Inhibition of an anti-Pr1d cold agglutinin by citrate present in commercial red cell preservative solutions

A patient with known cold autoimmune hemolyticanemia was admitted for surgery. Routine cold agglutinin evaluations, using commercial red cells (RBCs) in modified Alsever's preservative solution, revealed a cold agglutinin titer of 4 to 16. However, using RBCs washed four times with saline, a high-titer (greater than 2000 at 4 degrees C) cold autoagglutinin was demonstrated. The cold agglutinin was shown to be an IgM kappa paraprotein with anti-Pr1d specificity. The addition of Alsever's solution to washed RBCs inhibited the cold agglutinin. Each major component of Alsever's solution (neomycin, chloramphenicol, inosine, dextrose, and citrate) was tested individually; only citrate inhibited the patient's cold agglutinin. Various compounds structurally related to citrate were tested and found to cause various degrees of inhibition. The strongest inhibition correlated with the presence of either three carboxyl groups on molecules devoid of double-bonded carbon atoms or two carboxyl groups in cis configuration. A panel of 54 cold agglutinins, including 7 with anti-Pr specificity, was analyzed. None was significantly inhibited by Alsever's solution, although one with anti-Pr2 specificity was weakly inhibited. In summary, these studies describe an anti-Pr1d cold autoagglutinin that was inhibited by citrate in RBC preservative solutions. The failure to detect such a cold agglutinin can result from not washing RBCs free of citrate before testing.     

Modified silicone sling assisted temporalis muscle transfer in the management of lagophthalmos

Aim:

To evaluate the efficacy of modified temporalis muscle transfer (TMT) by silicone sling for the management of paralytic lagophthalmos.

Settings and Design:

Prospective interventional study.

Materials and Methods:

Ten patients of lagophthalmos due to facial palsy underwent modified TMT using silicone sling. The patients were followed-up for a period of 3 months. Palpebral aperture in primary gaze and during eye closure were assessed both pre- and postoperatively along with problems associated with lagophthalmos like exposure keratopathy and lacrimation.

Statistical Analysis:

Paired t-test was applied to measure the statistical outcome.

Results:

Eight patients achieved full correction of lagophthalmos with no lid gap on closing the eye. The mean (standard deviation (SD)) lid gap on eye closure was 7.7 (0.86) mm preoperatively, 0.5 (0.47) mm at 1^st postoperative day, and 0.7 (0.75) mm at 3^rd month. There was a reduction in mean lid gap on eye closure of 7 mm at 3 months (P < 0.0001) which is highly significant. The mean (SD) vertical interpalpebral distance during primary gaze was 12.05 (1.12) mm preoperatively, 10 (0.94) mm at 1^st postoperative day, and 10.35 (1.08) mm at 3^rd month. There was a reduction in mean vertical inter palpebral distance of 1.7 mm at 3 months (P = 0.001) which is significant. Exposure keratitis decreased in five out of six patients at 3 months.

Conclusion:

Modified TMT by silicone sling is a useful procedure with lesser morbidity and good outcomes for the treatment of paralytic lagophthalmos due to long standing facial palsy.     

The effect of physical activity on pelvic organ prolapse

Objective  The objective of this study was to determine whether pelvic organ prolapse increases after physical activity.
Design  Prospective observational study.
Setting  St Mary's Hospital, Manchester, UK.
Sample  Women undergoing surgery for pelvic organ prolapse.
Methods  Fifty-four women were recruited to the study. Symptoms and POPQ findings were assessed after a period of prescribed activity and overnight bedrest.
Main outcome measures  Primary outcome was an increase in Pelvic Organ Prolapse Quantification (POPQ) measurements with activity. Secondary outcomes were association of symptoms or quality-of-life scores (Pelvic Floor Distress Inventory [PFDI] and Pelvic Floor Impact Questionnaire [PFIQ]) with an increase in POPQ measurements.
Results  There was a significant increase in POPQ stage and five vaginal parameters (Aa, Ba, C, Ap and Bp) with physical activity ( P < 0.001). Reported symptoms, higher PFDI and PFIQ scores and higher individual symptom bother scores were not more common in the women with greater pelvic organ descent (measured by the POPQ system) following physical activity.
Conclusions  Greater pelvic organ prolapse was found on POPQ examination following physical activity, but this was not associated with worsening of symptoms and greater impairment of quality of life.     

