Effect of Pentavac and measles-mumps-rubella (MMR) vaccination on the intestine

To access full text version of this article. Please click on the hyperlink "Full Text" at the bottom of this pageBACKGROUND: The safety of infant vaccination has been questioned in recent years. In particular it has been suggested that the measles, mumps, and rubella (MMR) vaccination leads to brain damage manifesting as autism consequent to the development of an "enterocolitis" in the immediate post-vaccination period. AIM: To assess if MMR vaccination is associated with subclinical intestinal inflammation, which is central to the autistic "enterocolitis" theory. METHODS: We studied 109/58 infants, before and two and four weeks after immunisation with Pentavac and MMR vaccines, for the presence of intestinal inflammation (faecal calprotectin). RESULTS: Neither vaccination was associated with any significant increase in faecal calprotectin concentrations. CONCLUSIONS: The failure of the MMR vaccination to cause an intestinal inflammatory response provides evidence against the proposed gut-brain interaction that is central to the autistic "enterocolitis" hypothesis

Utility of oropharyngeal real-time PCR for S. pneumoniae and H. influenzae for diagnosis of pneumonia in adults.

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn To access publisher's full text version of this article click on the hyperlink at the bottom of the pageor click on the hyperlink at the To access publisher's full text version of this article, please click on the hyperlink in Additional Links field top of the page marked FilesA lack of sensitive tests and difficulties obtaining representative samples contribute to the challenge in identifying etiology in pneumonia. Upper respiratory tract swabs can be easily collected and analyzed with real-time PCR (rtPCR). Common pathogens such as S. pneumoniae and H. influenzae can both colonize and infect the respiratory tract, complicating the interpretation of positive results. Oropharyngeal swabs were collected (n = 239) prospectively from adults admitted to hospital with pneumonia. Analysis with rtPCR targeting S. pneumoniae and H. influenzae was performed and results compared with sputum cultures, blood cultures, and urine antigen testing for S. pneumoniae. Different Ct cutoff values were applied to positive tests to discern colonization from infection. Comparing rtPCR with conventional testing for S. pneumoniae in patients with all tests available (n = 57) resulted in: sensitivity 87 %, specificity 79 %, PPV 59 % and NPV 94 %, and for H. influenzae (n = 67): sensitivity 75 %, specificity 80 %, PPV 45 % and NPV 94 %. When patients with prior antimicrobial exposure were excluded sensitivity improved: 92 % for S. pneumoniae and 80 % for H. influenzae. Receiver operating characteristic curve analysis demonstrated for S. pneumoniae: AUC = 0.65 (95 % CI 0.51-0.80) and for H. influenzae: AUC = 0.86 (95 % CI 0.72-1.00). Analysis of oropharyngeal swabs using rtPCR proved both reasonably sensitive and specific for diagnosing pneumonia caused by S. pneumoniae and H. influenzae. This method may be a useful diagnostic adjunct to other methods and of special value in patients unable to provide representative lower airway samples.Icelandic Center for Research Rannis Landspitali University Hospital Science Fund University of Iceland Research Fun

Incidence, Etiology, and Outcomes of Community-Acquired Pneumonia: A Population-Based Study

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked FilesBACKGROUND: The microbial etiology of community-acquired pneumonia (CAP) is often unclear in clinical practice, and previous studies have produced variable results. Population-based studies examining etiology and incidence are lacking. This study examined the incidence and etiology of CAP requiring hospitalization in a population-based cohort as well as risk factors and outcomes for specific etiologies. METHODS: Consecutive admissions due to CAP in Reykjavik, Iceland were studied. Etiologic testing was performed with cultures, urine-antigen detection, and polymerase chain reaction analysis of airway samples. Outcomes were length of stay, intensive care unit admission, assisted ventilation, and mortality. RESULTS: The inclusion rate was 95%. The incidence of CAP requiring hospitalization was 20.6 cases per 10000 adults/year. A potential pathogen was detected in 52% (164 of 310) of admissions and in 74% (43 of 58) with complete sample sets. Streptococcuspneumoniae was the most common pathogen (61 of 310, 20%; incidence: 4.1/10000). Viruses were identified in 15% (47 of 310; incidence: 3.1/10000), Mycoplasmapneumoniae were identified in 12% (36 of 310; incidence: 2.4/10000), and multiple pathogens were identified in 10% (30 of 310; incidence: 2.0/10000). Recent antimicrobial therapy was associated with increased detection of M pneumoniae (P < .001), whereas a lack of recent antimicrobial therapy was associated with increased detection of S pneumoniae (P = .02). Symptoms and outcomes were similar irrespective of microbial etiology. CONCLUSIONS: Pneumococci, M pneumoniae, and viruses are the most common pathogens associated with CAP requiring hospital admission, and they all have a similar incidence that increases with age. Symptoms do not correlate with specific agents, and outcomes are similar irrespective of pathogens identified.Icelandic Center for Research, Rannis Landspitali University Hospital Science Fund University of Iceland Research Fun

