Implementation and evaluation of a nurse-led decision-coaching program for healthy breast cancer susceptibility gene (BRCA1/2) mutation carriers: a study protocol for the randomized controlled EDCP-BRCA study.

BACKGROUND: Female BRCA mutation carriers have an increased lifetime risk for breast and ovarian cancer compared to the general population. Women who carry this mutation have several options to deal with their cancer risk, such as risk-reducing surgeries or intensified breast cancer screening. Previous research has shown that preferences in this scenario are highly dependent on affected women's personalities and value systems. To support these women in the decision-making process, a structured decision support consisting of decision coaching combined with a decision aid might be helpful. METHODS/DESIGN: A randomized controlled trial will be conducted in order to compare usual care with structured decision support alongside usual care. The decision support program entails nurse-led decision coaching as well as an evidence-based patient decision aid. Nurses are qualified by a 4-day training program in informed decision-making and decision coaching. Six centers for Familial Breast and Ovarian Cancer in Germany will be included in the study, with a planned sample size of 398 women. The primary outcome is the congruence between the preferred and the actual played role in the decision-making process as measured by the Control Preferences Scale. It is hypothesized that the structured decision support will enable women to play the preferred role in the decision-making process. Secondary outcomes include the knowledge and attitudes about preventive options, decisional conflict, depression and anxiety, coping self-efficacy, impact of event, and self-concept. A process evaluation will accompany the study. DISCUSSION: The EDCP-BRCA study is the first study to implement and evaluate decision coaching combined with a decision aid for healthy BRCA mutation carriers worldwide. TRIAL REGISTRATION {2A}: DRKS-ID: DRKS00015527. Registered 30 October 2019.

Inhibitors of DNA Methylation, Histone Deacetylation, and Histone Demethylation: A Perfect Combination for Cancer Therapy.

Epigenetic silencing and inappropriate activation of gene expression are frequent events during the initiation and progression of cancer. These events involve a complex interplay between the hypermethylation of CpG dinucleotides within gene promoter and enhancer regions, the recruitment of transcriptional corepressors and the deacetylation and/or methylation of histone tails. These epigenetic regulators act in concert to block transcription or interfere with the maintenance of chromatin boundary regions. However, DNA/histone methylation and histone acetylation states are reversible, enzyme-mediated processes and as such, have emerged as promising targets for cancer therapy. This review will focus on the potential benefits and synergistic/additive effects of combining DNA-demethylating agents and histone deacetylase inhibitors or lysine-specific demethylase inhibitors together in epigenetic therapy for solid tumors and will highlight what is known regarding the mechanisms of action that contribute to the antitumor response.

[Smoking habits of employees and patients in the psychiatric department of a general hospital]. / Rauchverhalten von Mitarbeitern und Patienten der psychiatrischen Abteilung eines Allgemeinkrankenhauses.

OBJECTIVE: Health promotion is becoming an increasingly more meaning in hospitals within their health promotion, primary and secondary prevention programmes. With reference to the preventive measures regarding nicotine dependence, it was first of all the objective of this study to determine the smoking habits of employees and patients in a psychiatric clinic. The question was also which implications for clinical practice could be drawn from this. METHODOLOGY: Apart from the Fagerstroem Test for nicotine dependence, a new questionnaire was developed, supported by the questionnaire "Smoke free in hospital", developed by the Federal Agency for Health Education, and implemented. 382 Patients and 484 employees were questioned. The statistical analysis was done using SPSS, and in addition thereto, the T-Test and the chi (2)-Test were used. RESULTS: Definite gender differences pertaining to smoking habits could be demonstrated. Women smoked less often (p < 0.001) and less (p < 0.01) than men and were less dependent on nicotine (p < 0.007). With increasing age, the number of smokers declined. In questioning the employees, it was clear, that there were no significant differences between doctors and nurses regarding their smoking habits. However, employees in the clinic working shifts were consuming more cigarettes daily (p < 0.044) and had a higher degree of dependence (p < 0.01). On questioning the patients, it was demonstrated that the number of smokers (92%) consuming cigarettes, dependence were significantly higher on the wards for dependence diseases. Overall it was clear that there were definite qualitative and quantitative differences in the smoking habits of both patients and employees. Patients smoke more often (p < 0.001) and are more dependent (p < 0.001) than employees. There were no differences between the two groups regarding the motivation to stop smoking (smokers willing to stop: 36%). However, more patients (38.5%) than employees (23.8%) expressed the opinion, that it is the task of the Hospital employees to regularly point out the risks of smoking. DISCUSSION: In the psychiatric clinic in question, the results demonstrated that cigarette consumption and nicotine dependency, for both patients and employees, are serious problems that can be transferred into comparable clinics and departments. Patients are more affected than employees. Other studies proved that psychiatric patients smoke twice as much as people without psychiatric diseases. CONCLUSION: Against the background, that health promotion and prevention should increasingly become the task of every hospital, further studies will be necessary to establish health promotive activities influencing smoking patients and employees. Specific treatment modalities regarding the motivation to change are still not available. Added to that, it must be tested within the German Health System, whether a clinically supervised smoking cessation programme complementing the treatment of the main diagnosis (a psychiatric disease) is demanded by the affected person, whether the clinic can finance it, and whether it can be successfully implemented.

