Helminthiases among the population of northwestern Siberia. 1. Opisthorchiasis and mixed invasion in the native inhabitants of the Ob River basin and their clinical course

The use of multifactor statistic analysis for screening population of the northern part of the Ob river basin for helminthiasis allowed the authors to reveal a significant feedback between manifested opisthorchiasis and other types of this disease course in both sexes. The main component analysis indicates that the tentatively control group of males is presented by adolescents (14-17 years old) who are likely to be infected with Opisthorchis without evidence of its clinical manifestations. The correlation analysis demonstrated also a direct relationship between the age and manifest opisthorchiasis, as well as double mixed invasion of males (r-0.15 and 0.26, p less than 0.05 and 0.01, respectively). The first three main components explain about 55% variance in the correlation matrix of initial parameters and allow to reveal the variance source, taking into account, along with differentiation of 4 groups of opisthorchiasis patients, also the age- and sex-dependent combination of opisthorchiasis with other helminthic invasions.     

Multimethod teaching modules

The information in this article is for a wide variety of nurses who find themselves in a teaching role: the critical care nurse orienting another nurse (experienced or new graduate); the critical care manager who needs to present an inservice program; and the educator or clinical specialist looking for a new way to present the same information. The author describes how self-paced modules for inservice education offer variety to learners since learners choose the teaching strategy that best suits their learning styles.     

Identifying nursing research priorities: a first step in program development

This study determined nursing research priorities and focused on the development of a nursing research program within a single institution. Of the 715 nurses within the Department of Nursing, 286 (40%) responded to the first round of a two-round Delphi technique, and 137 (48%) responded to the second. The following clinical priorities were determined: prevention and treatment of pressure sores, pain management, treatment of nosocomial infections, and patient education. Nonclinical priorities included staffing and its effects on turnover and patient care, job satisfaction, and factors influencing the quality of nursing care. Serendipitous findings underscored the relevance of the Department of Nursing's conceptual framework to nursing practice and research, revealed the need for dissemination of current research results, and suggested that nurses want to participate in research without assuming responsibility beyond their expertise.     

Antibodies to the ADP/ATP carrier, an autoantigen in myocarditis and dilated cardiomyopathy, penetrate into myocardial cells and disturb energy metabolism in vivo

We identified the ADP/ATP carrier, located within the inner mitochondrial membrane, to be an organ- and conformation-specific autoantigen in myocarditis and dilated cardiomyopathy. We also showed that autoantibodies to the ADP/ATP carrier inhibit the nucleotide transport in vitro. Specific binding of the autoantibodies to the carrier was demonstrated by radioimmunoassay and the immunoblot technique; the inhibition of the nucleotide transport was determined by the inhibitor stop method. To establish if these autoantibodies might also affect cardiac energy metabolism in vivo, we measured whether they are capable of penetrating into myocytes and whether subcellular ATP/ADP ratios and phosphorylation potentials of ATP change in hearts of guinea pigs that have been immunized with the isolated ADP/ATP carrier. An intracellular deposition of autoantibodies was observed by direct immunofluorescence and by immunoperoxidase staining on cryosections of the myocardial tissue of animals immunized with the ADP/ATP carrier. Furthermore, binding of autoantibodies to mitochondrial membrane structures was shown by immunoelectron-microscopic methods. The cytosolic and intramitochondrial distribution of adenine nucleotides in stimulated, isolated perfused hearts of guinea pigs immunized with the ADP/ATP carrier was measured by nonaqueous fractionation. Compared with controls performing equal external heart work, the cytosolic ATP decreased in the immunized animals, whereas the mitochondrial ATP increased strongly; ADP concentrations showed an opposite change. Thus, a resultant cytosolic decrease and a marked mitochondrial increase of the ATP/ADP ratio was established. As a consequence, the cytosolic-mitochondrial phosphorylation potential of ATP was diminished. These findings demonstrate that antibodies against intracellular antigens are able to penetrate into living cells, and that autoimmunity to the ADP/ATP carrier may contribute to the pathophysiology of myocarditis and dilated cardiomyopathy by causing an autoantibody-mediated imbalance between intracellular energy delivery and demand.     

Natural history of aortoarteritis (Takayasu's disease)

The natural history of aortoarteritis was studied in 88 patients (54 women and 34 men). The average age was 24.0 +/- 8.8 years at onset of symptoms and 28.3 +/- 9.9 years at diagnosis. The follow-up period was 83.6 +/- 74.4 months from onset and 33.2 +/- 37.0 months from diagnosis. Ten patients (11.4%) died during follow-up (0.016 deaths/patient year), and 22 patients (25%) suffered major nonfatal events (0.042 events/patient year). The cumulative survival at 5 and 10 years after the onset was 91.0 +/- 3.3% and 84.0 +/- 5.6% (mean +/- SEM), respectively. The event-free survival rates at the same intervals after onset were 74.9 +/- 5.0% and 64.0 +/- 7.4%, respectively. The overall survival and event-free survival at 10 years after diagnosis was 80.3 +/- 6.5% and 61.6 +/- 7.5%, respectively. Patients with no complications or a mild single complication at diagnosis had a higher event-free survival rate than those with severe single complication or multiple complications at 5 years--97.0 +/- 2.9% and 59.7 +/- 7.3%, respectively (p less than 0.001). Severe hypertension (p less than 0.01), severe functional disability (p less than 0.01), and evidence of cardiac involvement (p less than 0.05) were good predictors of either death or major event on follow-up. These data are useful in making an objective assessment of the prognosis and in planning elective interventions.     

Prospective randomized comparison of mezlocillin therapy alone with combined ampicillin and gentamicin therapy for patients with cholangitis

Forty-six patients with cholangitis were randomized to receive therapy with mezlocillin sodium (24 patients) or a combination of ampicillin sodium--gentamicin sulfate (22 patients). The biliary concentration of mezlocillin was 112 times higher than that of ampicillin and 778 times higher than that of gentamicin. The ratio of the concentration in serum or bile over the minimum inhibitory concentration against aerobic gram-negative bacilli (therapeutic index) was higher for mezlocillin than for either ampicillin or gentamicin. Twenty (83%) of 24 patients were cured following mezlocillin therapy compared with 9 (41%) of 22 patients after ampicillin-gentamicin therapy. The 3 patients with superinfection were in the ampicillin-gentamicin arm of the study. Fewer toxic or adverse effects occurred in association with mezlocillin treatment than with ampicillin-gentamicin treatment. Mezlocillin therapy was more effective, less toxic, and less expensive than treatment with ampicillin and gentamicin for patients with cholangitis.