Antilymphoblast globulin in renal transplant patients. No allergic reactions.

The incidence and type of allergic reactions to antilymphoblast globulin (ALG) and their relationship to skin testing, histamine release, and serum levels of ALG and anti-ALG antibodies were studied prospectively in 50 patients receiving high-dose ALG therapy intravenously for the first two weeks after renal transplantation. No clinically apparent allergic reactions occurred in the patients studied.     

Digital subtraction angiography system evaluation with phantoms

Advances in digital subtraction angiography imaging demonstrate the need for critical evaluation of the performance of digital subtraction equipment. The design of a phantom set for noninvasive assessment of the imaging quality of digital subtraction equipment is described; components include a remotely controlled transport system and individual patterns to evaluate the contrast and detail properties of the image intensifier, low-contrast sensitivity and resolution of the system, geometric distortion of image, linearity, mechanical and electronic stability of equipment, and effects of bone and bowel gas on iodine perception. The performance of an add-on digital radiographic system is presented, along with radiation exposure levels at the image intensifier for a range of radiographic techniques.     

A Potential Role for PGE and IL-14 (HMW-BCGF) in B-Cell Hyperactivity of Patients with Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is a disease characterized by the prolonged production of high-affinity autoantibodies resulting in direct and immune complex-mediated tissue damage. Because autoantibody responses occur over several years, memory B cells are likely to be involved. Interleukin-14 (IL-14) is a cytokine implicated in the generation and maintenance of normal memory B cells. Many of the actions of IL-14, including inhibition of antibody synthesis and upregulation of IL-14 receptors (IL-14R), are dependent on the formation of prostaglandin E (PGE) and subsequently cAMP. We observed that IL-14 induces phospholipase A(2) (PLA(2))-dependent release of arachidonic acid from phosphatidylcholine and phosphatidylinositol. Production of PGE is blocked by the PLA(2) inhibitor bromophenacyl bromide. Exogenous PGE (misoprostol) induces similar inhibition of antibody synthesis and increases in IL-14R as IL-14. Lymphocytes from patients with inactive SLE were noted to spontaneously produce PGE. Lymphocytes from normal donors produced PGE only after Sac-activation and IL-14 stimulation. Peripheral B and T lymphocytes from SLE patients, but not normal donors, spontaneously produced IL-14. Increased numbers of peripheral B lymphocytes from patients with inactive SLE expressed IL-14R, when compared to normal donors. Thus, increased production of IL-14 and PGE in SLE may result in expansion of a memory B-cell population capable of long-term autoantibody production. Further study will be necessary to confirm these preliminary findings and to examine in greater depth the regulation of PGE and IL-14 in SLE patients and normal donors.     

Incidence of subclinical coronary atherosclerosis in patients with suspected embolic stroke using cardiac computed tomography

The purpose of this study was to investigate the incidence of subclinical coronary artery disease (CAD) in patients with suspected acute embolic stroke or transient ischemic attack (TIA) using 64-row multi-slice computed tomography (MSCT) and to examine its association with conventional risk stratification. We consecutively enrolled 175 patients (66?±?13?years, 50% men) suspected to have had embolic stroke/TIA clinically or radiologically, and underwent 64-row MSCT to evaluate for a possible cardiac source of embolism. Both coronary artery calcium scoring (CACS) and coronary CT angiography (CCTA) were concurrently performed based on standard scanning protocols. Patients with a history of angina or documented CAD, and those with significant carotid stenosis were excluded. Atherosclerotic plaques were indentified in 105 (60%) individuals; 37 (21%) had occult CAD of ≥50% diameter stenosis on CCTA. Subjects with and without ≥50% occult CAD on CCTA had similar prevalence of cardiovascular risk factors. Thirty out of 175 (17%) individuals with ≥50% occult CAD would have missed further cardiac testing based on the American Heart association and the American Stroke Association guideline. However, these numbers would be reduced to 2% (4/175) using CACS. In logistic regression analysis, only CACS independently predicted the presence ≥50% occult CAD evidenced by CCTA. Subclinical CAD, including ≥50% stenotic disease, is highly prevalent in patients who had suffered a suspected embolic stroke. The current guideline for further cardiac testing may have limited value to identify patients with ≥50% CAD in this patient population, which can be improved by adopting CACS.     

