Long-term effects of lung cancer computed tomography screening on health-related quality of life: the NELSON trial.

The long-term effects of lung cancer computed tomography (CT) screening on health-related quality of life (HRQoL) have not yet been investigated. In the Dutch-Belgian Randomised Lung Cancer Screening Trial (NELSON trial), 1,466 participants received questionnaires before randomisation (T0), 2 months after baseline screening (screen group only; T1) and at 2-yr follow-up (T2). HRQoL was measured as generic HRQoL (12-item short-form questionnaire and EuroQoL questionnaire), anxiety (Spielberger State-Trait Anxiety Inventory) and lung cancer-specific distress (impact of event scale (IES)). Repeated measures of ANOVA were used to analyse differences between the screen and control groups, and between indeterminate (requiring a follow-up CT) and negative screening result groups. At T0 and T2 there were no significant differences in HRQoL scores over time between the screen and control groups, or between the indeterminate or negative second-round screening result group. There was a temporary increase in IES scores after an indeterminate baseline result (T0: mean 4.0 (95% CI 2.8-5.3); T1: mean 7.8 (95% CI 6.5-9.0); T2: mean 4.5 (95% CI 3.3-5.8)). At 2-yr follow-up, the HRQoL of screened subjects was similar to that of control subjects, the unfavourable short-term effects of an indeterminate baseline screening result had resolved and an indeterminate result at the second screening round had no impact on HRQoL.

The impact of a lung cancer computed tomography screening result on smoking abstinence.

Receiving a lung cancer computed tomography screening result might be a teachable moment for smoking cessation, but it might also unintentionally reassure smokers to continue smoking. The objective of the present study was to investigate whether test results were associated with smoking abstinence in the Dutch-Belgian Randomised Controlled Lung Cancer Screening Trial (NELSON trial). Two random samples of male smokers who had received either only negative test results (n=550) or one or more indeterminate test result (n=440) were sent a questionnaire 2 yrs after randomisation. Smokers with an indeterminate result reported more quit attempts (p=0.02), but the prolonged abstinence rate in smokers receiving a negative test (46 (8.9%) out of 519 subjects) was comparable with the abstinence rate in smokers with one or more indeterminate results (48 (11.5%) out of 419 subjects) (p=0.19). A statistically insignificant increase was found after one or more indeterminate test result (10.9 and 15.0%, respectively) compared with receiving only negative test results (8.9%) (p=0.26). In conclusion, the outcome of the screening test had no impact on future smoking abstinence in male smokers, although all results suggest more favourable implications after one or more follow-up recommendations. Screening test outcomes could be used as a teachable moment for smoking cessation.

Arsenic in drinking water wells on the Bolivian high plain: Field monitoring and effect of salinity on removal efficiency of iron-oxides-containing filters.

In the rural areas around Oruro (Bolivia), untreated groundwater is used directly as drinking water. This research aimed to evaluate the general drinking water quality, with focus on arsenic (As) concentrations, based on analysis of 67 samples from about 16 communities of the Oruro district. Subsequently a filter using Iron Oxide Coated Sand (IOCS) and a filter using a Composite Iron Matrix (CIM) were tested for their arsenic removal capacity using synthetic water mimicking real groundwater. Heavy metal concentrations in the sampled drinking water barely exceeded WHO guidelines. Arsenic concentrations reached values up to 964 µ g L⁻¹ and exceeded the current WHO provisional guideline value of 10 µ g L⁻¹ in more than 50% of the sampled wells. The WHO guideline of 250 mg L⁻¹ for chloride and sulphate was also exceeded in more than a third of the samples, indicating high salinity in the drinking waters. Synthetic drinking water could be treated effectively by the IOCS- and CIM-based filters reducing As to concentrations lower than 10 µ g L⁻¹. High levels of chloride and sulphate did not influence As removal efficiency. However, phosphate concentrations in the range from 4 to 24 mg L⁻¹ drastically decreased removal efficiency of the IOCS-based filter but had no effects on removal efficiency of the CIM-based filter. Results of this study can be used as a base for further testing and practical implementation of drinking water purification in the Oruro region.