Accelerated Metastasis after Short-Term Treatment with a Potent Inhibitor of Tumor Angiogenesis

SummaryHerein we report that the VEGFR/PDGFR kinase inhibitor sunitinib/SU11248 can accelerate metastatic tumor growth and decrease overall survival in mice receiving short-term therapy in various metastasis assays, including after intravenous injection of tumor cells or after removal of primary orthotopically grown tumors. Acceleration of metastasis was also observed in mice receiving sunitinib prior to intravenous implantation of tumor cells, suggesting possible “metastatic conditioning” in multiple organs. Similar findings with additional VEGF receptor tyrosine kinase inhibitors implicate a class-specific effect for such agents. Importantly, these observations of metastatic acceleration were in contrast to the demonstrable antitumor benefits obtained when the same human breast cancer cells, as well as mouse or human melanoma cells, were grown orthotopically as primary tumors and subjected to identical sunitinib treatments

Shear wave splitting across the Iceland hot spot: Results from the ICEMELT experiment

We report on observations of upper mantle anisotropy from the splitting of teleseismic shear waves (SKS, SKKS, and PKS) recorded by the ICEMELT broadband seismometer network in Iceland. In a ridge-centered hot spot locale, mantle anisotropy may be generated by flow-induced lattice-preferred orientation of olivine grains or the anisotropic distribution of magma. Splitting measurements of teleseismic shear waves may thus provide diagnostic information on upper mantle flow and/or the distribution of retained melt associated with the Iceland mantle plume. In eastern Iceland, fast polarization directions lie between N10°W and N45°W and average N24°W; delay times between the fast and slow shear waves are generally 0.7–1.35 s. In western Iceland, in contrast, the fast polarization directions, while less well constrained, yield an average value of N23°E and delay times are smaller (0.2–0.95 s). We propose that splitting in eastern Iceland is caused by a 100- to 200-km-thick anisotropic layer in the upper mantle. The observed fast directions in eastern Iceland, however, do not correspond either to the plate spreading direction or to a pattern of radial mantle flow from the center of the Iceland hot spot. We suggest that the relatively uniform direction and magnitude of splitting in eastern Iceland, situated on the Eurasian plate, may therefore reflect the large-scale flow field of the North Atlantic upper mantle. We hypothesize that the different pattern of anisotropy beneath western Iceland, part of the North American plate, is due to the different absolute motions of the two plates. By this view, splitting in eastern and western Iceland is the consequence of shear by North American and Eurasian plate motion relative to the background mantle flow. From absolute plate motion models, in which the Eurasian plate is approximately stationary and the North American plate is moving approximately westward, the splitting observations in both eastern and western Iceland can be satisfied by a background upper mantle flow in the direction N34°W and a velocity of 3 cm/yr in a hot spot reference frame. This inference can be used to test mantle flow models. In particular, it is inconsistent with kinematic flow models, which predict southward flow, or models where flow is dominated by subduction-related sources of mantle buoyancy, which predict westward flow. Our observations are more compatible with the flow field predicted from global seismic tomography models, which in particular include the influence of the large-scale lower mantle upwelling beneath southern Africa. While the hypothesized association between our observations and this upwelling is presently speculative, it makes a very specific and testable prediction about the flow field and hence anisotropy beneath the rest of the Atlantic basin.This work was supported by the National Science Foundation under grants EAR-9316137, OCE-9402991, and EAR-9707193.Peer Reviewe

Genomic and phenotypic analysis of BRCA2 mutated breast cancers reveals co-occurring changes linked to progression

To access publisher full text version of this article. Please click on the hyperlink in Additional Links field.Inherited mutations in the BRCA2 gene greatly increase the risk of developing breast cancer. Consistent with an important role for BRCA2 in error-free DNA repair, complex genomic changes are frequently observed in tumors derived from BRCA2 mutation carriers. Here, we explore the impact of DNA copy-number changes in BRCA2 tumors with respect to phenotype and clinical staging of the disease. METHODS: Breast tumors (n = 33) derived from BRCA2 999del5 mutation carriers were examined in terms of copy-number changes with high-resolution aCGH (array comparative genomic hybridization) containing 385 thousand probes (about one for each 7 kbp) and expression of phenotypic markers on TMAs (tissue microarrays). The data were examined with respect to clinical parameters including TNM staging, histologic grade, S phase, and ploidy. RESULTS: Tumors from BRCA2 carriers of luminal and basal/triple-negative phenotypes (TNPs) differ with respect to patterns of DNA copy-number changes. The basal/TNP subtype was characterized by lack of pRb (RB1) coupled with high/intense expression of p16 (CDKN2A) gene products. We found increased proportions of Ki-67-positive cells to be significantly associated with loss of the wild-type (wt) BRCA2 allele in luminal types, whereas BRCA2wt loss was less frequent in BRCA2 tumors displaying basal/TNP phenotypes. Furthermore, we show that deletions at 13q13.1, involving the BRCA2wt allele, represents a part of a larger network of co-occurring genetic changes, including deletions at 6q22.32-q22.33, 11q14.2-q24.1, and gains at 17q24.1. Importantly, copy-number changes at these BRCA2-linked networking regions coincide with those associated with advanced progression, involving the capacity to metastasize to the nodes or more-distant sites at diagnosis. CONCLUSIONS: The results presented here demonstrate divergent paths of tumor evolution in BRCA2 carriers and that deletion of the wild-type BRCA2 allele, together with co-occurring changes at 6 q, 11 q, and 17 q, are important events in progression toward advanced disease.Eimskipafelag University Minningarsjodur Bergthoru Magnusdottur and Jakobs J Bjarnasonar Gongum Saman Icelandic Cancer Research Fund SKI Icelandic Centre for Research RANNIS The University of Icelan

