Low risk of viral infection after administration of vapor-heated factor VIII concentrate. International Investigator Group

A multicenter prospective study was carried out to evaluate whether a vapor-heated factor VIII concentrate transmitted blood-borne viral infections over a surveillance period of 15 months. Thirty-five patients with hemophilia and von Willebrand disease who had never received any blood components were treated. Twenty-eight were analyzed and found not to have non-A, non-B hepatitis. Sera from 20 of these 28 patients were also tested for the antibody to the hepatitis C virus. None had sero-converted during the follow-up period. None of the patients analyzed developed markers of the hepatitis B virus (n = 17) or the human immunodeficiency virus (n = 31). This vapor-heated factor VIII concentrate carries a low risk of transmitting hepatitis and human immunodeficiency virus infection.     

Immune response gene function correlates with the expression of an Ia antigen. II. A quantitative deficiency in A(e):E(a), complex expression causes a corresponding defect in antigen-presenting cell function

A series of experiments were performed to explore the role of complementing major histocompatability complex (MHC)-linked immune response Ir genes in the murine T cell proliferative response to the globular protein antigen pigeon cytochrome c. The functional equivalence of I-E-subregion-encoded, structurally homologous E(a) chains from different haplotypes bearing the serologic specificity Ia.7 was demonstrated by the complementation for high responsiveness to pigeon cytochrome c of F(1) hybrids between low responder B 10.A(4R) (I-A (k)) or B 10.S (I-A(8)) mice and four low responder E(a)- bearing haplotypes. Moreover, this Ir gene function correlated directly with both the ability of antigen-pulsed spleen cells from these same F(1) strains to stimulate pigeon cytochrome c-primed T cells from B10.A or B10.S(9R) mice, and with the cell surface expression of the two-chain Ia antigenic complex, A(e):E(a), bearing the conformational or combinatorial determinant recognized by the monoclonal anti-Ia antibody, Y-17. The B 10.PL strain (H-2(u)), which expresses an Ia.7-positive I-E- subregion-encoded E(a) chain, failed to complement with B10.A(4R) or B10.S mice in the response to pigeon cytochrome c. However, (B10.A(4R) × B10.PL)F(1) and (B10.S × B10.PL)F(1) mice do express A(k)(e):E(u)(a) and A(8)(e):E(u)(a) on their cell surface, although in reduced amounts relative to A(k,s)(e):E(k,d,p,r)(a) complexes found in corresponding F(1) strains. This quantitative difference in Ia antigen expression correlated with a difference in the ability to present pigeon cytochrome c to B 10.A and B 10.S(9R) long-term T cell lines. Thus, (B10.A(4R) × B10.PL)F(1) spleen cells required a 10-fold higher antigen dose to induce the same stimulation as (B10.A(4R) × B10.D2)F(1) spleen cells. In addition, the monoclonal antibody, Y-17, which reacts with A(e):E(a) molecules of several strains, had a greater inhibitory effect on the proliferative response to pigeon cytochrome c of B10.A T cells in the presence of (B10.A(4R) X B10.PL)F(1) spleen cells than in the presence of (B10.A(4R) X B10.D2)F(1) spleen cells. These functional data, in concert with the biochemical and serological data in the accompanying report, are consistent with the molecular model for Ir gene complementation in which appropriate two-chain Ia molecules function at the antigen-presenting cell (APC) surface as restriction elements. Moreover, they clearly demonstrate that the magnitude of the T cell proliferative response is a function of both the concentration of nominal antigen and of the amount of Ia antigen expressed on the APC. Finally, the direct correlation of a quantitative deficiency in cell surface expression of an Ia antigen with a corresponding relative defect in antigen-presenting function provides strong independent evidence that the I-region-encoded Ia antigens are the products of the MHC-linked Ir genes.     

Reduced Detection of Chlamydia trachomatis by the Ligase Chain Reaction Assay due to Suboptimal Storage of Urine

Detection of Chlamydia trachomatis by the ligase chain reaction assay was assessed in urine samples that had been stored at 4°C and at ambient temperature for 6–10 days before testing. Six of 67 (9%) ligase chain reaction-positive urine samples stored at 4°C and 5 of 29 (17%) stored at ambient temperature became negative, a difference that is not statistically significant. Most of the urine samples that were negative after storage contained a small number of chlamydial elementary bodies, and almost three-quarters of them were from women. Optimal pretest storage conditions for urine samples should be maintained if the maximum benefit is to be obtained from this highly sensitive assay. Electronic Publication     

General practitioners' immediate management of men presenting with urethral symptoms.