Sarcocystis mephitisi n. sp. (Protozoa: Sarcocystidae), Sarcocystis neurona-like and Toxoplasma-like infections in striped skunks (Mephitis mephitis).

Two structurally distinct types (A, B) of microscopic sarcocysts were found in muscles of 4 of 5 feral skunks. Type A sarcocysts had sarcocyst walls of up to 6 microm thick. The villar protrusions (Vp) on the sarcocyst wall were up to 5 microm long. The Vp were constricted at the base, expanded in the middle, and had a blunt tip. Numerous microtubules were present in the Vp and in the granular layer. Bradyzoites were up to 11 microm long and up to 3.2 microm wide. Based on the distinctiveness of the Vp, a new name, Sarcocystis mephitisi is proposed for type A sarcocysts. Type B sarcocysts had a relatively thin (approximately 1-2 microm thick) sarcocyst wall and the Vp were slender and tapered toward the tip. These sarcocysts were structurally similar to S. neurona sarcocysts. A Toxoplasma gondii-like tissue cyst was found in a section of tongue of 1 of the 4 skunks.

Muscular Sarcocystis infection in a bear (Ursus americanus).

Sarcocysts of an unidentified Sarcocystis species were found in sections of skeletal muscles of a black bear (Ursus americanus) from North Carolina. Two sarcocysts in a section measured 45 x 37.5 microm and 67.5 x 50 microm and had a thin (<2 microm) sarcocyst wall. The villar protrusions on the cyst wall were up to 2 microm long and up to 0.7 microm wide. The bradyzoites were approximately 6 X 2.5 microm in size. This is the first report of muscular Sarcocystis in a bear.

Release of chromaffin granular content from staphylococcal enterotoxin B (SEB)-treated and -untreated PC12 cells.

The release of chromaffin granular content from staphylococcal enterotoxin B (SEB)-treated and -untreated PC12 cells was studied by electron microscopy. The treatment of the cells with SEB at the concentration of 20 micrograms/ml caused marked increase of the chromaffin granules that either bound to the plasma membrane by the characteristic rods, measuring 15 to 20 nm in length and showing a tubular structure, or budded off at the free cell surface, surrounded by a layer of rod-containing cytoplasm and enclosed by the plasma membrane. The binding between the granular and plasma membranes by the rods did not lead to membrane fusion and exocytosis of the granular content. Many of the bound granules showed vesiculation with loss of the electron-dense core material; at the same time, some of the binding rods contained intraluminal electron-dense material similar to the granular core material. These findings suggested that the electron-dense material (i.e., norepinephrine) of the bound granules was released extracellularly through channels within the rods. Although the granules were bound to the plasma membrane with equal frequency at the free and contiguous cell surfaces, the granular budding occurred only at the free cell surface, indicating that it occurred incidentally to some granules bound at the free cell surfaces. On the basis of the morphological observations, it is postulated that the electron-dense material of the bound granule is selectively released extracellularly through the rods, leaving the vesiculated granules behind in the cytoplasm. The same mode of release of the granular content was observed, though less frequently, in the untreated control cells. No morphological evidence that indicated that the granular content was released extracellularly by exocytosis was found in the treated and control cells. The present observations indicated that the SEB treatment of PC12 cells stimulated the binding of chromaffin granules to the plasma membrane by the rods and the budding of the bound granules at the free cell surface.

Neosporosis-associated abortion in a dairy goat.

