem is accentuated when there are multiple baseline covariates with varying scales and magnitudes to be considered in the randomization, and creating a balanced solution becomes a combinatorial challenge. Our method, IRINI, uses an optimization technique to achieve treatment to subject group allocation across multiple prognostic factors concurrently. It ensures that the created groups are equal in size and statistically comparable in terms of mean and variance. This method is a novel application of genetic algorithms to solve the allocation problem and simultaneously ensure quality, speed of the results and randomness of the process. Results from preclinical trials demonstrate the effectiveness of the method.     

Schools, office buildings, leisure settings: diversity of indoor air quality issues. Global review on indoor air quality in these settings

This review provides a global overview of indoor air quality issues in schools, office buildings and recreational settings. It presents the most recent scientific publications and the on-going work conducted in France in the frame of the indoor air quality Observatory. Monitoring campaigns on indoor air quality in schools have been carried out in the recent years in Europe. However, few studies have specifically addressed the role of exposure in these buildings on children's health. Indoor air quality in office buildings has been little studied so far. However, some specificities, such as emissions from electronic devices, frequent cleaning, impossibility to open windows in high-rise buildings, for example, should be examined and their role on the health and comfort studied. Finally, even if the time spent in recreational settings is short, the quality of indoor air should also be considered because of specific pollution. This is the case of indoor swimming pools (exposure to chlorination byproducts) and ice-rinks (exposure to exhaust from machines used to smooth the ice).     

Standard versus inverted digital luminescence radiography in detecting pulmonary nodules: A ROC analysis

Objective

Observer performance tests were conducted to compare the effect of presenting digital luminescence radiography (DLR) monitor images in positive mode (“bones black”) or negative mode (“bones white”) in the detectability of subtle lung nodules.

Methods

Five radiologists independently reviewed digital radiographs of 55 patients with either (a) a single, small (6–12 mm), non- calcified peripheral nodule confirmed by chest CT (n = 47) or (b) normal finding (n = 8) confirmed by chest CT, respectively. Mean size of pulmonary nodules was 8.3 mm (range 6–12 mm, median 7 mm). Radiographs were displayed either in standard mode (bones white) or inverse intensity (bones black). A total of 550 observations resulted. For the evaluation ROC analysis was performed using a specialized computer algorithm.

Results

The standard presentation mode showed a sensitivity of 61.7% and a specificity of 72.5%, the inverse presentation mode a sensitivity of 68.1% and a specificity of 75.0%. ROC- analysis showed that the difference between the standard mode (Az- value 0.694) and the inverse mode (Az- value 0.810) was significant in favour of the inverse presentation mode (p = 0.001). This finding was especially observed in more experienced radiologist (Az- values 0.716 vs. 0.909, P < 0.001).

Conclusion

Our study demonstrates a significant advantage of the inverse mode in the detection of small pulmonary nodules compared with the commonly used negative mode when interpreted by more experienced radiologists.

Advance in knowledge

Inverse intensity images (“bones black”) may have some advantages in the detection of small pulmonary nodules in experienced readers when presented on a stand-alone display.     

Modulation of granulocyte oxidative response by recombinant interferon α2 and γ

Summary Interferon (IFN) has been described to influence various cellular functions. In this study we investigated whether the oxidative response of polymorphonuclear leukocytes (PMN) is also affected by IFN. In order to exclude the possible influence of impurities in IFN preparations, only recombinant human IFN 2 or were used. Lucigenin-dependent chemiluminescence (CL) of PMN was measured to assess the production of oxygen radicals. IFN at a concentration of more than 10 ng/ml elicited a minimal CL response in PMN. When PMN were incubated with IFN for 1 h and then stimulated with chemotactic peptide f-met-phe (FMP), zymosan-activated serum (ZAS), zymosan particles, or phorbol-myristate acetate (PMA), the CL response was increased as consequence of the generally enhanced oxidative metabolism. IFN 2 showed no such effect at any concentration tested. A 5-min pretreatment with IFN decreased the ZAS response but did not affect the reaction to the other stimuli. The possibility of a generation of IFN by PMN during the assay could be excluded as no IFN activity could be detected in an antiviral assay after stimulation of PMN for 6 h with PolyIxPolyC, LPS, ConA, C. parvum, PMA, zymosan, or FMP. The modulation of granulocyte activity by IFN may be important in the regulation of the anti-inflammatory response of PMN.     

