Is immobilization associated with an abnormal lipoprotein profile? Observations from a diverse cohort.

OBJECTIVE: The potential effects of ethnicity, gender, and adiposity on the serum lipid profile in persons with spinal cord injury (SCI) were determined. SUBJECTS: Subjects with SCI were recruited during their annual physical examination from Rancho Los Amigos Medical Center, Downey, California. Sedentary able-bodied controls were Bridge and Tunnel Officers of the Triboro Bridge and Tunnel Authority of the New York City metropolitan area. METHODS: Serum lipid profiles were investigated in 320 subjects with SCI and compared to those obtained from 303 relatively sedentary able-bodied controls. Serum lipid studies were obtained in the fasting state. Data were collected between 1993 and 1996. All lipid determinations were performed by the same commercial laboratory. MAIN OUTCOME MEASURES: The dependent variables were the values from the lipid profile analysis. The independent variables consisted of study group, gender, ethnic group, age, duration of injury, and anthropometric measurements. RESULTS: The serum high-density lipoprotein cholesterol (HDL-c) level was reduced in the SCI compared with the control group (mean+/-SEM) (42+/-0.79 vs 47+/-0.67 mg/dl, P<0.0005). The serum HDL-c level was significantly lower in males with SCI than males in the control group (39+/-0.83 vs 45+/-0.70 mg/dl, P<0.0001), but not for females (51+/-1.54 vs 54 1.52 mg/dl, n.s.). Within the subgroups for whites and Latinos, HDL-c values were also lower in subjects with SCI than in controls (whites: 41+/-1.02 vs 46+/-0.86 mg/dl, P<0.0001; Latinos: 37+/-1.53 vs 42+/-1.59 mg/dl, P<0.05), but not for African Americans (49+/-1.56 vs 51+/-1.27 mg/dl, n.s.). African Americans had higher HDL-c values than whites or Latinos (SCI: 49+/-1.56 vs 41+/-1.02 or 37+/-1.53 mg/dl, P< 0.0001; controls: 51+/-1.27 vs 46+/-0.86 mg/dl, P<0.01 or 42+/-1.59 mg/dl, P<0.0005). In persons with SCI, the serum HDL-c values were inversely related to body mass index and estimated per cent body fat (r=0.27, P<0.0001). CONCLUSION: In white and Latino males, but not in females or African Americans, immobilization from SCI appears to be associated with lower HDL-c values than in controls.     

A double-blind, placebo-controlled study of Mycobacterium-specific human immune responses induced by intradermal bacille Calmette-Guérin vaccination.

Recent studies have indicated that type 1 T cell responses (potent interferon-gamma and cytolytic responses, with absence of interleukin-4 production) are important for protective immunity against mycobacteria. These observations suggest that assays of type 1 T cell responses may be useful as surrogate markers of protective immunity in the evaluation of new tuberculosis vaccines. To be useful as surrogate markers, immunologic assays must distinguish between vaccine recipients and control subjects in clinical trials. Previous studies have shown that bacille Calmette-Guérin (BCG) vaccination can induce human type 1 T cell responses, but randomized trials have not been done to determine whether measurement of these responses can distinguish between BCG recipients and control subjects. We have conducted a double-blind, placebo-controlled trial of intradermal vaccination with two different BCG strains. We compared the mean lymphoproliferative, cytotoxic, Th1 and Th2 cytokine, and antibody responses detected in BCG and placebo recipients. These studies demonstrated that significant increases in Mycobacterium-specific T cell proliferative responses and type 1 cytokine responses were induced by BCG when compared with results with a placebo. In addition, BCG induced significant increases in Mycobacterium-specific antibody responses with an isotype profile characteristic of a type 1 cytokine bias. T cell and antibody assays involving the use of mycobacterial whole cell lysates or live BCG were able to discriminate between BCG and placebo recipients better than were assays using mycobacterial culture filtrates. These studies provide important information for the development of immunologic assays that might be useful as surrogate markers of protective immunity in future trials of new tuberculosis vaccines.     

Tubal abortions but not viable tubal pregnancies are characterized by an increased number of CD8+ T cells

OBJECTIVE: To examine immune cell phenotypes in viable tubal pregnancies (VTP) and in tubal abortions (TA). METHODS: Paraffin-embedded specimens of VTP (n=7) and ongoing TA (n=6) were double-stained for cytokeratin for trophoblast as well as for CD45, CD3, CD8, CD68 and CD20 for immune cell phenotypes. In all cases, the amniotic sac was detected by ultrasound. Histological examination showed no evidence of necrosis within the tissues included in this study. Quantification of the subpopulations was performed in each slide by two independent examiners in five areas (0.085 mm2 each) of the invasion zone as marked by cytokeratin-positive stromal extravillous trophoblast (EVT) cells. For statistical analysis, the non-parametric two-tailed t-test was used (p<0.05). RESULTS: The differences in the number of CD45(+), CD68(+) and CD20(+) cells was significant (p=0.0423, p=0.0469 and p=0.0494, respectively); however, the number of CD3(+), and among those the number of CD8(+) cells, was approximately eight-fold higher in TA than in VTP (p<0.0001 and p=0.0012, respectively). CONCLUSION: The unequal distribution of CD8(+) cells in VTP and TA suggests a significant role of this immune cell phenotype in the further outcome of a tubal pregnancy either to an abortive or a viable, potentially life-threatening, entity.     

