MRSA prevalence rates detected in a tertiary care hospital in Austria and successful treatment of MRSA positive patients applying a decontamination regime with octenidine.

Methicillin-resistant Staphylococcus aureus (MRSA) decontamination regimens predominantly use chlorhexidine bathing in combination with mupirocin nasal ointment. However, resistances in Staphylococcus aureus strains are increasingly common and there is a need of alternative, safe and feasible protocols. This interventional cohort study performed at the Albert Schweitzer Hospital in Graz, Austria, aimed to (1) determine MRSA prevalence at different body sites and (2) assess the efficacy of the decontamination using octenidine-based leave-on products added to existing robust infection control measures. All inpatients of this tertiary care hospital being treated in geriatric medical wards (GWs) and apallic care units (ACUs) were screened for MRSA and decontamination rates were determined after one, two or three decontamination cycles, respectively. At baseline, MRSA was detected in 25 of the 126 patients screened (19.8%). We found MRSA in 13/126 (10.3%) swabs from nasal vestibules, in 12/126 (9.5%) skin swabs, in 11/51 (21.6%) swabs from PEG-stomata or suprapubic catheters and in 8/13 (61.5%) tracheostomata swabs. A maximum of three 5-day decontamination cycles reduced the number of MRSA positive patients by 68.0%. Excluding non-compliant and deceased patients, decontamination reduced MRSA carriage by 93.3% (n = 15). No adverse events related to the applied decontamination regimen occurred. Exclusive screening of the nose might underreport MRSA prevalence rates. In this study, decontamination with octenidine-based leave-on products was safe and effective in a critical patient population.

Evaluation of induced and evoked changes in EEG during selective attention to verbal stimuli.

BACKGROUND: Two challenges need to be addressed before bringing non-motor mental tasks for brain-computer interface (BCI) control to persons in a minimally conscious state (MCS), who can be behaviorally unresponsive even when proven to be consciously aware: first, keeping the cognitive demands as low as possible so that they could be fulfilled by persons with MCS. Second, increasing the control of experimental protocol (i.e. type and timing of the task performance). NEW METHOD: The goal of this study is twofold: first goal is to develop an experimental paradigm that can facilitate the performance of brain-teasers (e.g. mental subtraction and word generation) on the one hand, and can increase the control of experimental protocol on the other hand. The second goal of this study is to exploit the similar findings for mentally attending to someone else's verbal performance of brain-teaser tasks and self-performing the same tasks to setup an online BCI, and to compare it in healthy participants to the current "state-of-the-art" motor imagery (MI, sports). RESULTS: The response accuracies for the best performing healthy participants indicate that selective attention to verbal performance of mental subtraction (SUB) is a viable alternative to the MI. Time-frequency analysis of the SUB task in one participant with MCS did not reveal any significant (p<0.05) EEG changes, whereas imagined performance of one sport of participants' choice (SPORT) revealed task-related EEG changes over neurophysiological plausible cortical areas. COMPARISON WITH EXISTING METHODS: We found that mentally attending to someone else's verbal performance of brain-teaser tasks leads to similar results as in self-performing the same tasks. CONCLUSIONS: In this work we demonstrated that a single auditory selective attention task (i.e. mentally attending to someone else's verbal performance of mental subtraction) can modulate both induced and evoked changes in EEG, and be used for yes/no communication in an auditory scanning paradigm.

The predictive value of serum soluble E-cadherin levels in breast cancer patients undergoing preoperative systemic chemotherapy.

