An Analysis of the Benefit of Using HEV Genotype 3 Antigens in Detecting Anti-HEV IgG in a European Population

Introduction Quatre génotypes pathogènes de l'hépatite E (HEV) sont actuellement connus. Ils présentent des caractéristiques épidémiologiques différentes. Les génotypes 1 et 2 infectent uniquement l'homme et sont à l'origine d'épidémies dans des pays en voie de développement. Les génotypes 3 et 4 se présentent sous forme de zoonose, endémiques chez des cochons et autres mammifères dans des pays industrialisés. Ces derniers génotypes sont à l'origine de cas sporadiques d'hépatite E autochtones. La majorité des tests de sérologie actuellement commercialisés se basent sur des virus de génotype 1 et 2. Le bénéfice de l'utilisation d'un test sérologique basé sur le génotype 3 dans des pays industrialisés n'a pas été étudié jusqu'à présent. Dans cette étude, les performances de tests sérologiques basés sur des antigènes de plusieurs génotypes de l'HEV ont été comparées. Méthode Les tests ont été appliqués à deux populations distinctes: une population de 20 patients, chez qui une infection aiguë d'hépatite E, génotype 3, a été documentée par PCR sanguine, et une population de 550 donneurs de sang de la région de Lausanne. Le dépistage des IgGs anti-HEV a été effectué dans le sérum des deux populations par trois «Enzyme Immuno Assays» (EIA) à savoir MP Diagnostics, Dia.Pro et Fortress. Les échantillons positifs avec au moins un des EIA ont été testés par un «Immunodot Assay», le recomLine HEV IgG/IgM. Tous les EIA sont basés sur des antigènes des génotypes 1 et 2, alors que l'immunodot se base sur des antigènes des génotypes 1 et 3. Résultats Tous les échantillons des cas d'hépatite E documentés et 124 sur 550 échantillons des donneurs de sang étaient positifs avec au moins un des tests sérologique. Parmi les cas confirmés par PCR, 45 %, 65 %, 95 % et 55 % étaient respectivement positifs avec le test de MP Diagnostics, Dia.Pro, Fortress et recomLine. Parmi les échantillons positifs des donneurs de sang avec au moins un des tests, 120/124 (97 %) étaient positifs avec le test Fortress, 19/124 (15 %) étaient positifs avec tous les EIA et 51/124 (41 %) étaient positifs avec le recomLine. Parmi les cas d'hépatite E confirmés, 11/20 (55 %) étaient positifs avec le recomLine et parmi ceux-ci, une réactivité plus forte pour le génotype 3 était observée dans 1/11 (9 %) et une réactivité identique dans 5/11 (45.5 %) cas. Conclusions Même si le recomLine contient des protéines dérivées de l'HEV génotype 3, sa sensibilité est inférieure à l'EIA de Fortress dans les cas d'hépatite E aiguë de génotype 3. De plus, chez environ 45 % des patients, le recomLine ne parvient pas à identifier une infection comme étant causé par un virus du génotype 3. Dans la population de donneurs de sang, nous avons observe de grandes variations dans les séroprévalences mesurées, allant de 4.2 % à 21.8 % selon les tests sérologiques employés.

Mitomycin C with continuous fluorouracil or with cisplatin in combination with radiotherapy for locally advanced anal cancer (European Organisation for Research and Treatment of Cancer phase II study 22011-40014).

PURPOSE: To assess the feasibility and activity of radio-chemotherapy with mitomycin C (MMC) and cisplatin (CDDP) in locally advanced squamous cell anal carcinoma with reference to radiotherapy (RT) combined with MMC and fluorouracil (5-FU). PATIENTS AND METHODS: Patients with measurable disease >4 cmN0 or N+ received RT (36Gy+2 week gap+23.4Gy) with either MMC/CDDP or MMC/5-FU (MMC 10mg/m(2) d1 of each sequence; 5-FU 200mg/m(2)/day c.i.v. daily; CDDP 25mg/m(2) weekly). Forty patients/arm were needed to exclude a RECIST objective response rate (ORR), 8 weeks after treatment, of <75% (Fleming 1, alpha=10%, beta=10%). RESULTS: The ORR was 79.5% (31/39) (lower bound confidence interval [CI]: 68.8%) with MMC/5-FU versus 91.9% (34/ 37) (lower bound CI: 82.8%) with MMC/CDDP. In the MMC/5-FU group, two patients (5.1%) discontinued treatment due to toxicity versus 11 (29.7%) in the MMC/CDDP group. Nine grade 3 haematological events occurred with MMC/CDDP versus none with 5-FU/MMC. The rate of other toxicities did not differ. There was no toxic death. Thirty-one patients in the MMC/5-FU arm (79.5%) and 18 in the MMC/CDDP arm (48.6%) were fully compliant with the protocol treatment (p=0.005). CONCLUSIONS: Radio-chemotherapy with MMC/CDDP seems promising as only MMC/CDDP demonstrated enough activity (RECIST ORR >75%) to be tested further in phase III trials; MMC/5-FU did not. MMC/CDDP also had an overall acceptable toxicity profile.

