Simultaneous estimation of urinary steroids by semi-automated gas chromatography. Investigation of neo-natal infants and children with abnormal steroid synthesis.

Development of a method for multicomponent analysis of urinary steroids on open-tubular columns is described. The urinary steroid conjugates were hydrolysed enzymatically, extracted on Amberlite XAD-2 columns, purified on columns of Sephadex LH-20, then analysed as methyloxime trimethylsilyl ethers on a gas chromatograph on which up to 24 samples may be automatically injected. All major urinary steroids from 17-oxosteroids to cortisol metabolites were analysed and these were quantified relative to internal standards, 5alpha-androstane-3alpha, 17alpha-diol and cholesteryl butyrate added to the samples prior to derivatisation. The precision of the full technique and reproducibility of repetitive automatic solid injection was found to be acceptable for the purpose of profile analysis. Examples of urinary steroid profiles in normal infants and infants with disorders of adrenal steroid production and excretion are given.     

A new variant of glucosephosphate isomerase deficiency (GPI-Utrecht).

A new case of glucosephosphate isomerase deficiency is described in a Dutch family. The activity of the enzyme was decreased to 20-25% of the normal value. Characterization of the defect enzyme showed a pronounced thermolability. Heating of the enzyme at 45 degrees C showed a loss of activity of 90% after one hour. The pH-optimum and the electrophoretic migration were normal. The Km-value for F-6-P, the Ki for the competitive inhibitors 2,3-DPG and 6-PG were in the normal range. The variant described here differs from all known variants. Therefore we propose to give to this new variant the name of GPI-Utrecht.     

Investigation of the effects of naloxone upon acupuncture analgesia

Two patients with severe thalamic pain and one patient with causalgia from the shoulder-hand syndrome are described whose pain was markedly improved or abolished by anticholinesterase drugs. Both short-acting parenteral and oral anticholinesterase preparations were employed. Anticholinesterase drugs are a new and potentially valuable approach to the treatment of chronic pain.     

A note on the practical aspects of the assay of N-acetyl-beta-glucosaminidase in human urine.

1. Some practical aspects of the assay of urinary N-acetyl-beta-glucosaminidase activity were studied in patients with renal disease. 2. Centrifugation and dialysis of urine were not necessary prior to assay. 3. When enzyme activity was related to urinary creatinine random urine samples could be used. 4. Since preservatives used to prevent bacterial growth may inhibit enzyme activities, samples should be assayed immediately after collection or stored at 4 degrees C or 20 degrees C. 5. Mild visible haemoglobinuria, eg. derived from lysed red blood cells did not interfere with the enzyme assay.     

Vibratory stimulation for the relief of pain of dental origin

The present paper describes the effect of vibratory stimulation on pain of dental origin in 36 patients. The patients were from a clinic for dental surgery and all had suffered pain from pulpal inflammation, apical periodontitis or postoperative pain following extraction of an impacted wisdom tooth for more than 2 days. Vibration at 100 Hz was applied to various points in the facial region or the skull. All the patients except three experienced an effective reduction of the intensity of the pain. In the patients who experienced pain reduction there was usually a best point at which vibration had a greater pain alleviating effect than at other points. At some points the stimulation added to the pain. In 16 patients the stimulation caused a reduction in pain intensity of 75–100%; out of these 12 patients reported a complete relief of pain.     

The diagnostic value of urinary enzyme measurements in hypertension

N-Acetyl-beta-D-glucosaminidase (NAG), beta-D-galactosidase, alkaline phosphatase (ALP) and leucine aminopeptidase (LAP) were assayed in the urine of 100 normal and 112 hypertensive subjects. Age-related urinary activities for these enzymes in the normotensive control subjects are presented. A new procedure for the assay of urinary ALP using 2-methoxy-4-(2'-nitrovinyl)phenyl (MNP) phosphate is described. Thirty-five of the hypertensive patients were considered to have primary renal disease. The urinary activity of NAG was increased in 27 (77%) of these patients and the detection of primary renal disease was not enhanced by measurements of the other urinary enzymes. Testing the urine both for NAG activity and protein, led to the detection of 91% of these patients. The assay procedures described are simple to perform and can be carried out in outpatient clinics. The measurement of urinary NAG activity is a cheap and reliable method for detecting renal disease in hypertensive patients but maximum diagnostic yield is achieved when proteinuria is determined as well.     

Evaluation of quantitative methods for determination of protein in urine.

The automated immunoprecipitin reaction (A.I.P.) and the Laurell electroimmuno assay (rocket electrophoresis) are applied to unconcentrated overnight urines from patients hospitalised for various diseases, including both Albustix-positive and Albustix-negative samples. The results of both methods and the results of a quantitative determination of total protein are compared. The correlation coefficients between the two immunochemical methods are good, with a significance level of p less than 0.01 for all r-values. The correlation coefficient between the immunochemical methods and the quantitative determination of total protein is dependent on the amount of protein excreted in the urine. If urines should be examined for proteins we recommend a quantitative screening method or an immunochemical determination of albumin. For the latter we find that the A.I.P.-reaction is the method of choice, because it is fast, precise, sensitive, and specific.     

The effect of pre-incubation and direct procedure for the alanine transaminase assay in two kits compared.

The kinetic measurement of serum alanine transaminase was carried out on two enzyme kits (Roche and Calbiochem), done as a direct method and a pre-incubation method. Variable results from commercial control sera and patient sera by these four procedures were obtained. Pre-incubation enzyme values were generally lower than the direct values (mean difference 10%), but there were marked differences between the results from the two kits. This finding has important significance especially for laboratories participating in external QC Programmes. Frequent precision checks of the method and a local reference range are therefore necessary.     

