The binding of human alloantibodies to recombinant glycophorin A

Chinese hamster ovary (CHO) cells were transfected with the wild-type, M allele of glycophorin A cDNA. The binding of human alloantibodies to recombinant glycophorin A was assessed with a modified hemagglutination-inhibition assay. Patient sera were incubated with acetone powders derived from CHO cells, and the adsorbed supernatants were tested in standard hemagglutination assays. Five M antibodies and one sample containing anti-En(a) bound to transfected CHO cells expressing glycophorin A but did not bind to untransfected CHO cells. Three N antibodies as well as 21 other alloantibodies (representing other major red cell blood group specificities) bound to neither CHO cell line. The M allele specificity of recombinant glycophorin A was further verified by the demonstration that a high-titer D alloantibody maintained the same titer of agglutination after incubation with recombinant glycophorin A. Transfected CHO cells thus express an M blood group antigen that appears to be serologically equivalent to that found on human red cells. A panel of cell lines expressing mutant glycophorin A molecules with defined variations in amino acid sequence and carbohydrate composition will be useful in studies of the fine specificity of human glycophorin alloantibodies. This approach may also provide an abundant source of artificial antigens for clinical use in blood group serology.     

Patient satisfaction with topical ocular hypotensives

Background: The aim of this study is to assess patient satisfaction, convenience of use, ease of administration, side effects and treatment burden of topical ocular hypotensives. Design: Prospective, observational cohort. Participants: Two thousand five hundred and forty‐one patients with glaucoma or ocular hypertension. Methods: The Treatment Impact Patient Satisfaction Scale (TIPSS) was administered by mail to all patients with glaucoma or ocular hypertension registered with Glaucoma New Zealand during a 3‐month study period. The questionnaire assessed patient demographics; topical ocular hypotensive use including number of medications, frequency of administration, ease of use, class of medication, and presence/severity of side effects; impact on quality of life; and patient satisfaction. Univariate and multivariate analyses were performed to identify determinants of patient satisfaction. Main Outcome Measures: Patient satisfaction. Results: Almost 80% of respondents were either ‘very satisfied’ or ‘satisfied’ with topical ocular hypotensives. Factors that were predictive of patient satisfaction included satisfaction with frequency of eye drop use {odds ratio (OR) 2.4 (95% confidence interval [CI] 1.8–3.1); P < 0.001}, subjective convenience (OR 2.6 [95% CI 2.0–3.4]; P < 0.001) and ease of administration (OR 2.5 [95% CI 2.0–3.3]; P < 0.001). Male gender was associated with lower satisfaction (OR 0.6 [95% CI 0.5–0.9]; P = 0.01). Factors that were not predictive of patient satisfaction included age, duration of eye drop use, class of medication and the presence of side effects. Conclusions: Patients with glaucoma and ocular hypotension are satisfied with topical ocular hypotensives. Efforts to improve patient satisfaction should focus on convenience and ease of administration.     

游离足趾移植术中Ⅱ趾血供系统的特点

目的：游离足趾移植是拇指Ⅱ类以上缺损再造术的首选。分析与Ⅱ趾移植相关的足部供血系统的血管走行、分支情况及变异程度，并提出临床应用中为保证手术成功而采取的相应对策。方法：对1978—03/2007—06天津医院手、显微外科收治的91例Ⅱ趾移植再造拇（手）指患者进行回顾性分析，所有病例均为ⅡB-ⅢB类型拇指缺损，均为择期手术，对治疗方案知情同意。术中遇第一跖背动脉纤细型，采取足背动脉-足底深支-第一跖底动脉的第2套供血系统。当第一跖背动脉走行不定而误伤时，手术继续进行，完整切取Ⅱ趾后，进行第一跖背动脉吻合修复。注意第一跖背动脉至足趾的分支解剖特点，辨清与Ⅱ趾的关系，采取不同的手术对策。结果：91例拇指缺损患者获得了97．8％的成活率及优良的外形与功能恢复，移植术中Ⅱ趾的使用率是100％。Ⅱ趾的血供系统特点：①由足背动脉发出的第二跖背动脉很少见，足背动脉的弓状动脉分支也很少见。②第一跖背动脉起始、走行、口径虽不恒定，但是有章可循。③第一跖背动脉终末交通支及至Ⅱ趾的分支情况分为3型，各型对Ⅱ趾的血供也有其不同特点。结论：全面掌握与Ⅱ趾移植相关的足部供血系统的解剖特点，术中仔细游离并采取相应的处理方法，是保证手术成功的关键。     

Temporomandibular joint: comparison of single- and double-contrast arthrography

Lower-space, single-contrast arthrography and dual-space, double-contrast arthrotomography were sequentially applied to 58 fresh temporomandibular joint (TMJ) autopsy specimens, and the findings were compared with observations in corresponding cryosections. Both modalities had high accuracy rates (greater than or equal to 84%) and no statistically significant differences between the two techniques were found. A side-by-side comparison of the two types of arthrograms, however, revealed that video tape recording of lower-space, single-contrast arthrography was superior in demonstrating joint dynamics and that dual-space, double-contrast arthrotomography was superior in demonstrating the soft-tissue anatomic features of the joint. It appears that lower-space, single-contrast arthrography can be recommended for examination of patients with clicking, catching, and intermittent locking, and that dual-space, double-contrast arthrotomography is preferable when information about morphologic alterations is clinically more important than information about joint dynamics.     

Abnormal assembly of membrane proteins in erythroid progenitors of patients with beta-thalassemia major

The life threatening anemia in beta-thalassemia major (Cooley's anemia) is characterized by profound intramedullary lysis, the cause of which is incompletely understood. Using marrow obtained from beta thalassemia major patients undergoing allogeneic bone marrow transplantation in Pesaro Italy, it became possible to directly study the mechanism of the intramedullary hemolysis. Based on our previous studies, we hypothesized that the unmatched alpha globin chains would interfere with normal assembly of erythroid precursor membrane proteins. Patient and control erythroid precursors were reacted with monospecific polyclonal rabbit antibodies directed against spectrin, band 3, and band 4.1 and with a monoclonal anti-alpha globin chain antibody. Using laser confocal fluorescence microscopy, normal erythroid precursors show no alpha globin chain accumulation and exhibited uniformly smooth rim fluorescence of the three membrane proteins. In some thalassemic precursors, spectrin appeared to interact with large alpha globin accumulations, and in many of these cells the spectin appeared clumped and discontinuous. Band 4.1 interacted strongly with accumulations of alpha globin in thalassemic precursors to produce bizarrely clumped zones of abnormal band 4.1 distribution. Band 3 was incorporated smoothly into thalassemic erythroblast membranes. However, the proerythroblasts and basophilic erythroblasts were significantly deficient in band 3. Thus, accumulations of alpha globin in beta- thalassemia major colocalized with and disrupt band 4.1 and spectrin assembly into the membrane. The cause of deficient band 3 incorporation into thalassemic proerythroblast membranes remains unknown. These profound membrane alterations would likely contribute to the intramedullary lysis seen in Cooley's anemia.