Tomographic image of the Mid-Atlantic Plate Boundary in southwestern Iceland

Publisher's version (útgefin grein)The 170 km South Iceland Seismic Tomography (SIST) profile extends from the west and across the Mid‐Atlantic Ridge spreading center in the Western Volcanic Zone and continues obliquely through the transform zone (the South Iceland Seismic Zone) to the western edge of the Eastern Volcanic Zone. A total of 11 shot points and 210 receiver points were used, allowing precise travel times to be determined for 1050 crustal P wave rays and 180 wide‐angle reflections. The large amplitudes of the wide‐angle reflections and an apparent refractor velocity of 7.7 km/s are interpreted to be from a relatively sharp Moho at a depth of 20–24 km. This interpretation differs from the earlier models (based on data gathered in the 1960s and 1970s), of a 10–15 km thick crust underlain by a upper mantle with very slow velocity of 7.0–7.4 km/s. Nevertheless, these older data do not contradict our new interpretation. Implication of the new interpretation is that the lower crust and the crust‐mantle boundary are colder than previously assumed. A two‐dimensional tomographic inversion of the compressional travel times reveals the following structures in the crust: (1) a sharp increase in thickness of the upper crust (“layer 2A”) from northwest to southeast and (2) broad updoming of high velocity in the lower crust in the Western Volcanic Zone, (3) depth to the lower crust (“layer 3”) increases gradually from 3 km at the northwestern end of the profile to 7 km at the southeastern end of the profile, (4) a low‐velocity perturbation extends throughout the upper crust and midcrust into the lower crust in the area of the transform in south Iceland (South Iceland Seismic Zone), and (5) an upper crustal high‐velocity anomaly is associated with extinct central volcanos northwest of the Western Volcanic Zone. The travel time data do not support the existence of a large (> 0.5 km thick) crustal magma chamber in this part of the Western Volcanic Zone but do not exclude the possibility of a smaller one.This research was supported by the U.S. National Science Foundation, the Iceland National Science Foundation, the National Energy Authority of Iceland, the Incorporated Research Institutions for Seismology, IcelandAir, and the Lamont-Doherty Geological Observatory of Columbia University.Peer Reviewe

Severity of influenza A 2009 (H1N1) pneumonia is underestimated by routine prediction rules. Results from a prospective, population-based study.

Characteristics of patients with community-acquired pneumonia (CAP) due to pandemic influenza A 2009 (H1N1) have been inadequately compared to CAP caused by other respiratory pathogens. The performance of prediction rules for CAP during an epidemic with a new infectious agent are unknown. Prospective, population-based study from November 2008-November 2009, in centers representing 70% of hospital beds in Iceland. Patients admitted with CAP underwent evaluation and etiologic testing, including polymerase chain reaction (PCR) for influenza. Data on influenza-like illness in the community and overall hospital admissions were collected. Clinical and laboratory data, including pneumonia severity index (PSI) and CURB-65 of patients with CAP due to H1N1 were compared to those caused by other agents. Of 338 consecutive and eligible patients 313 (93%) were enrolled. During the pandemic peak, influenza A 2009 (H1N1) patients constituted 38% of admissions due to CAP. These patients were younger, more dyspnoeic and more frequently reported hemoptysis. They had significantly lower severity scores than other patients with CAP (1.23 vs. 1.61, P= .02 for CURB-65, 2.05 vs. 2.87 for PSI, P<.001) and were more likely to require intensive care admission (41% vs. 5%, P<.001) and receive mechanical ventilation (14% vs. 2%, P= .01). Bacterial co-infection was detected in 23% of influenza A 2009 (H1N1) patients with CAP. Clinical characteristics of CAP caused by influenza A 2009 (H1N1) differ markedly from CAP caused by other etiologic agents. Commonly used CAP prediction rules often failed to predict admissions to intensive care or need for assisted ventilation in CAP caused by the influenza A 2009 (H1N1) virus, underscoring the importance of clinical acumen under these circumstances.Icelandic Center for Research, Rannis 100436021 Landspitali University Hospital Science Fun