Flow cytometry of leucocyte alkaline phosphatase in normal and pathologic leucocytes

Leucocyte alkaline phosphatase (LAP) is an enzyme expressed on the external aspect of the neutrophilic granulocyte plasma membrane, and represents a specific marker for the fully differentiated granulocyte. In this report we characterize 1B12.1, a monoclonal antibody raised against human bone alkaline phosphatase, by its ability to recognize the LAP protein. As assessed by Western blot analysis, following electrophoresis under non-reducing conditions, the antibody specifically reacts with LAP upon forced expression of the protein in simian COS-7 fibroblasts. In addition, the 1B12.1 antibody recognizes partially purified LAP isolated from peripheral blood granulocytes. With this antibody we developed a quantitative flow-cytometry-based method for the determination of LAP. Double fluorescence flow cytometry demonstrated that the LAP protein was present in relatively high amounts in neutrophilic granulocytes, but not in monocytes, natural killer cells, or B and T lymphocytes of normal individuals. The protein was completely absent in granulocytes obtained from chronic myeloid leukaemia and paroxysmal nocturnal haemoglobinuria patients. Higher than normal levels of LAP protein were evident in neutrophilic granulocytes of patients suffering from polycythaemia vera, essential thrombocythaemia and severe aplastic anaemia. However, the highest amounts of LAP protein were present in the granulocytes of normal individuals treated with G-CSF for the isolation of peripheral blood stem cells.     

Interactions between sleep and sensory physiology

The processing of sensory information is definitely present during sleep, however, profound modifications occur. All sensory systems reviewed (visual, auditory, vestibular, somesthetic and olfactory) demonstrate some influence on sleep and, at the same time, sensory systems undergo changes that depend on the sleep or waking state of the brain. Thus, different sensory modalities encoded by their specific receptors and pathways may not only alter the sleep and waking physiology, but also the sleeping brain imposes ‘rules’ on the incoming information. It is suggested that the neural networks responsible for sleep and waking control are actively modulated by sensory inputs in order to enter and maintain normal sleep and wakefulness. Furthermore, both sensory stimulation and deprivation may induce changes in sleep/waking neural networks. This leads to the conclusion that the central nervous system and sensory input have reciprocal interactions, on which normal sleep/waking cycling and behaviour depends.     

β-Thalassaemia in south-western Spain: high frequency of G → A (IVS I-1) mutation

Huelva province is situated in southwestern Spain; its historic and geographic characteristics contribute to the existence of erythrocyte genetic anomalies, such as β thalassaemia. We have carried out a prenatal study of microcytosis, with a preliminary β-gene analysis. Our findings show a β-thalassaemia trait prevalence of 0.81%. In the molecular research there was a high frequency of G → A (IVS I-1) injury: 55%. By comparing the rates of this mutation in neighbouring Cáceres province in western Spain (47%) and Algarve in south Portugal (32%), it demonstrates that this β-gene defect has a high frequency in the southwest of the Iberian Peninsula.     

Temporary Atrial Pacing in the Prevention of Postoperative Atrial Fibrillation

Background: Atrial fibrillation (AF) is a common complication after coronary artery bypass grafting (CABG). Since its prevention with prophylactic drug therapy has limited success, alternative approaches are desirable. This study examined the efficacy of atrial or biatrial pacing, compared with no pacing, on the incidence of AF after isolated CABG.
Methods: From August 2002 to September 2004, 240 patients underwent CABG. After surgery, right and left atrial epicardial pacing wires were implanted for 72 hours of temporary pacing. Patients were randomly assigned to one of three groups: no pacing (control group), right atrial (RA), and biatrial (BiA) pacing. Cardiac rhythm was monitored continuously during intensive care, or daily on the ward. The primary endpoints of this study were an episode of AF occurring up to 72 hours after CABG and the risk factors correlated with this event.
Results: Atrial and BiA pacing significantly lowered the incidence (1.25% vs 25%, P = 0.001) of AF episodes, and were both correlated (odd ratio 0.038; 95% confidence interval 0.005–0.29) with a decrease in rates of postoperative AF. Multivariable analysis identified older age (odd ratio 1.074; 95% confidence interval 1.024–1.12) and no pacing as independent risk factors of postoperative AF.
Conclusions: Temporary right atrial or biatrial pacing after CABG significantly decreased the postoperative incidence of AF. Multivariable analysis identified older age and no pacing as predictors of AF occurrence .     