Rapid characterization of protein epitopes recognized by monoclonal antibodies using direct probing on thin-layer and paper chromatograms

A simple method for the comparison and identification of protein epitopes recognized by monoclonal antibodies directly on thin-layer plates and 3MM paper chromatograms is described. Enzyme digests of myelin basic protein were separated on thin-layer plates and 3MM paper, fixed with glutaraldehyde and probed directly with affinity-purified mouse monoclonal antibodies. Detection of the immunoreactive peptides was enhanced using a second rabbit anti-mouse immunoglobulin and finally located using an alkaline phosphatase-conjugated anti-rabbit immunoglobulin. By probing the same enzyme digests of MBP with various monoclonal antibodies raised against MBP, a different binding 'pattern' of reactive peptides is rapidly obtained for monoclonal antibodies of differing specificities. This procedure was extended to the identification of the antigenic determinant using synthetic peptides. The major advantages of this procedure are its simplicity, non-radioactive nature and speed. Furthermore, there is the possibility of sequencing immunoreactive peptides eluted from the 3MM paper.     

Depression and life satisfaction among people ageing with post-polio and spinal cord injury

Purpose and background: Attention has recently begun to focus on the ageing of individuals with disability, not only as a longterm follow-up issue but as a unique developmental issue itself. The majority of individuals with an onset of disability before age 30 can now expect to live into their 60s, 70s and beyond. Most of the secondary medical conditions that foreshortened life expectancy have been controlled and improved rehabilitation techniques have evolved over the last 50 years. The average age of persons with post-polio in the United States is over 50 and the average age of persons with spinal cord injury is in the late 40s. New medical, functional and psychosocial problems have been discovered among persons ageing with these and other disabilities. Most of these problems lack sufficient scientific explanation, and therefore, clinical interventions. Quality of life (QOL) issues become involved as these changes occur. From a psychological perspective, QOL can be either positive, as reflected in high life satisfaction, or negative, as reflected in distress and depression. Methods: This study reports on life satisfaction and depression in 360 persons, 121 with post-polio, 177 with SCI and 62 nondisabled age-matched comparisons. The Geriatric Depression Scale and the Older Adult Health and Mood Questionnaire assess depressive symptomatology and a 10-item life satisfaction scale with four-point ratings on each item used. Results: Life satisfaction varied by the group, with the nondisabled group higher than one or both of the other two groups on all scales and the post-polio group higher than the SCI group on six scales. Satisfaction with health, finances, work and overall life were most different. 22% of the post-polio group, 41% of the SCI group and 15% of the non-disabled group had at least significant repressive symptomatology. Conclusion: The results for each group are discussed in terms of their relation to other coping variables that were assessed, particularly social support and coping methods.     

Prevalence of transfusion‐acquired hepatitis C in an Australian bleeding disorders population

In Australia prior to 1992, many patients with bleeding disorders were exposed to hepatitis C through blood products. However, the incidence, complications and response to treatment of chronic hepatitis C (CHC) in this population are poorly characterized. The aim of this study was to examine the prevalence of CHC and response to treatment in an Australian bleeding disorders population. Demographic data, virological data and liver disease status from these 700 patients with inherited bleeding disorders were analysed. Of these 700 patients, 424 (61%) had been tested for CHC infection and 219 (52%) were hepatitis C antibody positive, with the prevalence approaching 100% in patients with severe bleeding disorders. Of 219 patients, 73 (33%) had received treatment for their infection with a response rate of 33/73 (45%) across all genotypes. Of 219 patients, 34 (16%) had spontaneous viral clearance. When measured with transient elastography, 44/98 (45%) patients with CHC had significant liver fibrosis and 15/98 (15%) had liver cirrhosis. Of 130 patients, 38 (29%) with CHC infection had no evidence of follow‐up with an appropriate clinician in the past 2 years. This study demonstrates that testing for CHC in this population is incomplete and treatment rates are low. Given the substantial morbidity and mortality associated with CHC and new therapeutic options becoming available, it seems important to reengage patients to diagnose, offer treatment and monitor this infection.     

Civil protection against chemical and biological warfare

In the United Kingdom, the value of civil defence remains controversial. Proponents of civil defence argue that it is a necessary humanitarian duty to mitigate the impact of potential future war on the civilian population. Opponents point to ministerial and military statements that the principal function of civil defence is to enhance the credibility of nuclear deterrence, not to protect people.

Against a backdrop of this broad debate, the issue of civil preparedness for possible chemical or biological attack is examined. This article considers current expert advice delivered to local authority emergency planning officers and volunteer civil defence Scientific Advisers at a Seminar held in May 1987, in the context of developments in chemical and biological weaponry and UK government policy. Detailed consideration is given to the difficulties in executing suggested individual and collective protection measures, and it is argued that a ‘credibility gap’ exists between advice on protection and the capacity for its effective implementation.