Frequency of Asymptomatic Hepatitis Types B and C in an Inner City Community and Relation to Possible Risk Factors

The frequency of asymptomatic carriage of the hepatitis virustypes B and C in an inner city area (South London) was assessedin a survey of 1002 subjects attending their General Practitionerfor minor, non-hepatic complaints. Ten subjects were seropositivefor hepatitis B surface antigen (HBsAg) (1 per cent), but onlyone, who declined liver biopsy, had any clinical laboratoryevidence of hepatitis B virus-related chronic liver disease.Carriage of, and exposure to, hepatitis B virus was significantlymore frequent among people born outside the UK/Eire and thosewith a history of jaundice. Among people of Caribbean originthe frequency of hepatitis B virus markers fell from 31 percent among those born in the Caribbean to 11 per cent amongstsecond generation subjects born in this country. Despite carefulcounselling, offers of further investigation and treatment ofthose affected, and vaccination of vulnerable children or partners,were often declined. Four percent of the same population hadantibodies to the hepatitis C virus using the Ortho anti-hepatitisC virus enzyme-linked immunosorbent assay but this figure fellto 0.9 per cent when a second test, based on synthetic peptidesrather than a recombinant antigen, was used. None had any abnormalityof standard liver function tests. Chronic asymptomatic carriage of hepatitis, particularly ininner city areas, may be more common than previously recognized.Effective use of antiviral agents and vaccination will be limiteduntil appropriate health education dispels the widespread misconceptionsand fears associated with a diagnosis of chronic viral hepatitis.     

Neutral maltase: the first human B-cell enzymatic marker reflecting terminal differentiation of mature B cells into plasma cells

Neutral maltase activity (alpha-D-glucoside glucohydrolase; EC: 3.2.1.20) was measured in B and T lymphocytes from peripheral blood of normal subjects and patients suffering from chronic or acute lymphoid leukemias. Neutral maltase activity is undetectable in T cells from normal subjects as well as in patients with chronic or acute T-lymphoid leukemias. Conversely, whereas this enzyme activity is always undetectable in chronic or acute B-lymphoid leukemia, neutral maltase activity is expressed in mature B cells from normal subjects. The detection of higher neutral maltase activity in plasma cells from myelomas than in normal B cells supports the concept that the expression of neutral maltase activity is related to the stages of differentiation and maturation reached by lymphocytes of the B-cell lineage. Neutral maltase therefore appears as the first B-cell enzymatic marker described that is expressed in the course of terminal differentiation of mature B cells into plasma cells.     

CYP2D6和GST在白种人晚期肾病中的遗传变异

目的生物转化酶细胞色素P4502D6(CYP2D6)和谷胱苷肽转移酶-M1(GST-M1)、谷胱苷肽转移酶-T1(GST-T1)共同代谢内源性和外源性毒素,一部分人群由于相应基因变异导致这些酶缺乏表达,我们检测白种人群中晚期肾病(ESRD)病人这些酶的基因多态性是否比健康者有较高的频率.方法从列克星顿及周围地区征募330名晚期肾病病人和303名健康者,均为白种人,给予他们进行CYP2D6和GST-M1和T1基因分型.结果在ESRD病人中CYP2D6和GST-M1和GST-T1以及CYP2D6和GST-M1或GST-T1都缺乏分别为2.1%和4.2%;而在健康者中均为0.3%(P<0.01).结论CYP2D6和GST-M1和/或GST-T1酶缺乏在ESRD病人中有较高的频率,提示这些酶缺乏可以预计慢性肾病进展的可能性.     

Differentiation of bone marrow-derived cells into regenerated mesothelial cells in peritoneal remodeling using a peritoneal fibrosis mouse model

Marked thickening of the peritoneum and vasculopathy in the submesothelial compact zone have been reported in long-term peritoneal dialysis patients. Bone marrow (BM)-derived cell lines are considered to be useful tools for therapy of various diseases. To clarify the role of BM-derived cells in the peritoneal fibrosis (PF) model, we analyzed several lineages of cells in the peritoneum. BM cells from green fluorescent protein (GFP) transgenic mice were transplanted into na?ve C57Bl/6 mice. Chlorhexidine gluconate (CG) was injected intraperitoneally to induce PF. Immunohistochemical analysis was performed with parietal peritoneum using anti-Sca-1 or -c-Kit and -GFP antibodies. Isolated BM cells were also transplanted into the CG-stimulated peritoneum. BM-derived cells from GFP transgenic mice appeared in the submesothelium from days 14 to 42. Both GFP- and stem cell marker-positive cells were observed in the submesothelium and on the surface. Isolated c-Kit-positive cells, transplanted into the peritoneal cavity, differentiated into mesothelial cells. In this study, we investigated whether or not BM-derived cells play a role in the repair of PF and immature cells have the potential of inducing repair of the peritoneum. The findings of this study suggest a new concept for therapy of PF.     

Review article: Sepsis in the emergency department – Part 2: Investigations and monitoring

Sepsis is characterised by organ dysfunction resulting from infection, with no reliable single objective test and current diagnosis based on clinical features and results of investigations. In the ED, investigations may be conducted to diagnose infection as the cause of the presenting illness, identify the source, distinguish sepsis from uncomplicated infection (i.e. without organ dysfunction) and/ or risk stratification. Appropriate sample collection for microbiological testing remains key for subsequent confirmation of diagnosis and rationalisation of antimicrobials. Routine laboratory investigations such as creatinine, bilirubin, platelet count and lactate are now critical elements in the diagnosis of sepsis and septic shock. With no biomarker sufficiently validated to rule out bacterial infection in the ED, there remains substantial interest in biomarkers representing various pathogenic pathways. New technologies for screening multiple genes and proteins are identifying unique network ‘signatures’ of clinical interest. Other future directions include rapid detection of bacterial DNA in blood, genes for antibiotic resistance and EMR‐based computational biomarkers that collate multiple information sources. Reliable, cost‐effective tests, validated in the ED to promptly and accurately identify sepsis, and to guide initial antibiotic choices, are important goals of current research efforts.     

Medically certified work loss, recurrence and costs of wage compensation for back pain: a follow-up study of the working population of Jersey

The 1 yr incidence, prevalence and wages compensation costs of work loss due to medically certified back pain in the working population of Jersey were identified by analysis of the Social Security database for the year 1994. A total of 2291 subjects absenting due to back pain during this period were followed for up to 3 yr to identify return to work rates and subsequent absences. Incidence and prevalence rates were 5.6 and 6.3%, respectively. The cost of wages compensation was 1.29 million pounds or 10.5% of such benefits paid. Work loss was greater for the second absence. The rate of return to work was broadly in line with that suggested by the Clinical Standards Advisory Group (CSAG), but the number still absent at 1 yr was less, suggesting that the CSAG figures for long-term absence may have been overestimated. The influence of compensation systems and unemployment on work-related absence due to back pain is highlighted.      

Consumer involvement in emergency medicine research: Lessons from engaging sepsis survivors

Collaboration with consumers is an emerging focus for medical researchers worldwide. Public involvement is increasingly encouraged, and in some cases stipulated by funding bodies, in order to secure financial support. While consumer involvement could be viewed as another hurdle in the funding application process, it can add immense value to research outcomes. However, given the diverse and transient nature of our consumer group, how can we develop meaningful public engagement in emergency medicine research?