OBJECTIVES: To date, no reliable markers are available to predict response to or to assess prognosis after preoperative systemic chemotherapy (PST) in patients with locally advanced breast cancer. Previous studies demonstrated that elevated levels of soluble E-cadherin (sE-cadherin), a product of proteolytic cleavage of cell surface E-cadherin, are associated with higher risk for metastatic disease and poor prognosis in various tumor types. We, therefore, hypothesized that serum sE-cadherin levels measured before PST may correlate with pathological response. DESIGN AND METHODS: In a retrospective analysis, sE-cadherin levels were measured in sera of 108 female patients with histologically proven breast cancer before initiation of PST by using a commercially available quantitative sandwich enzyme immunoassay technique. Patients received a median number of 4 (range 3-6) cycles of anthracyline-based chemotherapy. The median patient age was 51.5 (range 21-71) years. Tumor size was measured clinically and translated into the tumor-node-metastasis (TNM)-system before the start of chemotherapy. Histopathological response in surgically removed specimens was evaluated using a modified Sinn regression score. In univariate analyses the correlations between levels of sE-cadherin and pathological response to PST were calculated. RESULTS: The histopathological regression scores correlated significantly with tumor grading (p=0.045), clinical lymph node status before PST (p=0.031) and sE-cadherin levels (p=0.039). No correlation was seen between histopathological regression scores and hormone receptor and menopausal status as well as Her2-neu status. CONCLUSION: sE-cadherin may be a marker predicting response to PST for patients with breast cancer. Our findings warrant further evaluation of sE-cadherin in a prospective trial.

[Mobile geriatric consultant services for rest homes. Study of the effects of consultations by internal medicine specialists in the medical care of rest home residents]. / Mobiler geriatrischer Konsiliardienst für Pflegeheime. Untersuchung der Effektivität eines internistisch-fachärztlichen Konsiliardienstes zur medizinischen Versorgung von Pflegeheimbewohnern.

BACKGROUND: Hospital admissions are frequent among long-term residents of nursing homes and can result in detrimental complications affecting the patients' somatic, psychological, and cognitive status. In this prospective controlled study, we investigated the effects of a mobile geriatric consultant service (GECO) offered by specialists in internal medicine on frequency of hospitalizations in nursing home residents. METHODS: During a 10-month observation period, residents in a control nursing home received medical attendance by general practitioners as is common in Austrian nursing homes. Residents in the intervention nursing home also received the medical service of GECO. RESULTS: Within the group of rest home residents receiving GECO support, a statistically significant lower frequency of acute transports to hospitals was observed in comparison to residents of the control nursing home (mean number of acute transports to hospitals/100 residents/month: 6.1 versus 11.7; p < 0.01). The number of planned non-acute hospital and specialist office presentations was also lower in the intervention nursing home (mean number of hospital and specialist office presentations/100 residents/month: 14.4 versus 18.0); however, this difference did not reach statistical significance. CONCLUSION: This study shows that a mobile medical geriatric consultant service based on specialists in internal medicine can improve medical care in nursing homes resulting in a statistically significant reduction of acute transports to hospitals.

A phase I/II study of bortezomib and capecitabine in patients with metastatic breast cancer previously treated with taxanes and/or anthracyclines.

BACKGROUND: Proteasome inhibitors are a novel class of compounds entering clinical trials as a method to increase tumour sensitivity to standard chemotherapy. This phase I/II trial was carried out to evaluate the combination of capecitabine and the proteasome inhibitor bortezomib in anthracycline and/or taxane-pretreated patients with metastatic breast cancer. PATIENTS AND METHODS: A total of 35 patients were treated with bortezomib (1.0-1.3 mg/m(2) on days 1, 4, 8 and 11) and capecitabine (1500-2500 mg/m(2) on days 1-14) in 3-week intervals for up to eight cycles. RESULTS: The maximum tolerated doses (MTDs) were bortezomib 1.3 mg/m(2) and capecitabine 2500 mg/m(2). The treatment was generally well tolerated and associated with toxic effects that were consistent with the known side-effects of the individual agents. The intent-to-treat overall response rate was 15% and an additional 27% of patients had stable disease (SD). In the 20 patients treated at the MTD, the response rate was 15% and 40% had SD. Median time to progression and overall survival were 3.5 months [95% confidence interval (CI) 1.9-4.4] and 7.5 months (95% CI 5.6-14.6), respectively. Median duration of response was 4.4 months. CONCLUSION: The combination of bortezomib and capecitabine is well tolerated and has moderate antitumour activity in heavily pretreated patients.

A prospective randomised phase III trial of adjuvant chemotherapy with 5-fluorouracil and leucovorin in patients with stage II colon cancer.