OBJECTIVES: To describe the immediate reported management, by general practitioners (GPs), of men presenting with symptoms of urethral discharge, or dysuria only. SUBJECTS: All 692 GPs in practice in Brent, Harrow, Ealing, Hammersmith, and Hounslow (UK). METHOD: Data were collected using a GP completed questionnaire concerning the management of the last male patient seen, aged less than 40 years, complaining of urethral discharge, and the last male patient under 40 years complaining of dysuria only. RESULTS: The response rate among GPs was 52%. Fifty three per cent of men with urethral symptoms, 86% of men with a urethral discharge and 24% with dysuria only, were identified by GPs and referred without investigation or treatment to a genitourinary medicine clinic. Of men with dysuria only, 93% of investigations by GPs were reported to include a mid-stream urine (MSU) specimen for bacteriology, and 19% a urethral swab for chlamydia. Seventy eight per cent of GPs reported using treatments with a broad spectrum antibiotic, 53% with trimethoprim, whilst 14% of GPs reported using a tetracycline in common use to treat non-gonococcal urethritis. Urine specimens were reported to be "culture positive" in 41% of men who had an MSU specimen tested, and 15% of men who had a urethral swab tested were reported to be chlamydia positive. CONCLUSION: The GPs included in this study were not a full sample, or representative of all the GPs, and the data are retrospective. Nevertheless, we found a large difference in GPs reported management for men with urethral symptoms according to whether or not urethral discharge was a reported complaint. Reported management is likely to be, at least, indicative of actual management. Therefore, the results suggest that assessment by GPs of men presenting with dysuria should be explored and more appropriate management strategies defined.     

Anti-Ata causing mild hemolytic disease of the newborn

We report here a case of moderately severe hemolytic disease of the newborn (HDN) due to anti-Ata. The gravida 5 proposita was group A rr and previously was found to have anti-Ata and -D. At the 35-week mark of this pregnancy, her anti-Ata demonstrated a titer of 256, score 79. Fluid obtained by amniocentesis at 36 weeks showed an optical density at 450 nm of 0.08 (midzone). The baby was delivered at 38 weeks by cesarean section. The cord cells were group A rr with a 3+ direct antiglobulin test. The dichloromethane eluate of the infant's cells demonstrated anti-Ata specificity only. At birth, the infant's total bilirubin (TB) was 2.1 mg per dl and the hematocrit level (Hct) was 33.8 percent. Within 8 hours, the TB had risen to 3.8 mg per dl. Phototherapy was initiated at 7-1/2 hours and maintained for 40 hours. The infant's TB rose to a maximum level of 10.5 mg per dl 24 hours after phototherapy was discontinued. At discharge 4 days postpartum, the infant's TB had dropped to 9.2 mg per dl, and the Hct value was 38 percent. On a visit 7 days postpartum, the infant's TB level had fallen to 6.5 mg per dl and the hct value was 38 percent. Transfusions were not necessary.     

