The effect of tourniquet release timing on perioperative blood loss in simultaneous bilateral cemented total knee arthroplasty: a prospective randomized study.

Today the use of pneumatic tourniquet is commonly accepted in total knee arthroplasty (TKA) to reduce perioperative blood loss. There are a few prospective randomised and nonrandomised studies that compare the effect of tourniquet release timing in cementless or cemented unilateral TKA. However, many of these studies show an inadequate reporting and methodology. This randomized prospective study was designed to investigate the efficiency of tourniquet release timing in preventing perioperative blood loss in a simultaneous bilateral TKA study design. To our knowledge, this is the first study of its kind, in which the effect of tourniquet release timing on perioperative blood loss was investigated in simultaneous bilateral cemented TKA to compare both techniques intraindividually. In 20 patients (40 knees) one knee was operated with tourniquet release and hemostasis before wound closure, and the other knee with tourniquet release after wound closure and pressure dressing. We found no significant difference in total blood loss between both techniques (p=0.930), but a significant difference in operating time (p=0.035). There were no postoperative complications at a follow-up of 6 month. Other studies report an increase the blood loss in early tourniquet release and an increase the risk of early postoperative complications in deflation of tourniquet after wound closure. In this study we found no significant difference in perioperative blood loss and no increase of postoperative complications. Therefore, we recommend a tourniquet release after wound closure to reduce the duration of TKA procedure and to avoid possible risks of extended anaesthesia.     

The prevalence of Candida albicans-associated diarrhoea in Buea, South West Cameroon

A total of 362 stool specimens were collected from 184 and 178 patients presenting at the Buea district Hospital with and without diarrhoea, respectively. The samples were screened and cultured for Candida albicans using standard microbiological procedures. Of the 184 diarrhoeic stool cultures, 35.9% showed C. albicans overgrowth as indicated by count >or=10(4) CFL/mL. Of the 178 non diarrhoeic stool cultures, C. albicans was identified in 23.6% of samples and counts were all <10(4) CFU/mL. An association was observed for C. albicans overgrowth and diarrhoea (p<0.001). The majority of isolates (87.8%) from the 66 samples showing candida overgrowth were susceptible to Amphotericin B in anti-fungal drug sensitivity assays. Results of the study highly suggest that C. albicans is an important cause of diarrhoea in the study area. We recommend that this fungus should be routinely checked in individuals presenting with diarrhoea particularly children and patients on prolonged or frequent antibiotic therapy.     

Stimulation of murine B lymphocytes to IgG synthesis and secretion by the mitogens lipopolysaccharide and lipoprotein and its inhibition by anti-immunoglobulin antibodies.

The two mitogens, lipopolysaccharide (LPS) and lipoprotein (LP), both stimulate to an equal extent murine B lymphocytes to develop IgG-synthesizing and IgG-secreting cells. IgG synthesis and secretion was detected either by biosynthetic labeling of stimulated B cells, followed by immunoprecipitation and polyacrylamide gel electrophoresis of labeled Ig, or by the protein A plaque assay detecting all IgG-secreting cells with IgG-specific developing antisera. B cells from spleen, lymph node, thoracic duct and fetal liver of normal and T cell-deficient nu/nu mice are all stimulated by the two mitogens to develop IgG-secreting cells. Mitogen-induced IgG secretion, therefore, can occur independently of T cells and of external antigen. Anti-Ig antibodies inhibit the mitogen-induced development of Ig-secreting cells. Antibodies with specificities for μ chains when added before or soon after mitogenic stimulation of small, resting B cells, will inhibit these cells from developing into IgG-secreting cells. Later in culture, antibodies with specificities for γ chains also become inhibitory for the mitogen-induced development of IgG-secreting cells. These results indicate that the precursors of the IgG-secreting cells carry IgM in the outer surface membrane. They also suggest that during mitogen-stimulated growth of B cell clones, IgG becomes expressed in the surface membrane in a functional way which allows the inhibition of mitogen-induced IgG secretion by anti-γ antibodies.     

