Rapid diagnosis of acute norovirus-associated gastroenteritis: evaluation of the Xpert Norovirus assay and its implementation as a 24/7 service in three hospitals in Jönköping County, Sweden.

Noroviruses are a leading cause of epidemic and sporadic cases of acute gastroenteritis worldwide. The rapid diagnosis of norovirus infection is important for prompt infection control measures and may reduce the need for additional diagnostic testing. Here we evaluated the performance of the rapid Xpert Norovirus assay, and assessed the turn-around time (TAT) before and after the implementation of the analysis as a 24/7 service at all the three hospitals in Jönköping County, Sweden. We describe the implementation process which was performed in two steps during 2014. A total number of 276 clinical samples (stool and vomitus) from patients with symptoms of acute gastroenteritis were included in 2014-2015. The samples were analysed with the Xpert Norovirus assay and the already existing routine method: an in-house reverse transcription real-time PCR. Samples showing discrepant results with the two assays were further analysed by a third PCR method. The Xpert Norovirus assay performed well with a sensitivity of 100% and a specificity of 93% compared to the gold standard (defined as the result obtained by at least two of the three PCR methods). The median TAT decreased from 22 hours in 2013 to 2.4 hours in 2015 (p<0.001). We conclude that the performance of the Xpert Norovirus assay was excellent, and that the implementation of the analysis as a 24/7 service at all three hospitals in the county has greatly reduced the time to diagnosis which is beneficial for both patients and healthcare providers.

Point-of-care testing has a limited effect on time to clinical decision in primary health care.

OBJECTIVE: To investigate the clinical logistics of laboratory routines at primary health care centres (PHCs). DESIGN AND METHODS: Prospective registration was carried out for each PHC using questionnaires during 2-week intervals between the end of November 2001 and mid-January 2002. The study included 9 PHCs in the county of Ostergötland and 4 in the county of Jönköping, Sweden, with different numbers of blood tests analysed using point-of-care testing (POCT). Data for B-glucose, HbA1c, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), thyroid-stimulating hormone (TSH), T4, cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides were collected. Main outcome measures were median time from sampling to available test result (TATa) and median time from sampling to clinical decision (TATd), and the proportion of patients informed of the outcome of the blood test in question during the sampling occasion. RESULTS: A total of 3542 samples were collected. The median TATa showed that B-glucose, ESR and CRP were immediately analysed at all 13 PHCs. For the other tests, TATa varied from immediately to about two days. The median TATd varied from immediately to about a week. When POCT was used, 30% of the patients were informed about the outcome of the test during the sampling occasion. CONCLUSION: POCT has a limited effect on the clinical logistics in PHCs.

Association of extracellular acetylcholinesterase with gustatory nerve terminal fibers in the nucleus of the solitary tract.

Acetylcholinesterase (AChE) staining is associated with terminal fields of the glossopharyngeal and chorda tympani nerves in the nucleus of the solitary tract (NST). To address AChE function at these sites, the location of the staining was examined at the fine structural level in combination with the labeling of chorda tympani nerve fibers with biotinylated dextran in golden Syrian hamsters. AChE staining was located in the endoplasmic reticulum of geniculate ganglion neuronal somata, and extracellularly, surrounding labeled chorda tympani terminal fibers and boutons in the NST. Neuronal profiles adjacent to these labeled fibers were stained less intensely, whereas most non-adjacent profiles were unstained. The location of staining is consistent with the secretion of AChE into the extracellular space by primary afferent chorda tympani fibers. AChE staining was reduced in the dextran-labeled chorda tympani fibers and terminals as well as adjacent non-labeled profiles 2 weeks following nerve transection and dextran application. The distribution of staining outside synapses and the loss of staining following denervation is suggestive of a non-cholinergic role for AChE in the intact gustatory system.

Troponin T and I assays show decreased concentrations in heparin plasma compared with serum: lower recoveries in early than in late phases of myocardial injury.