灯盏花素对糖尿病大鼠早期肾皮质一氧化氮和血管紧张素Ⅱ水平的影响

目的:以肾脏肥大指数、肾小球形态结构、一氧化氮和血管紧张素Ⅱ水平为指标,观察灯盏花素对糖尿病大鼠早期肾脏的保护作用。方法:实验于2006-03/06在遵义医学院珠海校区中心实验室完成。实验分组:雄性Wistar大鼠34只,腹腔单次注射链脲佐菌素65mg/kg制备糖尿病大鼠模型,将造模成功(血糖≥16.65mmol/L)30只大鼠随机分为糖尿病组和灯盏花素治疗组,每组10只;另设正常对照组10只。实验过程:灯盏花素治疗组给予20mg/(kg·d)腹腔注射灯盏花素注射液持续4周,糖尿病组及正常对照组给予同体积的生理盐水。实验评估:①4周后计算肾脏肥大指数(肾脏肥大指数=双侧肾质量/体质量׉)。②苏木精-伊红染色观察肾小球病理形态变化。③硝酸还原酶法测定血清及肾皮质组织一氧化氮水平。④放免法测血浆及肾皮质组织血管紧张素Ⅱ水平。结果:参加实验34只大鼠,有4只未达糖尿病成模标准,最终30只大鼠进入结果分析。①肾脏肥大指数:糖尿病模型组、灯盏花素治疗组显著高于正常对照组[(13.29±4.73)/1000,(11.07±2.19)/1000,(4.78±0.06)/1000,P<0.01],灯盏花素治疗组低于糖尿病模型组(P<0.05)。②肾小球病理形态:正常对照组大鼠肾小球血管袢薄而清晰,内皮细胞和系膜细胞数目正常;糖尿病大鼠肾小球血管壁可见玻璃样变性,基底膜增厚,系膜基质增生;灯盏花素治疗后肾小球血管壁未见明显变性,基底膜未见明显增厚,其病理变化明显改善。③血清及肾皮质组织一氧化氮水平:糖尿病模型组、灯盏花素治疗组显著高于正常对照组[血清一氧化氮水平:(31.36±4.21),(27.03±3.54),(25.21±3.39)μmol/L,P<0.05;肾皮质组织一氧化氮水平:(1.95±0.25),(1.27±0.32),(0.73±0.12)μmol/g,P<0.01]。灯盏花素治疗组低于糖尿病模型组(P<0.05,P<0.01)。④血浆和肾皮质组织血管紧张素Ⅱ水平:糖尿病模型组显著高于正常对照组[血浆血管紧张素Ⅱ水平:(693.98±297.22),(356.48±85.21)ng/L,P<0.05;肾皮质组织血管紧张素Ⅱ水平:(6964.56±2128.48),(3127.07±1519.98)pg/g,P<0.01]。灯盏花素治疗组低于糖尿病模型组(P<0.05)。结论:灯盏花素在降低糖尿病大鼠肾脏肥大和改善肾脏形态结构的同时还可降低外周血及肾皮质组织一氧化氮与血管紧张素Ⅱ水平,在一定程度上可改善糖尿病早期的肾损害。     

自主研制镍钛记忆合金左心耳封堵器封闭左心耳对实验动物左心功能的影响

目的:应用经胸彩色多普勒超声技术评价自主研制的镍钛记忆合金左心耳封堵器封闭左心耳对实验动物猪左心房、左心室功能的影响。方法:实验于2005-09/2006-08在南京医科大学第一附属医院江苏省实验动物中心完成。①实验分组:选用苏钟小型种猪17只,随机分为实验组12只和对照组5只。②实验干预:实验组12只苏钟小型种猪使用自主研制的左心耳封堵器(发明专利号码:200610037789.3,公开号CN1799521,由镍钛合金骨架、多聚四氟乙烯膜和传送连接部分等构成。其外观呈单盘状,封堵器的左心房面呈圆盘状,直接连接放入心耳内的圆柱体结构)行左心耳封堵,对照组5只手术步骤相同而不采用封堵器行左心耳封堵。③实验评估:两组动物分别于术前、术后1周、2周、4周采用经胸超声心动图检查观察心功能的改变,测量左心房内径、最大及最小容积、左房射血分数、左心房搏出量、血流分数等左房功能参数以及左室射血分数、左室短轴缩短率、Tei指数、E/A比值等指标。结果:①实验动物数量分析:在施行左心耳封堵后,1头猪于术中出血过多并出现室颤后死亡,1头猪因封堵器脱入左房,卡在二尖瓣口导致死亡。其余动物封堵效果良好。②两组动物术后1,2,4周左房功能指标各参数与术前比较无明显变化(P>0.05);与术前相比,实验组术后1周、2周左室射血分数、左心室短轴缩短率、E/A比值分别由术前的0.70±0.04、0.39±0.03、1.33±0.28降低至术后1周的0.59±0.05、0.31±0.03、0.95±0.11(P<均0.01)及术后2周的0.62±0.05、0.33±0.05、0.90±0.05(P<均0.01);Tei指数由术前的0.48±0.02增加至术后1周的0.59±0.03(P<0.01)及术后2周的0.58±0.04(P<0.01)。对照组手术前后左室功能指标差异无显著性。结论:自主研制左心耳封堵器可以有效的封堵左心耳;左心耳封堵后短期内对实验动物左房功能无明显影响;封堵后短期内对左心室功能具有短期的减弱,更长期的安全性有待于进一步研究。     

Donation reactions among autologous donors

Studies of risk factors associated with reactions among autologous blood donors have been limited. Therefore, 2091 autologous and 4737 homologous donations were examined. Donors at greatest risk for reaction were autologous donors who had reactions at first donation; among 45 who made repeat donations for the same surgery, 17 (38%) had repeat reactions. The group least likely to experience reactions were the autologous donors greater than or equal to 66 years old; they experienced a 1.9 greater than or equal to percent (6/310) incidence of reactions. More reactions were seen in both autologous and homologous donors in the categories of first-time donor, female gender, decreasing age, and lower weight. Multiple logistic regression analysis showed that all of these variables were independent predictors of donor reaction, with first-time donation (odds ratio, 2.4) and female gender (odds ratio, 1.9) being the strongest predictors of reaction. Donor room personnel should be alerted that autologous donors who react at first donation are very likely to react at subsequent donations. Contrary to common concern, elderly autologous donors are least likely to have reactions.     

