Sequential drain amylase to guide drain removal following pancreatectomy

Background

Although used as criterion for early drain removal, postoperative day (POD) 1 drain fluid amylase (DFA) ≤ 5000 U/L has low negative predictive value for clinically relevant postoperative pancreatic fistula (CR-POPF). It was hypothesized that POD3 DFA ≤ 350 could provide further information to guide early drain removal.

Broad human immunodeficiency virus (HIV)-specific T cell responses to conserved HIV proteins in HIV-seronegative women highly exposed to a single HIV-infected partner

Eighteen highly exposed but persistently seronegative (HEPS) women (HW) and their human immunodeficiency virus (HIV) type 1-seropositive male partners were studied for HIV-specific T cells and other host factors. Circulating HIV-specific T cells were measured by interferon-gamma enzyme-linked immunospot assays, using recombinant vaccinia virus vectors expressing HIV proteins. Nine (50%) of the HW and all HIV-seropositive persons had HIV-specific T cell responses. Only 2 (22%) of the HEPS responders recognized Env, compared with 94% of HIV-seropositive persons. A high percentage (75%) of the HW with HIV-specific T cell responses reported recent HIV exposure. Remarkably, however, long-lived HIV-specific T cells were detected in 2 HW who had an extended period (>3.9 years) of no HIV exposure. These findings have important implications for HIV vaccine design.     

The relationship between blood pressure and C-reactive protein in the Multi-Ethnic Study of Atherosclerosis (MESA).

OBJECTIVES: The goal of this study was to determine the relationship between resting blood pressure (BP) and C-reactive protein (CRP) in a multi-ethnic cohort of men and women from the Multi-Ethnic Study of Atherosclerosis (MESA). BACKGROUND: Several investigators have observed elevated levels of CRP in individuals with hypertension. Hypertension prevalence varies considerably across ethnic groups. Important questions remain regarding whether the relationship between hypertension and CRP is similar across ethnic and gender subgroups. METHODS: The MESA participants had CRP levels determined at the baseline clinical examination (N = 6,814). Hypertension, treated as a dichotomous variable (yes/no), was defined as a systolic or diastolic BP > or =140/90 mm Hg or a self-reported history of hypertension and use of antihypertensive medications. RESULTS: The geometric mean CRP in hypertensive participants was 2.3 +/- 0.07 mg/l compared with 1.6 +/- 0.07 mg/l among normotensive participants (p < 0.0001). The relative difference in CRP levels in hypertensives compared with normotensives was similar regardless of gender (13% in men and 13% in women). Ethnic comparisons showed that Chinese participants had the lowest CRP concentration but the largest difference in CRP by hypertension status (24%). Caucasians and African Americans had 10% to 15% higher CRP levels with hypertension, whereas Hispanics had no significant difference in CRP by hypertension status. CONCLUSIONS: This study confirms the existence of an independent association between hypertension and inflammation in both men and women. Ethnic group differences were evident, with the strongest association observed in Chinese participants and no difference in CRP levels by hypertension status in Hispanics.     

A videotape-based training method for improving the detection of depression in residents of long-term care facilities

PURPOSE: This article reviews the effectiveness of a new training program for improving nursing staffs' detection of depression within long-term care facilities. The course was designed to increase recognition of the Minimal Data Set (MDS) Mood Trigger items, to be brief, and to rely on images rather than didactics. DESIGN AND METHODS: This study used a delayed intervention design. Twenty nurses from two facilities participated in all four sessions of the study. RESULTS: Staff exposed to the intervention (Site 1) improved significantly in their ability to detect mood symptoms in videotaped patients after completing the training course compared with those exposed to the delayed intervention (Site 2). Improvement in detection skills at Site 2 following the training confirmed the intervention's utility. The improvement was demonstrated across levels of staff (licensed and unlicensed). Maintenance of skills was demonstrated at the 4-month follow-up. IMPLICATIONS: Staff successfully improved knowledge and skill of MDS mood triggers. This method may lend itself to other MDS domains.     

Outbreak of hepatitis A among men who have sex with men: implications for hepatitis A vaccination strategies

Between November 1998 and May 1999, 136 cases of hepatitis A were reported in Columbus, Ohio. Eighty-nine (65%) case patients were reinterviewed. Of 74 male case patients, 47 (66%) were men who have sex with men (MSM). These 47 MSM were compared with 88 MSM control subjects, to identify risk factors for infection and potential opportunities for vaccination. During the exposure period, 6 (13%) case patients reported contact with a person who had hepatitis A, compared with 2 (2%) control subjects (odds ratio, 6.15; 95% confidence interval, 1.04-48.02); neither number of sex partners nor any sex practice was associated with illness. Most case patients and control subjects (68% and 77%, respectively) saw a health care provider at least annually, and 93% of control subjects reported a willingness to receive hepatitis A vaccine. MSM are accessible and amenable to vaccination; increased efforts are needed to provide vaccination, regardless of reported sex practices.     

Decreased treatment failure in recipients of HLA-identical bone marrow or peripheral blood stem cell transplants with high CD34 cell doses

We studied the association between CD34 cell dose and transplant outcomes in 359 bone marrow (BM) and 511 peripheral blood stem cell (PBSC) transplant recipients from human leucocyte antigen (HLA)-identical siblings, reported to the International Bone Marrow Transplant Registry (IBMTR). Transplants for leukaemia were performed between 1995 and 1998. Patients were divided into those receiving below or above the median CD34+ dose, for BM (3 x 106/kg) and PBSC (6 x 106/kg) grafts respectively. Cox proportional hazards regression was used to adjust for baseline patient-, disease- and transplant-related characteristics. Analysis of the BM recipients showed that high CD34 cell dose was associated with lower transplant-related mortality [relative risk (RR) = 0.60, P = 0.033] and treatment failure (inverse of leukaemia-free survival, RR = 0.69, P = 0.032). Among PBSC recipients, high CD34 dose was associated with faster recovery of neutrophils to > 0.5 x 109/l (RR = 1.38, P < 0.001) and platelets to > 20 x 109/l (RR = 1.34, P = 0.003), lower risk of relapse (RR = 0.62, P = 0.029) and treatment failure (RR = 0.74, P = 0.03). We conclude that higher CD34 cell doses decrease treatment failure in recipients of HLA-identical sibling BM and PBSC transplants.     

Lung inflation with direct injection of agarose: a technique for simultaneous molecular and morphometric measurements

The usual methods for preparing lungs for morphologic study involve the instillation of fixatives that modifyproteins and RNA such that the tissue is unsuitable for molecular studies. To develop a technique suitable for molecular studies, pieces of adult rat lungs were infiltrated with agarose, glutaraldehyde, or paraformaldehyde and the consistency of alveolar inflation was compared to lungs inflated with 10% formalin. Only direct injection with 1% agarose resulted in comparable inflation of lung tissue and preserved RNA and protein. Thus, this technique enables simultaneous molecular and morphometric analysis of the lung on small pieces of lung tissue in heterogeneous lung diseases.