The purpose of this trial was to investigate the efficacy of adjuvant chemotherapy with 5-fluorouracil (5-FU) and leucovorin (LV) in stage II colon cancer. Patients with stage II colon cancer were randomised to either adjuvant chemotherapy with 5-FU/LV (100 mg m(-2) LV+450 mg m(-2) 5-FU weekly, weeks 1-6, in 8 weeks cycles x 7) or surveillance only. Five hundred patients were evaluable for analyses. After a median follow-up of 95.6 months, 55 of 252 patients (21.8%) have died in the 5-FU/LV arm and 58 of 248 patients (23.4%) in the surveillance arm. There was no statistically significant difference in overall survival (OS) between the two treatment arms (hazard ratios, HR 0.88, 95% CI 0.61-1.27, P=0.49). The relative risk for tumour relapse was higher for patients on the surveillance arm than for those on the 5-FU/LV arm; however, this difference was not statistically significant (HR 0.69, 95% CI 0.45-1.06, P=0.09). Consequently, disease-free survival (DFS) was not significantly different between the two trial arms. In conclusion, results of this trial demonstrate a trend to a lower risk for relapse in patients treated with adjuvant 5-FU/LV for stage II colon cancer. However, in this study with limited power to detect small differences between the study arms, adjuvant chemotherapy failed to significantly improve DFS and OS.

The Genome Austria Tissue Bank (GATiB).

In the context of the Austrian Genome Program, a tissue bank is being established (Genome Austria Tissue Bank, GATiB) which is based on a collection of diseased and corresponding normal tissues representing a great variety of diseases at their natural frequency of occurrence from a non-selected Central European population of more than 700,000 patients. Major emphasis is put on annotation of archival tissue with comprehensive clinical data, including follow-up data. A specific IT infrastructure supports sample annotation, tracking of sample usage as well as sample and data storage. Innovative data protection tools were developed which prevent sample donor re-identification, particularly if detailed medical and genetic data are combined. For quality control of old archival tissues, new techniques were established to check RNA quality and antigen stability. Since 2003, GATiB has changed from a population-based tissue bank to a disease-focused biobank comprising major cancers such as colon, breast, liver, as well as metabolic liver diseases and organs affected by the metabolic syndrome. Prospectively collected tissues are associated with blood samples and detailed data on the sample donor's disease, lifestyle and environmental exposure, following standard operating procedures. Major emphasis is also placed on ethical, legal and social issues (ELSI) related to biobanks. A specific research project and an international advisory board ensure the proper embedding of GATiB in society and facilitate international networking.

A prospective randomised trial to study the role of levamisole and interferon alfa in an adjuvant therapy with 5-FU for stage III colon cancer.

The purpose of this trial was to examine the efficacy of the addition of levamisole (LEV) or interferon alfa (IFN) to an adjuvant chemotherapy with 5-fluorouracil (5-FU) in patients with stage III colon cancer. According to a 2 x 2 factorial study design, 598 patients were randomly assigned to one of four adjuvant treatment arms. Patients in arm one received 5-FU weekly for 1 year, patients in arm two 5-FU plus LEV, in arm three 5-FU plus IFN and patients in arm four 5-FU, LEV and IFN. The relative risk of relapse and the relative risk of death were significantly higher for patients treated with LEV compared with those without LEV treatment (HR 1.452, 95% CI 1.135-1.856, P=0.0028; HR 1.506, 95% CI 1.150-1.973, P=0.0027, respectively). No significant impact on survival was observed for therapy with IFN in the univariate analysis. The addition of LEV to adjuvant 5-FU significantly worsened the prognosis of patients with stage III colon cancer. Interferon alfa had no significant influence on survival when combined with adjuvant 5-FU, but increased the toxicity of therapy substantially.

[Late potentials in high resolution ECG in thyroid gland dysfunction]. / Spätpotentiale im High-Resolution-EKG bei Schilddrüsen-Funktionsstörungen.

In this study we examined 278 patients as to the effect of thyroidal dysfunctions upon late-potential parameters in high-resolution ECG (HR-ECG). It could be demonstrated that both hyper- and hypothyroidism tend to produce late potentials. It is remarkable that even "subclinical" dysfunctions reveal significant alterations in HR-ECG. As late potentials represent a risk factor for ventricular arrhythmias these results are an additional indication that already "subclinical" dysfunctions of thyroid gland call for an appropriate therapy. In hyperthyroidism late potentials may be eliminated rapidly by propranolol even in low dosages.