Maturation of mitogen-activated bone marrow-derived lymphocytes in the absence of proliferation

Mouse B lymphocytes respond by increased rates of DNA synthesis 14–24 hours after stimulation with the mitogen lipopolysaccharide. If, at this time, stimulated cells are treated for 12 hours with a “hot pulse” of thymidine, subsequent mitogen-induced maturation to high rate IgM-producing plaque-forming cells is abolished. Thus, B cells stimulated by mitogen to mature also incorporate thymidine into DNA and proliferate. DNA synthesis is inhibited to 99 % in 48-hour mitogen-stimulated B lymphocytes by 10^?2 M hydroxyurea or 10^?3 M cytosine arabinoside, while protein and IgM synthesis and secretion and the plaque-forming capacity of those cells are unaffected. When hydroxyurea is added to small, resting B cells at the time of initiation of mitogenic stimulation, these cells mature to 19 S IgM- secreting, plaque-forming cells in the absence of DNA synthesis and proliferation. Maturation in the absence of DNA synthesis is also manifested by an increase in ratios of rates of synthesis and secretion of IgM over those of all proteins in the cell and by the attachment of the “branch” sugars, galactoses and fucoses, to 19 S IgM secreted by the cells. This maturation of B cells in the absence of DNA synthesis occurs within 12 to 30 hours after stimulation and is mitogen dose dependent. The inhibition of B cells to synthesize DNA and to develop into clones of plaque-forming cells can be reversed by the removal of hydroxyurea for as long as 36 hours after mitogenic stimulation in the presence of the inhibitor. In the presence of hydroxyurea, B cells are stimulated to immature plasmablast-like cells containing surface-bound and little intracytoplasmic Ig within 16 to 24 hours of stimulation. Mature plasma cells containing no detectable surface-bound Ig, but abundant intracytoplasmic Ig are only developed in the uninhibited, but not in the hydroxyurea-inhibited mitogen-stimulated cells later in the response. Thus, two stages of B cell maturation and differentiation can be distinguished: the first stage of an immature plasmablast develops in the absence of DNA synthesis, while the later stage of the development of the mature plasma cell requires DNA synthesis.     

The kinectics of proliferation and maturation of mitogen-activated bone marrow-derived lymphocytes

The B cell mitogens lipopolysaccharide (LPS), purified protein derivative of tuberculin (PPD) and fetal calf serum (FCS) all stimulate spleen cells from nude mice to increased DNA-synthesis 14 to 16 h after the initiation of mitogenic stimulation. The three mitogens also induce the maturation of B cells to plaque-forming cells (PFC). All three mitogens stimulate largely identical B cell populations. The extent to which B cells are stimulated to DNA synthesis and to the development of PFC varies from mitogen to mitogen. PFC arise by clonal growth through proliferation and maturation. A “hot pulse” of radioactive thymidine given between 0 and 20 h of stimulation has no effect on the development of PFC during subsequent mitogenic stimulation. Pulses given between 24 and 36 h after stimulation abolish the development of over 90 % of the PFC. The minimum pulse time required for maximum inhibition of the development of PFC during that time is 6 h. Beyond 36 h of stimulation by either of the three mitogens, PFC emerge rapidly. Between 60 and 72 h less than 10 % of all PFC emerging at 72 h are abolished by a “hot pulse”. The kinetics of the clonal development of PFC after mitogenic stimulation are compared to that of antigenic stimulation. The comparison suggests that B cells stimulated by antigen in the in vivo primary immune response culture system go through a longer period of proliferation than when they are stimulated by mitogen before maturation to PFC.     

Histocompatibility Determinants in Israeli Jewish Patients with Multiple Sclerosis

The distribution of 24 HLA antigens of the A and B loci was investigated in 197 Israeli Jewish patients with multiple sclerosis (MS) from various Jewish ethnic origins including central and eastern Europe, countries bordering the Mediterranean, the Middle East and from native-born Israelis. The results were compared with the HLA antigen frequencies in a control sample of 455 unrelated individuals representing the general Jewish population. The frequency of HLA-Bw40 among all MS patients (15%) was significantly greater (P less than 0.001) than among the controls (7%). In contrast to the findings in MS patients from other populations, there was no increased frequency of A3 and B7 and Dw2 was present in only one out of 28 patients. The study showed a similar distribution of HLA-A and -B locus antigens, especially of Bw40, in Jews of diverse ethnic origins represented in the control group.     