HR (Paroven,Venoruton; 0-(beta-hydroxyethyl)-rutosides) in venous hypertensive microangiopathy: a prospective,placebo-controlled,randomized trial

The aim of this study was to demonstrate whether HR (Paroven-Venoruton; 0-(beta-hydroxyethyl)-rutosides), was effective in improving the microcirculation in venous hypertension and microangiopathy. Sixty patients with severe venous hypertension due to chronic venous insufficiency, ankle swelling, and lipodermatosclerosis were included. After informed consent, patients were randomized into a treatment group and a placebo group. Patients in the treatment group received oral HR (2 g/day for 8 weeks); those in the placebo group received a comparable placebo. RESULTS: The two groups were comparable for age and sex distribution. The mean age was 45 years (SD 9) in the treatment group (31 patients) and 45.5 (SD 10) in the placebo group (29 patients). There were no differences between the placebo and treatment groups at inclusion. There was no change between inclusion and measurements at 8 weeks in the placebo group. A significant decrease (P < 0.05) in flux at rest and rate of ankle swelling was observed in the treatment group. The decrease in capillary filtration was associated with improvement in signs and symptoms (P < 0.05). The difference in flux, sign and symptoms, and filtration was clinically important at 8 weeks in the treatment group when compared with the placebo group. No adverse effects were observed. CONCLUSION: Venous microangiopathy was improved by HR treatment.     

人工髓核假体置入治疗腰椎间盘突出症的疗效分析

目的：观察已在临床初步开展起来的人工髓核置换术治疗腰椎间盘突出症的中、远期临床疗效及并发症,分析其对策。 方法：纳入2002-02/2004-08南方医科大学附属南方医院脊柱骨病外科采用单枚人工髓核假体置换术治疗单节段腰椎间盘突出症患者98例,获得24～48个月随访患者75例,按平均随访时间达24,36,48个月,分为24个月组（n=30）,36个月组（n=23）,48个月组（n=22）。选同期采用单纯椎间盘髓核摘除术患者30例作为对照组,评估各组术后临床疗效,主观症状采用Oswestry功能障碍指数问卷表（0%表示正常,越接近100%则功能障碍越严重）和Prolo功能评分表（小于或等于5分为差,6～7分为中等,8～10为优）评价,分析术后影像学检查并测量手术节段活动度和椎间隙高度变化情况,同时观察假体位置情况,腰椎MRI观察假体位置和软骨终板的信号变化情况。腰椎活动度=（腰椎中立角度-前屈角度）＋（后伸角度-腰椎中立角度）=后伸角度-前屈角度;为消除X射线放大率的影响,椎间隙高度变化情况采用病变椎间隙后缘高度与上位椎体中部矢状径的比值表示。 结果：75例获得24～48个月随访者,全部进入结果分析。①48个月组2例、36个月组1例发生假体脱出,二次手术取出。其余患者术后临床症状均明显缓解,疼痛消失。②24,36,48个月组及对照组术后末次Oswestry功能障碍指数均较术前降低,差异有显著性意义（14.2%,52.1%;15.5%,55.2%;15.1%,53.6%;15.5%,51.5%;P〈0.05）。③24,36,48个月组及对照组术后末次Prolo能评分均较术前升高,差异有显著性意义（8.5,4.6分;8.6,4.5分;8.7,4.3分;8.4,4.2分;P〈0.05）。④24,36,48个月组同期手术节段腰椎活动度均高于对照组,差异有显著意义（P〈0.05）。⑤24个月组手术节段椎间高度较术前降低约4%、36个月组降低约12%、48个月组降低约18%、对照组较术前降低约25%,各组术前和术后椎间隙高度比值比较,差异具有显著性意义（P〈0.05）。⑥主要并发症：早期出现术后一过性腰痛24例,假体脱出3例。中、远期发现假体下沉32例,软骨终板损伤39例。 结论：单枚人工髓核假体置换治疗腰椎间盘突出症中、远期随访临床疗效肯定,但存在较严重并发症,应慎重开展此项手术。