Health services decentralization in Mexico: formulation, implementation and results of policy

This article provides a critique of decentralization of healthcare systems in underdeveloped countries, taking the Mexicancase as an example. The formulation, implementation and interruptionof integrative decentralization in the 1980s is analysed inthe context of the interests served in Mexico by administrativecentralization and institutional fragmentation. The short-termresults of decentralization upon state-level politics, finance,planning and health service distribution and equity are analysedin their relationship to bureaucratic and political interests. Initially the most underdeveloped region of the country wasselected for a special comparative study of the effects of decentralizationupon health service planning and equity. One state of this regionbecame decentralized, while the other underwent only minor changes.It was therefore possible to compare the specific effects ofadministrative changes in the two states. Decentralization was interrupted at the national level, withonly 14 states actually undergoing administrative change. Thepolicy was also short of its devolutionary intentions, actuallybecoming an attempt towards recentralizing power around a differentadministrative structure. Regional disparities in the distributionof health services were accentuated due to the privileges furtheredby decentralization in the richer municipalities, and the fallin services in the poorer ones related to interinstitutionalconflicts at the central level     

PHARMACOKINETICS OF RECTAL KETAMINE IN CHILDREN

We have studied the pharmacokinetics of ketamine administeredrectally in a dose of 10 mg kg^–1 to five children aged6–9 yr and mean weight 28.80 (SD 6.55) kg. An acceptablelevel of anaesthesia was not obtained in any patient. Despitethis, the degree of analgesia obtained was good and no childrequired further administration of analgesics during the postoperativeperiod. Tolerance to the suppositories was excellent. The absorptionof ketamine was found to be relatively fast, with a median peakconcentration of 160 ng ml^–1 (range 96–250 ng ml^–1)at 0.75 h (range 0.50–1.00 h) after administration. Theplasma concentrations of norketamine were greater than thoseof the parent drug, with a maximum of 510 ng ml^–1 (range450–810 ng ml^–1) at 0.81 h (range 0.50–1.00h) after administration. The medians of the half-lives of ketamineand norketamine were 3.15 h and 2.56 h, respectively (range1.57–4.95 h and 1.47–5.30 h, respectively).     

Doppler Echocardiographic Assessment of the Bjork-Shiley Monostrut Valve Prosthesis in the Aortic Position

In order to determine the standard Doppler hemodynamic characteristics of the Bjork-Shiley monostrut aortic prosthesis and the value of the continuity equation to calculate the prosthetic valvular area, we performed Doppler echocardiographic study in 106 stable patients with this prosthesis and in 7 patients with suspicion of aortic Bjork-Shiley dysfunction. We measured maximum and mean Doppler gradients, prosthetic valvular area using the continuity equation, and degree of aortic regurgitation. The maximum and mean Doppler gradients in the 106 stable patients ranged from 9.5 to 51 mmHg (X?= 28.9 ± 11 mmHg) and from 2 to 24 mmHg (X?= 12.7 ± 5.2 mmHg), respectively. Maximum Doppler gradients > 45 mmHg and mean Doppler gradients > 20 mmHg occurred only in size 23 or smaller. No patient had a mean Doppler gradient > 25 mmHg. We found significant differences between sizes 25 and 27 (P < 0.01) and 21 and 25 (P < 0.01), but not between sizes 19, 21, and 23, or 23 and 25. There was significant difference in Doppler prosthetic valvular area between each valve size. The correlation coefficient between the prosthetic size and the echo-Doppler valvular area was 0.89 according to a lineal equation (SEE = 16). We could demonstrate mild aortic regurgitation in 25 cases (24%). The Doppler-derived prosthetic valvular area was < 0.38 cm² in two patients with obstruction and > 2 cm² in three patients with regurgitation alone. We conclude that high pressure gradients can be observed through the smallest sizes of the Bjork-Shiley monostrut aortic prostheses. Mild aortic regurgitation is a common finding. Our values are suggested as a reference for comparison in the case of suspected Bjork-Shiley valve dysfunction. The Doppler-derived prosthetic valvular area may be useful in patients with dysfunction of this prosthesis, especially to differentiate obstruction and regurgitation from regurgitation alone.