Anti-PM/Scl-100 and anti-RNA-polymerase III antibodies in scleroderma.

BACKGROUND: Systemic sclerosis (SSc) is a rare autoimmune disease characterized by the presence of various autoantibodies, including anti-centromere, anti-topoisomerase (Scl-70), anti-PM/Scl-100, and anti-RNA-polymerase III (RNA Pol-III) antibodies. Recently, new ELISA based immunoassays have become available for the detection of anti-PM/Scl and anti-RNA Pol-lII antibodies. OBJECTIVE: We studied the prevalence and clinical association of anti-PM/Scl-100 (PM1-Alpha) and anti-RNA Pol-III antibodies. METHODS: Antibodies to PM1-Alpha and RNA Pol-III were measured by ELISA (DR. Fooke Laboratories and Inova Diagnostics, respectively) in 242 patients with various connective tissue diseases (CTD) (including 70 SSc patients) and in 36 non-CTD controls. RESULTS: Low levels of PM1-Alpha antibodies were found in various CTDs, whereas high levels were exclusively found in SSc, dermatomyositis and polymyositis, albeit at low frequency (4.7%). Anti-RNA Pol-III antibodies were found in 7% of SSc and in 1% of non-CTD and CTD controls. Anti-centromere and anti-Scl-70 antibodies were found in 37% and 21% of SSc patients, respectively. Anti-centromere antibodies were associated with limited cutaneous SSc and anti-Scl-70 antibodies with diffuse cutaneous SSc and interstitial lung disease. Because of the low number of samples positive for anti-PM/Scl-100 or RNA Pol-III antibodies, no clinical feature was statistically correlated with the presence of either reactivity, but taken together the presence of either antibody was correlated with interstitial lung disease. Anti-PM1-Alpha and anti-RNA Pol-III antibodies were mutually exclusive with anti-Scl-70 antibodies. CONCLUSIONS: At high levels, anti-PM/Scl-100 antibodies were associated with SSc, PM, and DM, albeit at low frequency. Anti-RNA Pol-III antibodies were associated with SSc (in 7%) with high specificity.

Short-term health-related quality of life consequences in a lung cancer CT screening trial (NELSON).

BACKGROUND: In lung cancer CT screening, participants often have an indeterminate screening result at baseline requiring a follow-up CT. In subjects with either an indeterminate or a negative result after screening, we investigated whether health-related quality of life (HRQoL) changed over time and differed between groups in the short term. METHODS: A total of 733 participants in the NELSON trial received four questionnaires: T0, before randomisation; T1, 1 week before the baseline screening; T2, 1 day after the screening; and T3, 2 months after the screening results but before the 3-month follow-up CT. HRQoL was measured as generic HRQoL (the 12-item Short Form, SF-12; the EuroQol questionnaire, EQ-5D), anxiety (the Spielberger State-Trait Anxiety Inventory, STAI-6), and lung-cancer-specific distress (the Impact of Event Scale, IES). For analyses, repeated-measures analysis of variance was used, adjusted for covariates. RESULTS: Response to each questionnaire was 88% or higher. Scores on SF-12, EQ-5D, and STAI-6 showed no clinically relevant changes over time. At T3, IES scores that were clinically relevant increased after an indeterminate result, whereas these scores showed a significant decrease after a negative result. At T3, differences in IES scores between the two baseline result groups were both significant and clinically relevant (P<0.01). CONCLUSION: This longitudinal study among participants of a lung cancer screening programme showed that in the short term recipients of an indeterminate result experienced increased lung-cancer-specific distress, whereas the HRQoL changes after a negative baseline screening result may be interpreted as a relief.

Acute abdominal pain due to biliary cystadenoma.

We present a case of a biliary cystadenoma, a rare benign cystic tumor arising in most cases of the intrahepatic bile ducts. A 30-year old woman presented with abdominal pain in the right upper quadrant for about 10 days with increasing severity. Radiological evaluation by means of abdominal ultrasound and CT-scan revealed a multilocular cystic lesion in the right liver lobe, not present on abdominal ultrasound performed 10 years before. The diagnosis of a biliary cystadenoma was proposed and complete surgical resection of the mass was performed.

