Evaluation of a Novel Multiplex Human Papillomavirus (HPV) Genotyping Assay for HPV Types in Skin Warts

Public Health and primary careMinor Ailment

Design of the Verbiest trial: cost-effectiveness of surgery versus prolonged conservative treatment in patients with lumbar stenosis

Background: Degenerative changes of lumbar spine anatomy resulting in the encroachment of neural structures are often regarded progressive, ultimately necessitating decompressive surgery. However the natural course is not necessarily progressive and the efficacy of a variety of nonsurgical interventions has also been described. At present there is insufficient data to compare surgical and nonsurgical interventions in terms of their relative benefit and safety. Previous attempts failed to provide clear clinical recommendations or to distinguish subgroups that substantially benefit from a certain treatment strategy. We present the design of a randomized controlled trial on (cost-) effectiveness of surgical decompression versus prolonged conservative treatment in patients with neurogenic intermittent claudication caused by lumbar stenosis. Methods/Design. The aim of the Verbiest trial is to evaluate the effectiveness of prolonged conservative treatment compared to decompressive surgery. The study is a multi-center randomized controlled trial with two parallel groups design. Patients (age over 50) presenting

Evaluation of a Novel Broad-Spectrum PCR-Multiplex Genotyping Assay for Identification of Cutaneous Wart-Associated Human Papillomavirus Types

A large number of human papillomavirus (HPV) types, distributed over five papillomavirus genera, are detectable in the skin. HPV types belonging to the alpha, gamma, and mu genera have been detected in cutaneous warts. A state-of-the-art HPV genotyping assay for these cutaneous wart-associated HPV types does not exist although warts constitute a highly prevalent skin condition, especially in children (33%) and organ transplant recipients (45%). Cutaneous warts are again the focus of attention as their clinical relevance rises with the increasing number of chronically immunosuppressed patients. The objective of this study was to develop and evaluate a DNA-based genotyping system for all known cutaneous wart-related HPV types using PCR and Luminex xMAP technology. The broad-spectrum PCR amplified DNA of all known wart-associated HPV types from the genera alpha (HPVs 2, 3, 7, 10, 27, 28, 29, 40, 43, 57, 77, 91, and 94), gamma (HPVs 4, 65, 95, 48, 50, 60, and 88), mu (HPVs 1 and 63), and nu (HPV41). The probes were evaluated using plasmid HPV DNA and a panel of 45 previously characterized cutaneous wart biopsy specimens showing high specificity. HPV was also identified in 96% of 100 swabs from nongenital cutaneous warts. HPV types 1, 2, 27, and 57 were the most prevalent HPV types detected in 89% of the swabs. In conclusion, this Luminex-based genotyping system identifies all known cutaneous wart HPV types including phylogenetically related types, is highly HPV type specific, and is suitable for large-scale epidemiological studies.Minor Ailment

Cost-effectiveness of a vocational enablement protocol for employees with hearing impairment; design of a randomized controlled trial

Background: Hearing impairment at the workplace, and the resulting psychosocial problems are a major health problem with substantial costs for employees, companies, and society. Therefore, it is important to develop interventions to support hearing impaired employees. The objective of this article is to describe the design of a randomized controlled trial evaluating the (cost-) effectiveness of a Vocational Enablement Protocol (VEP) compared with usual care. Methods/Design. Participants will be selected with the 'Hearing and Distress Screener'. The study population will consist of 160 hearing impaired employees. The VEP intervention group will be compared with usual care. The VEP integrated care programme consists of a multidisciplinary assessment of auditory function, work demands, and personal characteristics. The goal of the intervention is to facilitate participation in work. The primary outcome measure of the study is 'need for recovery after work'. Secondary outcome measures are coping with hearing impairment, distress, self-efficacy, psychosocial workload, job control, general health status, sick leave, work productivity, and health care use. Outcome measures will be assessed by questionnaires at baseline, and 3, 6, 9, and 12 months after baseline. The economic evaluation will be performed from both a societal and a company perspective. A process evaluation will also be performed. Discussion. Interventions addressing occupational difficulties of hearing impaired employees are rare but highly needed. If the VEP integrated care programme proves to be (cost-) effective, the intervention can have an impact on the well-being of hearing impaired employees, and thereby, on the costs for the company as well for the society. Trial registration. Netherlands Trial Register (NTR): NTR2782. © 2012 Gussenhoven et al; BioMed Central Ltd

Prolonged conservative treatment or 'early' surgery in sciatica caused by a lumbar disc herniation: rationale and design of a randomized trial [ISRCT 26872154]