BACKGROUND: Heparinized plasma samples allow more rapid analysis than serum samples, but preliminary studies showed lower cardiac troponin T (cTnT) results in plasma. We undertook a multicenter study to characterize this effect for cTnT and cardiac troponin I (cTnI). METHODS: Blood samples were collected with and without heparin at five hospitals. cTnT was measured by a "third generation" assay (Elecsys((R))), and cTnI was measured by a commercial immunoassay (IMMULITE((R))). RESULTS: Mean cTnT was 15% lower in heparin sampling tubes than in serum. Measured concentrations of cardiac troponins also decreased with increasing heparin concentrations added to sera. Heparin-induced losses were greater in early than in late phases after onset of chest pain. Addition of heparin ( approximately 100 IU/mL) to serial samples from nine acute myocardial infarction patients produced mean cTnT losses of 33% at 1-12 h after onset of chest pain, 17% at 13-48 h, and 7% after 48 h. The changing heparin effects were seen for both cTnT and cTnI during time courses of individual patients with myocardial infarction. CONCLUSION: We suggest that binding of heparin to troponins decreases immunoreactivity, especially in early phases of myocardial injury. The resulting losses may depend on the antibodies used in each troponin assay.

Long-term results of recurrent laryngeal nerve resection for adductor spasmodic dysphonia.

From a total of 43 adductor spasmodic patients over a 10-year period, 11 underwent resection of a portion of the recurrent laryngeal nerve on one side. The initial results were excellent but a varying degree of recurrence took place in 8 patients. In 4, a reoperation was done. At the final follow-up, 2-8 years after the primary operation, 4 patients were no longer suffering from spasmodic dysphonia, another 5 were better off than before surgery, and 1 remained unchanged. Only 1 was worse off. Electromyographic findings indicated that the recurrence of symptoms was due to regeneration of the nerve fibers.

Identification of a parasite-specific cytoplasmic 67 kDa Entamoeba histolytica antigen recognized by patient sera and monoclonal antibodies.

To avoid false positive reactions in tests for anti-ameba antibodies, we wanted to identify parasite-specific component(s). Amebiasis patient sera recognized an antigen of 67 kDa by immunoblotting in an active E. histolytica fraction obtained by ion exchange chromatography. Monoclonal antibodies against the fraction were made. Antibody 3G2 reacted with three antigenic components of 67, 40 and 25 kDa and in the immunocytology with an epitope located in the cytoplasm of E. histolytica trophozoites. ELISAs using the isolated parasite fraction and monoclonal antibody 3G2 (to assay inhibition of binding) were capable of distinguishing specific reactivity in sera from amebiasis patients.

Radiation therapy in early glottic cancer. Analysis of 177 consecutive cases.

Early vocal cord carcinomas (TiS or T1) in a consecutive series of 177 patients treated by primary radiotherapy over a 10-year period 1970-79 at the Department of General Oncology, Radiumhemmet, Karolinska Sjukhuset, were analysed regarding treatment results. In 137 cases the tumours were invasive (T1N0M0) and in 40 cases carcinoma of in situ type (TiS). Patient were treated with cobalt 60 gamma irradiation in fractions of 2 Gy up to a total dose of 64 Gy delivered as split course (CRE=17.8). Minimum follow-up time was 5 years. Tumour recurred in 21 cases (12%). All but 4 patients were rescued by subsequent surgery, giving 98% total survival. Treatment failures after primary radiotherapy were analysed in detail. Failures could not be attributed to treatment irregularities. No difference in pretreatment tumour size was detected when cured patients were compared with patients who relapsed. Biological factors that cause a relative radioresistance are considered to be the main reason for radiotherapy failures in early glottic cancer.

Tumor markers carcinoembryonic antigen, CA 50, and CA 19-9 and squamous cell carcinoma of the esophagus. Pretreatment screening.

Pretreatment serum levels of the tumor markers carcinoembryonic antigen (CEA), CA 50, and CA 19-9 in 95 patients with squamous cell carcinoma of the esophagus and 32 age-matched controls were compared. Thirty-nine percent of the cancer patients showed elevated (greater than or equal to 5 micrograms/l) serum CEA levels, 41% had elevated (greater than or equal to 17 U/ml) CA 50 levels, and 13% showed elevated (greater than or equal to 37 U/ml) CA 19-9 levels. The tumor markers showed a considerable degree of complementarity, and combined tumor marker analysis increased the sensitivity to 59%. Raised CEA levels were found significantly more frequently in intrathoracically localized tumors than in cervical cancers. Patients surviving less than 6 months showed a higher rate of elevated CEA assays than those who survived 6 to 18 months. No certain correlation was established between tumor marker elevation and tumor stage or tumor differentiation.