Variety of Expiratory Resistance Between Different Continuous Positive Airway Pressure Devices for Preterm Infants

Continuous positive airway pressure (CPAP) systems for preterm infants work with conventional ventilators or use a jet ventilation system. It is assumed that the most important advantage of jet‐CPAP systems is a lower expiratory resistance (R_E). We investigated the R_E of seven different CPAP systems. We studied two primary‐care CPAP systems, three jet‐CPAP generators, and two conventional CPAP devices. All devices were adjusted at 6 mbar and connected with a test lung simulating a standardized expiration volume. Maximum pressure increase during expiration was measured and maximum R_E was calculated. In primary‐care CPAP devices, the maximum R_E of the Benveniste valve was 9.7 mbar/L/s (SD 1.2) while that of the Neopuff was 102.8 mbar/L/s (SD 7.9) (P < 0.01). In jet‐CPAP devices, the R_E of the Infant Flow was 6.8 mbar/L/s (SD 1.7), the one of the Medijet REF 1000 was 43.5 mbar/L/s (SD 1.5), and that of the Medijet REF 1010 was 36.7 mbar/L/s (SD 0.3) (P < 0.01). In conventional CPAP systems, the R_E of the Baby Flow was 29.7 mbar/L/s (SD 1.1) and that of the Bubble CPAP was 37.1 mbar/L/s (SD 4.3) (P < 0.01). All CPAP devices created an R_E. Jet‐CPAP devices did not produce lower R_E than conventional CPAP devices.     

Hydroxychloroquine use associated with improvement in lipid profiles in rheumatoid arthritis patients

Objective

Cardiovascular disease (CVD) is the leading cause of death in patients with rheumatoid arthritis (RA). Disease‐modifying therapies that improve risk factors for CVD, such as dyslipidemia, are desired. This study used an electronic health record to determine if hydroxychloroquine (HCQ) use was associated with an improvement in lipid levels in an inception RA cohort.

Methods

All adult individuals with the initial diagnosis of RA between January 1, 2001, and March 31, 2008, were identified (n = 1,539). Only patients with at least one lipid level post–RA diagnosis were included (n = 706). Information on demographics, medical history, body mass index (BMI), laboratory measures, and medications were collected at office visits. Potential risk and protective factors for dyslipidemia were controlled for in linear mixed‐effects regression models for low‐density lipoprotein (LDL), high‐density lipoprotein (HDL), total cholesterol, triglycerides, LDL/HDL, and total cholesterol/HDL.

Results

Patients were 69% women and 98% white, with a median age of 65 years and a median BMI of 29.8 kg/m². In the adjusted regression models, HCQ use was associated with the following average differences in lipids: LDL decrease of 7.55 mg/dl (P < 0.001), HDL increase of 1.02 mg/dl (P = 0.20), total cholesterol decrease of 7.70 mg/dl (P = 0.002), triglycerides decrease of 10.91 mg/dl (P = 0.06), LDL/HDL decrease of 0.136 (P = 0.008), and total cholesterol/HDL decrease of 0.191 (P = 0.006), which were stable over time.

Conclusion

Use of HCQ in this RA cohort was independently associated with a significant decrease in LDL, total cholesterol, LDL/HDL, and total cholesterol/HDL. Considering these results, its safety profile, and low cost, HCQ remains a valuable initial or adjunct therapy in this patient population at high risk for CVD.