Neospora canium tachyzoites and tissue cysts were found in tissues of a goat fetus aborted after 3.5 months of gestation. The fetus had hydrocephalus and a hypoplastic cerebellum. The predominant lesion in the fetus was severe encephalitis associated with numerous N canium tissue cysts. Parasites in fetal tissues reacted positively with N caninum antibodies in immunohistochemical tests. The doe was clinically normal and had a 1:800 antibody titer to N caninum as determined by use of an indirect fluorescent antibody test 9 months after abortion. Five of 77 other does from this herd also had indirect fluorescent antbody titers to N caninum that were > or = 1:100.

Fatal congenital Neospora caninum infection in a lamb.

Neospora caninum tissue cysts were found in the brain and spinal cord of a 1-wk-old lamb that was unable to stand after birth. The lamb was originally diagnosed as having toxoplasmosis, but ultrastructural and immunohistochemical techniques used in the present study permitted a definitive diagnosis of Neospora caninum tissue cysts in the brain and spinal cord of this lamb. This is the first report of N. caninum in sheep.

In vivo hematopoietic effects of recombinant interleukin-1 alpha in mice: stimulation of granulocytic, monocytic, megakaryocytic, and early erythroid progenitors, suppression of late-stage erythropoiesis, and reversal of erythroid suppression with erythropoietin.

Interleukin-1 alpha (IL-1 alpha) is a macrophage-derived, multifunctional cytokine that broadly potentiates myelopoiesis and induces the synthesis of hematopoietic colony-stimulating factors (CSF) in vitro and in vivo. To evaluate the possibility for use of IL-1 alpha in ameliorating in vivo bone marrow suppression induced by drugs or radiation, we examined the in vivo effects of the cytokine on erythropoietic and other hematopoietic progenitor cells. Normal mice were treated with a single intraperitoneal (IP) injection of recombinant human IL-1 alpha at varying doses and were assayed at various times post-treatment. By six hours postinjection, a significant suppression of mature erythroid progenitors (CFU-E) was observed in animals treated with IL-1 alpha (0.5 micrograms/mouse), with maximum suppression of CFU-E and peripheral blood reticulocyte counts occurring at 24 hours. Decreases in peripheral blood hematocrit did not occur after a single IL-1 alpha injection but were observed after multiple injections of the cytokine. The suppressive effects of IL-1 alpha on late-stage erythropoiesis were abrogated by simultaneous administration of erythropoietin (EPO). At 48 hours post-treatment, a marked stimulation was observed in the numbers of spleen and marrow immature erythroid (BFU-E), macrophage (CFU-M), granulocyte (CFU-G), granulocyte-macrophage (CFU-GM), and megakaryocyte (CFU-meg) progenitor cells. These results demonstrate the potential use of IL-1 alpha as a generalized stimulator of hematopoiesis and show that the cytokine-induced suppression of late-stage erythropoiesis can be prevented by EPO.

Toxoplasmosis in black-faced kangaroos (Macropus fuliginosus melanops).

An epizootic of toxoplasmosis among captive black-faced kangaroos (Macropus fuliginosus melanops) is reported. Eight of 25 adult kangaroos had antibodies to Toxoplasma gondii. Serologic data indicated recent exposure to T. gondii in six kangaroos. Two kangaroos had high T. gondii antibody titers (greater than or equal to 16,384) in the modified agglutination test and their infants died when less than 7 months old. Toxoplasma gondii tachyzoites were found in several organs of one infant kangaroo (joey) that died at about 82 days of age and numerous cysts were seen in skeletal muscles of the other joey that died at about 7 months of age. Adult kangaroos had subclinical infections. The modified agglutination test and the dye test were more sensitive than the indirect hemagglutination and latex agglutination tests for the detection of T. gondii antibodies in kangaroo sera.

Neonatal Neospora caninum infection in dogs: isolation of the causative agent and experimental transmission.

Neospora caninum infection was diagnosed in 5 young dogs from 2 litters with a common parentage. The pups were born healthy, but developed hind limb paresis 5 to 8 weeks after birth. The predominant lesions were polyradiculoneuritis and granulomatous polymyositis. Neospora caninum was seen microscopically in sections of naturally infected pups, and was isolated in cell cultures, mice, and dogs inoculated with infected canine tissues. Antibodies to N caninum were detected in sera of infected dogs by indirect fluorescent antibody test.