Nurse case management of hypercholesterolemia in patients with coronary heart disease: results of a randomized clinical trial

Background Despite the large body of evidence confirming the effectiveness of lipid lowering for the secondary prevention of coronary heart disease (CHD) events, undertreatment of hyperlipidemia is common. This study tested the effectiveness of a nurse case management program to lower blood lipids in patients with CHD. Methods A total of 228 consecutive, eligible adults with hypercholesterolemia and CHD were recruited during hospitalization after coronary revascularization. Patients were randomized to receive lipid management, including individualized lifestyle modification and pharmacologic intervention, from a nurse practitioner for 1 year after discharge in addition to their usual care (NURS), or to usual care enhanced with feedback on lipids to their primary provider and/or cardiologist (EUC). Results Significantly more patients in the NURS group than in the EUC group achieved low-density lipoprotein cholesterol (LDL-C) levels <2.59 mmol/dL (100 mg/dL, 65% vs 35%, P = .0001). Favorable changes in lipids and lipoproteins were accompanied by significant improvements in dietary and exercise patterns in the NURS group. In a multivariate analysis adjusting for other covariates, being assigned to the NURS group (P = .0001) and being on a lipid-lowering medication (P = .001) were significant independent predictors of LDL-C level. Conclusions Control of hypercholesterolemia in patients who have undergone coronary revascularization can be improved by a nurse case-management program. Because the National Cholesterol Education Program Adult Treatment Panel III guidelines have broadened the definition of high-risk populations that warrant aggressive treatment, nurse case-management programs may offer key opportunities to enhance appropriate application of new treatment paradigms. (Am Heart J 2002;144:678-86.)     

Superoxide-forming enzyme from human neutrophils: evidence for a flavin requirement

The superoxide-forming activity of 27,000-g particles prepared from homogenates of zymosan-treated human neutrophils is lost if the assay is conducted in the presence of 0.045% Triton X-100. This loss in activity in the presence of detergent is prevented by 40 micron flavin adenine dinucleotide (FAD), but not by flavin mononucleotide, riboflavin, adenosine 5'-diphosphate, or adenosine 5'-monophosphate. With resting particles or particles from zymosan-treated chronic granulomatous disease neutrophils, no superoxide-forming activity is detectable even in the presence of FAD; this is true whether or not detergent is present in the assay. Particles extracted with detergent prior to assay are fully active if assayed in the presence of FAD, but show little activity if FAD is omitted from the assay mixture. These results suggest that the superoxide-forming enzyme from human neutrophils is a FAD-requiring enzyme.     

Cardiovascular Response to Acute Cold Stress in Non-Obese and Obese Healthy Adults

Background

Obesity is a global epidemic with important health care and financial implications. The cold pressor test (CPT) which is considered to be a sympathy-excitatory manoeuvre is a simple, noninvasive and validated test. The objective of this study was to assess and compare the cardiovascular response to cold pressor test in non-obese and obese healthy adults.

Methods

The study included 400 subjects, of which the study group included 200 adults who had body mass index (BMI) of more than 30 Kg/m,² and 200 non-obese adults were enrolled as controls with BMI less than 25 kg/m². The study was conducted for a period of two months. CPT was used to assess cardiac response to acute cold exposure in the present study. Baseline systolic and diastolic blood pressure recording was done using mercury sphygmomanometer during resting condition and following cold pressor test. The results were expressed as mean, standard deviation, and data were analyzed using ANOVA test. P < 0.05 was considered statistically significant.

Results

The mean change in systolic blood pressure before and after cold pressor test (CPT) was less in obese (7.12 ± 5.28) as compared to non-obese subjects (10.38 ±6.35). This was statistically significant which indicates impaired sympathetic function in otherwise healthy obese.

Conclusion

The study concluded that blood pressure response to cold pressor test was reduced in obese compared to non-obese subjects indicating reduced sympathetic activity in healthy obese adults.