Informed participation in a randomised controlled trial of computed tomography screening for lung cancer.

The actual lung cancer (screening) knowledge, attitudes, risk perceptions, reasons to participate in or decline participation, and informed decisions of subjects who decided to or decided not to participate in the Dutch-Belgian randomised controlled trial for lung cancer screening in high-risk subjects (the NELSON trial) were evaluated. A total of 2,500 high-risk subjects were asked to complete a questionnaire 3 weeks after they had received a brochure with information about the trial. Differences in knowledge, attitude and risk perception between participants and nonparticipants were analysed with logistic regression analyses adjusted for sex and smoking status. The questionnaire response of trial participants was 80% (n = 889) whereas the response of nonparticipants was low (7%, n = 97) and selective. Participants' responses to knowledge items on lung cancer as a disease were on average more often correct (mean+/-sd 68+/-17%) than items on lung cancer screening (49+/-29%). Participants had adequate knowledge on lung cancer screening (51%) more often than the nonparticipants (38%; p = 0.009). Of the decisions regarding participation, 49% were uninformed, mainly due to insufficient knowledge. Most of the participants (99%) and 64% of the nonparticipants had a positive attitude towards lung cancer screening. Additional efforts are required to improve the knowledge and understanding of subjects who are in the process of decision-making regarding participation in a lung cancer screening trial.

Ee-CBP, a hevein-type antimicrobial peptide from bark of the spindle tree (Euonymus europaeus L.).

Ee-CBP, a hevein-type antimicrobial peptide was isolated from the bark of the spindle tree (Euonymus europaeus L.). This 4992.5 Da protein exhibited a very strong antifungal activity against five different fytopathogenic fungi that were tested. Concentrations required to inhibit the growth of Botrytis cinerea in agar diffusion assays and microtiterplate assays were 5 micrograms/ml and 1 microgram/ml, respectively. Comparative tests further indicated that Ee-CBP is a more potent antifungal protein than Ac-AMP2, an antimicrobial peptide from seeds of Amaranthus caudatus L. when tested with the same fungus.

[Social fate (return to work) after coronary heart surgery and/or aneurysmectomy (author's transl)]. / Soziales Schicksal bei operierten und konservativ behandelten Koronar- und Aneurysmapatienten.

The "return to work"-rate of 4 groups of patients with myocardial infarction (MI) is evaluated (all coronary angiography): Group 1: 314 patients after aorto-coronary bypass operation: mean age 50.5 years. Time after infarction 28 months, after surgery 18 months. The social fate of 52% were not yet decided. 20% got pension, 25% returned to work. Group 2: 86 patients after conservative treatment of myocardial infarction: mean age 42 years. Time after MI 18 months. The social fate of 21% was not yet decided, 41% got pension, 36% returned to work. Patients with one-vessel disease returned to work in 52%, with two-vessel disease in 20% and with three-vessel disease in 12.5%. Group 3: 24 patients after aneurysmectomy: mean age 47 years. Time after infarction 28 months, time after operation 11 months. Social fate of 8 out of 24 patients was not yet decided, 7 out of 24 got pension, 5 out of 24 returned to work. Group 4: 27 patients with conservatively treated left ventricular aneurysm: mean age 43 years. Time after infarction 42 months. The social fate of 2 out of 27 patients was not yet decided, 14 out of 27 got pension, and 8 out of 27 returned to work. Exercise-tolerance is no good indicator for the work status 18 months after myocardial infarction, 18 months after aorto-coronary bypass, 18 months after aneurysmectomy and 42 months after conservative treatment of left ventricular aneurysm. Selection of patients (all were examined by coronary angiography because of limitation by angina pectoris in daily life activities) may be partly responsible for the poor long-term work status. But more important seems to be the "tied social network". Decision for "return to work" or "pension" should be made 6 months after MI or after operation.