糖尿病人大动脉顺应性的二维超声评价

目的：用超声检测糖尿病患者的大血管顺应性。材料和方法：比较40例糖尿病人、40例高血压病人及40例正常对照组的升主动脉和腹主动脉扩张性（DIS）、僵硬度指数（β），并与脉压差等作相关分析。结果：糖尿病人大血管内径、DIS、β指数与对照组有明显差异（P<0.01),而与高血压患者之间差异不明显（P>0.05)。结论：糖尿病人大动脉硬化时，血管顺应性降低，并与脉压差、管腔内径有一定相关。     

In vitro assessment of the intra luminal phase of gliadin digestion in coeliac disease: γ-glutamyl transpeptidase-like activity in saliva

γ-Glutamyl transpeptidase (GGTP) is an enzyme of potential relevance to the digestion of dietary gliadin, and hence of possible importance in the development of coeliac disease (CD). We have confirmed that human saliva has GGTP-like activity. Comparison of this activity between treated CD patients in long-term remission, age- and sex-matched normal control subjects, and unaffected relatives of CD patients did not show statistically significant differences. Although our results have not demonstrated a primary abnormality of this particular enzyme activity in CD, the intraluminal phase of gliadin processing is potentially important in the aetiology and pathogenesis of CD and thus deserves further study.     

Use of Mental Health Services by Adolescents After Traumatic Brain Injury: A Secondary Analysis of a Randomized Controlled Trial

Background

Mental health problems are common after pediatric traumatic brain injury (TBI). Many patients in need of mental health services do not receive them, but studies have not consistently used prospective and objective methods or followed samples for more than 1 year.

Reliability and Validity of Subjective Measures of Aerobic Intensity in Adults With Spinal Cord Injury: A Systematic Review

Objective

To systematically synthesize and appraise research regarding test-retest reliability or criterion validity of subjective measures for assessing aerobic exercise intensity in adults with spinal cord injury (SCI).

Studies of intracellular distribution of acid phosphatase 5 in the spleen cells of leukemic reticuloendotheliosis by isopycnic gradient centrifugation

A fresh spleen sample obtained from a patient with leukemic reticuloendotheliosis was homogenized and subjected to centrifugation on a sucrose density gradient. A major portion of acid phosphatase band 5 was observed in the lysosome, confirming that the elevated phosphatase activity in the neoplastic spleen is a lysosomal enzyme. However, a significant amount of band 5 was also observed in the microsome. The microsomal and lysosomal enzymes have different affinity to CM-cellulose. The relationship between lysosomal and microsomal enzymes has not been established.     

Stability of self-report measures of improvement in chronic pain: a five-year follow-up

Seventy patients with chronic low-back pain not due to malignancy returned a questionnaire assessing functional status 5 years following treatment with epidural or subarachnoid nerve blocks. One hundred fifty-one patients had been surveyed 3 years earlier in an initial follow-up. The respondents to the present survey were older and more able to bend and took more medication for pain than non-respondents. The results revealed a tendency for gender-associated differences in improvement noted in the initial survey to be maintained, with women showing greater absolute improvement than men, particularly in vocational abilities. Men were somewhat more improved as a group on the current follow-up than on the initial follow-up. The use of medication for pain remained generally unchanged over time, but the number of respondents reporting the need for additional surgical treatments declined. The results were seen as indicating the need for using multiple, functional criteria in assessing response to treatment, including both global pain ratings and functional-behavioral measures of improvement.     

Measurement of glycosylated haemoglobins using an affinity chromatography method

After removal of the labile material, we have measured the stable glycosylated fraction of haemoglobin with a new, commercially available, phenylboronic acid affinity gel, Glycogel B. The mean value was established for 61 non-diabetics as 7.31 (SD ± 0.92)% and for 108 diabetics as 12.70 (SD ± 2.88)%. The method is highly reproducible with a coefficient of variation below 2.0%. The effect of changing the temperature from 7°C to 37°C, and pH from 8.1 to 8.9 was investigated. For accurate results the temperature should be maintained between 20°C ± 1°C, and the pH between 8.6 ± 0.1. A poor, but significant correlation (r = 0.43) between glycosylated haemoglobin and simultaneous blood glucose was shown. There was a good correlation with the agar gel electrophoretic method (r = 0.95). The slope of the regression Une was 1.20 which indicates that this affinity method measures more than just HbA₁. The affinity method appears to offer greater selectivity for diabetics than the electrophoretic method.     

Kinetics of the inactivation of human and bovine trypsins and chymotrypsins by alpha1-proteinase inhibitor and of their reactivation by alpha2-macroglobulin.

The time dependency of inactivation of human cationic trypsin and chymotrypsin II and of bovine trypsin and alpha-chymotrypsin by human serum has been investigated. Since the molar concentration of serum alpha1-proteinase inhibitor is much higher than that of other inhibitors, this time dependence could be used to calculate the rate constants kass for the association of alpha1-proteinase inhibitor with the four proteases. The association process was found to be second order, with kass ranging from 1 x10(4) s-1 (human trypsin) to 2.6 x 10(6) s-1 (bovine chymotrypsin). The human proteases react much more slowly with human alpha1-proteinase inhibitor than the bovine ones. But, whatever the species, chymotrypsin is inhibited more quickly than trypsin. Addition of alpha2-macroblobulin to the inactive complexes resulted in a time-dependent regeneration of enzymic activity due to the formation of alpha2-macroglobulin-protease complexes. The reactivation (i.e. dissociation) process was first order and extremely slow: the half-life of the alpha1-proteinase inhibitor-proteinase complexes ranged from 8 days (bovine chymotrypsin) to 9 months (human chymotrypsin). The human proteases formed the most stable complexes with alpha1-proteinase inhibitor. The pathological implications of these findings are discussed.