Does successful interferon treatment of tumor patients require life-long treatment?

Case histories of 5 tumor patients treated with natural leukocyte interferon-alpha (IFN-alpha) are presented. One patient with juvenile laryngeal papillomatosis responded well to interferon treatment, but the disease recurred when therapy was withdrawn. Upon reinstitution of treatment, the patient once again responded well. Another patient with myelomatosis also responded well to interferon therapy and in this case, too, the tumor recurred when interferon treatment was withdrawn. Reinstitution of interferon therapy was, however, unsuccessful. One patient with generalized giant cell tumor of bone responded with regression after more than 5 years of interferon treatment. Another patient with pulmonary osteosarcoma metastases, having received irradiation and interferon combination therapy followed by sole interferon treatment, responded well with a lasting stationary radiogram after 6 years of interferon treatment. One patient with malignant glioma, showing signs of tumor growth during the first few months of interferon therapy, eventually responded, and became disease-free after 6 years. The latter 3 patients are continuously receiving interferon therapy although more than 5 years have elapsed since their interferon therapy was initiated. It is suggested that interferon therapy for malignant tumors be given for life (or to progression of disease) in responding patients. Such a concept entails biological implications for interferon therapy in general and for antitumor action of interferons in particular. Other possible clinical schedules should only be constructed within the framework of controlled clinical trials.

Interferon therapy in juvenile laryngeal papillomatosis.

Seventeen patients with severe juvenile laryngeal papillomatosis (12 in Stockholm and five in Umeå) were treated with exogenous leukocyte interferon (IFN-alpha) prepared in Helsinki and Umeå, respectively. Tumor progression occurred in all cases before treatment. During treatment tumor growth diminished in all cases, up to complete tumor disappearance. Of 17 patients, nine were cured and no longer are being treated, four exhibit no tumor growth but are still being treated, one has visible tumor but only slight growth, two still have active but diminished growth, and one, who has refused further treatment, is experiencing active tumor growth as before the start of interferon therapy. It is concluded that IFN-alpha therapy in a dosage of 3 X 10(6) units three times a week intramuscularly can arrest papilloma growth. Further trials are needed to optimize treatment.

Tracheobronchial clearance after flexible fiberoptic bronchoscopy.

As the tracheobronchial mucosa is vulnerable to mechanical trauma it is important to investigate whether examination with a flexible fiberoptic bronchoscope (FFB) damages the respiratory mucosa. In 12 subjects, tracheobronchial clearance was measured 1 day before and 1 day after FFB performed under topical anaesthesia. Mucociliary transport was studied by having the patients inhale 6 micron teflon particles tagged with 99mTc, and by external measurements of the radioactivity retained in the lungs. Most of the patients had a similar clearance on both days. A marked impairment after FFB was only seen in one patient. This study suggests that the tracheobronchial clearance system has a large reserve against mechanical trauma. FFB may possibly change mucociliary clearance in some patients, and this can be of practical significance in patients unable to cough.

Interferon therapy in juvenile laryngeal papillomatosis.

Seven cases of severe juvenile laryngeal papillomatosis were treated with exogenous leukocyte interferon (IFN-alpha). Tumor progression occurred in all cases before treatment. During treatment, the tumors decreased in size. When treatment was discontinued (five cases), tumor growth recurred, and after restarting therapy, the tumors once more decreased in size. In one case, the tumor completely vanished. In another case with extensive papillomatosis that extended up to the base of the tongue, a tracheostomy could be closed with only a thin mass of papillomatous tissue that remained on the vocal cords. Exogenous leukocyte interferon therapy can affect the clinical course of juvenile laryngeal papillomatosis. The optimal schedule for therapy has yet to be determined.

Radiographic diagnosis of foreign bodies in the oesophagus.

In a group of patients suspected of harbouring a foreign body in the oesophagus, the diagnostic accuracy of radiographic examination is found to be high. Only 1 of 243 patients examined by radiography presented a false negative result.