Ir-LDHB: map position and functional analysis

Different strains of mice immunized with lactic dehydrogenase B (LDH_B) can be classified into high and low responders. Breeding experiments suggest regulation of this immune response by a dominant gene (Ir-LDH_B), which is linked to the major histocompatibility complex (H-2). Studies in recombinant inbred mice made it possible to map Ir-LDH_B within the H-2 complex between Ir-1 and Ss-Slp. The argument that it is a single gene or only a small gene cluster which regulates immune responsiveness to the multideterminant enzyme molecule is strengthened by our finding of only two levels of responsiveness among a variety of inbred mouse strains. Responsiveness in this system is thymus-dependent and can be transferred to low responders by transfer of normal or immune spleen cells from high responders. Experiments in an adoptive transfer system, in which 4-hydroxy-5-iodo-3-nitrophenacetyl (NIP)-LDH_B was used as a hapten-carrier complex, demonstrated that LDH_B-specific helper activity was detectable in LDH_B-primed spleen cells of responder animals only. This indicates a deficiency of LDH_B-specific T cells in low responder mice. Immunization of congenic mice with the hybrid isoenzyme LDH_AB results in equal production of anti-LDH_B antibodies in low and high responders. Examination of these sera in isoelectric focussing (IEF) led to the following conclusions. a) Individual sera show, in general, little heterogeneity of anti-LDH_B antibodies. b) Low responders exhibit a similar degree of heterogeneity as do high responders. c) A few groups of bands, indistinguishable in IEF, appear repeatedly in individual sera, irrespective of the H-2 allele of the donor. We conclude that Ir-LDH_B is expressed exclusively at the level of T cell function.     

Ultrastructural and elemental analysis of calcification of advanced swine aortic atherosclerosis

During progression and in the early phase on a regression regimen, calcification of the necrotic portion of the atheroma of swine abdominal aorta occurred primarily in degenerated cells or in membranous, vesicular cellular degradation products which varied in size, shape, and the amount of mineral deposit. Calcium appeared to be deposited in amorphous granular or needle-like crystalline forms. Energy dispersive X-ray and line profile analysis showed that the major elements in the heavily calcified portions of the plaques were calcium and phosphorus. There was a direct relationship between the distribution and concentration of these elements indicating that the mineral deposit was a calcium phosphate. Select area electron diffraction analysis of grossly calcified portions of the plaque gave a diffraction pattern identical to that of calcium hydroxyapatite. Calcification was not observed to occur on elastic tissue or collagen fibers.     

An IgM-producing tumor with biochemical characteristics of a small B lymphocyte.

A lymphocytic tumor, 38C-13, induced by the chemical carcinogen 7, 12-dimethylbenz(a)anthracene in C3H/eB mice and adapted to tissue culture, produces 7-8 S IgM with "core" carbohydrates (N-acetylglucosamines, mannoses), but not "branch" carbohydrates (neuraminic acids, fucoses, galactoses) attached to the mu heavy, but not to the light chains. Turnover of the 7-8 S 38C-13 IgM is slow (half disappearance time = 10-15 h). The IgM is released from the cells as 7-8 S IgM. The ratio of IgM synthesis to the synthesis of all cellular glycoproteins is 0.005-0.01. After comparison of these data with data obtained with normal B lymphocytes before and after mitogenic stimulation, we conclude that 38C-13 tumor cells are transformed counterparts very near or within the population of small, mitogen-sensitive, resting B lymphocytes.     

Predictability of Individual Differences in Activation Processes in a Field Setting Based on Laboratory Measures

The predictability of individual differences in activation processes was investigated in a multi-method laboratory-field study. Male students of physical education (N=58) were examined under various emotionally activating and physically demanding conditions (mental arithmetic, reaction time, free speech, cold pressor test, bicycle ergometer). The assessment included multi-channel recordings of pre-start phases in an athletic stadium and performance on a 1000 m run. Basal heart rate was also recorded during sleep. This multi-situational assessment was repeated after three weeks, three months, and, for most (N=42) subjects, after one year. Significant relationships exist between scores from corresponding conditions of relaxation, anticipation, and performance of physical exercise. However, with the exception of heart rate, correlation coefficients are rather small and seem to be of questionable predictive validity. A generalizability study further supports the general conclusion: To increase the practical relevance in psychophysiological investigations of stress/strain phenomena, such studies should directly assess individual differences in the criterion situations themselves.