BACKGROUND: The design of a randomized multicenter trial is presented on the effectiveness of a prolonged conservative treatment strategy compared with surgery in patients with persisting intense sciatica (lumbosacral radicular syndrome). METHODS/DESIGN: Patients presenting themselves to their general practitioner with disabling sciatica lasting less than twelve weeks are referred to the neurology outpatient department of one of the participating hospitals. After confirmation of the diagnosis and surgical indication MRI scanning is performed. If a distinct disc herniation is discerned which in addition covers the clinically expected site the patient is eligible for randomization. Depending on the outcome of the randomization scheme the patient will either be submitted to prolonged conservative care or surgery. Surgery will be carried out according to the guidelines and between six and twelve weeks after onset of complaints. The experimental therapy consists of a prolonged conservative treatment under supervision of the general practitioner, which may be followed by surgical intervention in case of persisting or progressive disability. The main primary outcome measure is the disease specific disability of daily functioning. Other primary outcome measures are perceived recovery and intensity of legpain. Secondary outcome measures encompass severity of complaints, quality of life, medical consumption, absenteeism, costs and preference. The main research question will be answered at 12 months after randomization. The total follow-up period covers two years. DISCUSSION: Evidence is lacking concerning the optimal treatment of lumbar disc induced sciatica. This pragmatic randomized trial, focusses on the 'timing' of intervention, and will contribute to the decision of the general practictioner and neurologist, regarding referral of patients for surgery

Behavioral and Neurophysiological Effects of Singing and Accompaniment on the Perception and Cognition of Song

In order to further investigate the effects of singing and accompaniment on the processing of language, a classroom experiment reported earlier was followed by an EEG experiment, using the same materials. 24 participants listened to four songs, each in one of four versions: spoken, sung a cappella, complete (sung with accompaniment), or vocalized (sung a cappella on ‘lala’). During listening, EEG was measured, and after each song, a questionnaire was filled out. Behavioral results suggest that singing supports cued word recall, even after just one exposure, and focus on the lyrics. Furthermore, an accompaniment supports positive affect and appreciation of voice quality, and decreases seriousness. A preliminary EEG data analysis reveals that out-of-key notes elicit a slightly larger ERAN and N400 than in-key notes, a smaller P2 and N5, and a larger P600, followed by a larger late negativity (‘N1400’). However, the larger ERAN and P2 are not visible in all conditions; the larger N400 is only significant in the condition complete, the larger P600 predominantly in the condition vocalized, and the late negativity only in the condition a cappella. These differences lead to the conclusion that the processing of in-key and out-of-key notes interacts with the presence of interpretable lyrics, indicating that music might affect the meaning of words or vice versa. The interaction between the processing of these notes and the presence of an accompaniment is more difficult to interpret

Analysis of low-temperature tolerance of a tomato (Lycopersicon esculentum) cybrid with chloroplasts from a more chilling-tolerant L-hirsutum accession

Growth and photosynthesis of an alloplasmic tomato (cybrid), i.e. line AH47, containing the nuclear genome of the chilling-sensitive cytoplasmic albino mutant of L. esculentum Mill. 'Large Red Cherry' (LRC) and the plastome of a more chilling-tolerant high-altitude accession of the related wild species L, hirsutum Humb. & Bonpl. LA 1777, were investigated at an optimal (25/20 degrees C) and suboptimal (16/14 degrees C) day/night temperature regime and their performance compared with that of both euplasmic parents. The cybrid shoot had a similar biomass and development rate to the nuclear tomato (L. esculentum) parent at both temperature regimes. Compared with the biomass production of shoots grown at optimal temperature, the reduction in shoot biomass at suboptimal temperature was smaller for L. hirsutum than for L, esculentum and the cybrid. This difference was related to a stronger inhibition of leaf area expansion in L, esculentum and the cybrid in the suboptimal temperature regime than in L. hirsutum. Irrespective of the temperature regime under which the plants were grown, photosynthetic performance and leaf pigment, carbohydrate and soluble-protein contents of the cybrid resembled those of the nuclear parent. No advantages of the alien L. hirsutum chloroplast with respect to growth and photosynthesis-related characteristics were observed in the cybrid in the suboptimal temperature regime, indicating that the temperature sensitivity of the photosynthetic apparatus is regulated by nuclear genes, An adverse consequence of interspecific chloroplast transfer was the increased susceptibility to chill-induced photoinhibition of the cybrid. It is concluded that cybridization is not a useful tool for improving low-temperature tolerance of tomato. (C) 2000 Annals of Botany Company