Application of European accounting standards to the public healthcare sector: a comparative study on the application of the European System of Accounts ESA-95 to healthcare centres in the United Kingdom, France and Germany

This report aims to analyse how European accounting standards (European System of Accounts ESA-95) are interpreted and applied to the public healthcare sector, from the standpoint of comparative law. Specifically, the study focuses on the application of ESA-95 to healthcare centres in the United Kingdom, France and Germany, with the aim of reaching useful conclusions for the Public Companies and Consortia (EPIC, for their initials in Catalan) in the Catalan Public Healthcare System.

Oral versus intravenous empirical antimicrobial therapy for fever in patients with granulocytopenia who are receiving cancer chemotherapy. International Antimicrobial Therapy Cooperative Group of the European Organization for Research and Treatment of Cancer.

BACKGROUND: Intravenously administered antimicrobial agents have been the standard choice for the empirical management of fever in patients with cancer and granulocytopenia. If orally administered empirical therapy is as effective as intravenous therapy, it would offer advantages such as improved quality of life and lower cost. METHODS: In a prospective, open-label, multicenter trial, we randomly assigned febrile patients with cancer who had granulocytopenia that was expected to resolve within 10 days to receive empirical therapy with either oral ciprofloxacin (750 mg twice daily) plus amoxicillin-clavulanate (625 mg three times daily) or standard daily doses of intravenous ceftriaxone plus amikacin. All patients were hospitalized until their fever resolved. The primary objective of the study was to determine whether there was equivalence between the regimens, defined as an absolute difference in the rates of success of 10 percent or less. RESULTS: Equivalence was demonstrated at the second interim analysis, and the trial was terminated after the enrollment of 353 patients. In the analysis of the 312 patients who were treated according to the protocol and who could be evaluated, treatment was successful in 86 percent of the patients in the oral-therapy group (95 percent confidence interval, 80 to 91 percent) and 84 percent of those in the intravenous-therapy group (95 percent confidence interval, 78 to 90 percent; P=0.02). The results were similar in the intention-to-treat analysis (80 percent and 77 percent, respectively; P=0.03), as were the duration of fever, the time to a change in the regimen, the reasons for such a change, the duration of therapy, and survival. The types of adverse events differed slightly between the groups but were similar in frequency. CONCLUSIONS: In low-risk patients with cancer who have fever and granulocytopenia, oral therapy with ciprofloxacin plus amoxicillin-clavulanate is as effective as intravenous therapy.

European cancer mortality predictions for the year 2012.

BACKGROUND: Estimating current cancer mortality figures is important for defining priorities for prevention and treatment.Materials and methods:Using logarithmic Poisson count data joinpoint models on mortality and population data from the World Health Organization database, we estimated numbers of deaths and age-standardized rates in 2012 from all cancers and selected cancer sites for the whole European Union (EU) and its six more populated countries. RESULTS: Cancer deaths in the EU in 2012 are estimated to be 1 283 101 (717 398 men and 565 703 women) corresponding to standardized overall cancer death rates of 139/100 000 men and 85/100 000 women. The fall from 2007 was 10% in men and 7% in women. In men, declines are predicted for stomach (-20%), leukemias (-11%), lung and prostate (-10%) and colorectal (-7%) cancers, and for stomach (-23%), leukemias (-12%), uterus and colorectum (-11%) and breast (-9%) in women. Almost stable rates are expected for pancreatic cancer (+2-3%) and increases for female lung cancer (+7%). Younger women show the greatest falls in breast cancer mortality rates in the EU (-17%), and declines are expected in all individual countries, except Poland. CONCLUSION: Apart for lung cancer in women and pancreatic cancer, continuing falls are expected in mortality from major cancers in the EU.

Performance Analysis of Two Quantum Reaction Dynamics Codes: Time-Dependent and Time-Independent Strategies

The computer simulation of reaction dynamics has nowadays reached a remarkable degree of accuracy. Triatomic elementary reactions are rigorously studied with great detail on a straightforward basis using a considerable variety of Quantum Dynamics computational tools available to the scientific community. In our contribution we compare the performance of two quantum scattering codes in the computation of reaction cross sections of a triatomic benchmark reaction such as the gas phase reaction Ne + H2+ %12. NeH++ H. The computational codes are selected as representative of time-dependent (Real Wave Packet [ ]) and time-independent (ABC [ ]) methodologies. The main conclusion to be drawn from our study is that both strategies are, to a great extent, not competing but rather complementary. While time-dependent calculations advantages with respect to the energy range that can be covered in a single simulation, time-independent approaches offer much more detailed information from each single energy calculation. Further details such as the calculation of reactivity at very low collision energies or the computational effort related to account for the Coriolis couplings are analyzed in this paper.