Q fever outbreak among travelers to Germany associated with live cell therapy - United States and Canada, 2014: a co-publication.

WHAT IS ALREADY KNOWN ON THIS TOPIC?: Q fever is a zoonotic disease caused by Coxiella burnetii and is usually transmitted through inhalation of air contaminated with animal excreta. The disease is considered to be underdiagnosed because symptoms are nonspecific and can vary from patient to patient, making diagnosis difficult. WHAT IS ADDED BY THIS REPORT?: During September-October 2014, the New York State Department of Health identified Q fever in five patients with exposure to a treatment known as live cell therapy, an alternative medicine practice involving injections of fetal sheep cells, which is a type of xenotransplantation. Investigation revealed that a group of U.S. residents traveled to Germany twice a year to receive this treatment. WHAT ARE THE IMPLICATIONS FOR PUBLIC HEALTH PRACTICE?: Clinicians should consider zoonotic diseases, such as Q fever, in patients whose history includes receipt of a treatment known as live cell therapy. International travel for xenotransplantation procedures can facilitate transmission of zoonotic disease.

Interpretation of oligonucleotide mass spectra for determination of sequence using electrospray ionization and tandem mass spectrometry.

Procedures are described for interpretation of mass spectra from collision-induced dissociation of polycharged oligonucleotides produced by electrospray ionization. The method is intended for rapid sequencing of oligonucleotides of completely unknown structure at approximately the 15-mer level and below, from DNA or RNA. Identification of sequence-relevant ions that are produced from extensive fragmentation in the quadrupole collision cell are based primarily on (1) recognition of 3'- and 5'- terminal residues as initial steps in mass ladder propagation, (2) alignment of overlapping nucleotide chains that have been constructed independently from each terminus, and (3) use of experimentally measured molecular mass in rejection of incorrect sequence candidates. Algorithms for sequence derivation are embodied in a computer program that requires < 2s for execution. The interpretation procedures are demonstrated for sequence location of simple forms of modification in the base and sugar. The potential for direct sequencing of components of mixtures is shown using an unresolved fraction of unknown oligonucleotides from ribosomal RNA.

Complications of jejunostomy tube feeding in nursing facility patients.

Maintaining nutrition in patients who are unable to eat is difficult. Jenunostomy feeding has been recommended, especially for patients known to aspirate, but few data are available regarding its efficacy in the nursing home setting. We performed a retrospective review of 44 consecutive jejunostomy fed patients in a skilled nursing facility (SNF) to determine the incidence of complications, particularly aspiration pneumonia. Among them, 81.8% experienced at least one complication, most frequently tube dislodgement or obstruction. In 52.2%, intervention by the physician was required before feeding could be resumed. The incidence of aspiration pneumonia was 15.9%: 31.6% in patients who had previously aspirated and 4% in those without previous aspiration (p less than 0.05). We conclude that jejunostomy feeding does not protect against aspiration pneumonia in patients known to aspirate, and that the high overall complication rate makes its use problematic in the SNF setting.