Impact of bowel obstruction at the time of initial presentation in women with ovarian cancer

Objective  To determine whether the presence of bowel obstruction at the time of initial presentation has any prognostic significance in these women.
Design  Retrospective cohort study.
Setting  Dedicated gynaecological oncology service of a large tertiary institution.
Population  Women who had a bowel obstruction as part of their initial presentation of ovarian cancer were identified between 1995 and 2007. Each woman was matched with four control women (with disease but no obstruction).
Methods  Women with disease were compared with controls to determine the impact, if any, of bowel obstruction at presentation. Several prognostic variables including bowel obstruction were also evaluated in a Cox proportional hazard model.
Main outcome measures  Progression-free survival (PFS) and overall survival (OS).
Results  Forty-eight women with disease and 192 controls were identified during the study period. The median follow-up period was 19 months among women with disease versus 20 months in controls. No differences were seen in demographics and clinical characteristics of the women. Optimal cytoreduction rate was similar between the two groups (75% versus 78%, P  = 0.7). Patients with bowel obstruction had a shorter PFS and OS compared with controls [19 months versus 21 months ( P  = 0.01) and 22 versus 35 months ( P  = 0.008)], respectively. Bowel obstruction at presentation was an independent prognostic variable with a hazard ratio of 1.5 ( P  = 0.009). Other prognostic variables were age, stage and extent of surgical cytoreduction.
Conclusions  Bowel obstruction at the time of initial presentation is an adverse prognostic factor in women with ovarian cancer.     

人近端肾小管上皮细胞上表达黏附分子CD146与细胞的增殖生长状态

目的:观察正常人近端肾小管上皮细胞(HK2)是否表达黏附分子CD146,初步探讨CD146与肾小管上皮细胞的关系及其生理意义。方法:实验于2005-05/2006-02在上海交通大学医学院临床检验系实验室完成。①实验材料:人近端肾小管上皮细胞株(HK2,由中国科学院上海生物化学与细胞生物学研究所惠赠)。②实验干预:体外培养的HK2连续观察72h。③实验评估:采用倒置显微镜、光学显微镜下观察肾小管上皮细胞的形态;用反转录-聚合酶链反应方法检测CD146 mRNA的表达;流式细胞仪和免疫荧光法测定CD146蛋白质的表达及其定位;进一步在培养细胞的上清液中检测CD146的可溶性形式(sCD146)。结果:①肾小管上皮细胞的形态学观察和鉴定:传代培养的HK2三四天融合后呈铺路石样铺于培养瓶底,相关抗原检测抗人keratin阳性,抗Ⅷ因子相关抗原阴性。②CD146 mRNA水平的表达:HK2在培养早期(24h)即表达CD146 mRNA(0.092±0.012),但延长细胞的培养时间似乎并没有进一步改变CD146 mRNA的表达水平(0.097±0.005,0.113±0.015,P>0.05)。③CD146蛋白质水平的表达和定位:CD146不仅位于肾小管上皮细胞膜上,而且在细胞核和胞浆中也有表达。体外培养的HK2相互融合时,位于细胞膜上的CD146表达增强,呈线性、持续性地表达于细胞-细胞间的连接部位,同时胞内的CD146标记也相应增强。④细胞上清液中sCD146的检测:HK2上清液中存在CD146的可溶性形式(sCD146)。培养细胞观察24～72h,sCD146水平在48h升高[(18.00±0.80)μg/L],到72h达到高峰[(29.33±1.22)μg/L],与24h[(13.87±0.46)μg/L]比较,差异均有显著性意义(P<0.05)。结论:人近端肾小管上皮细胞组成性地表达CD146,是肾小管上皮细胞新的生物学标志;CD146在细胞内外的表达强度有赖于细胞间联系的建立和细胞增殖的程度,CD146在促进细胞生长和维持组织完整性等方面发挥重要作用。肾小管上皮细胞上清液中存在CD146的可溶性形式,sCD146在一定程度上也反映了细胞的生长和增殖状况。     

Reversal of slow flow phenomenon during primary stenting by bail-out administration of abciximab

BACKGROUND: Slow flow or no reflow phenomenon is increasingly being recognized as a serious problem during coronary angioplasty and stenting. This phenomenon is seen more often during angioplasty in highly thrombogenic milieux, especially in a setting of acute myocardial infarction. The treatment of this complication is often not satisfactory. efficacy of abciximab, a potent antiplatelet drug, in treating slow flow or no reflow phenomenon during primary percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction (AMI). METHODS: Twenty-one instances of persistent slow flow phenomenon were encountered in 131 consecutive patients subjected to primary PTCA for AMI (16%). It was more common in patients presenting with AMI complicated by cardiogenic shock (nine of 21, 43%). Of these 21 cases of slow flow, 10 patients were given injection abciximab during the procedure of primary PTCA as a bail-out measure after encountering the complication of slow flow or no reflow. A predischarge coronary angiography was carried out in all patients who survived. RESULTS: In seven of 10 patients in the abciximab group flow had improved to TIMI-3. In contrast, in the non-abciximab group TIMI flow improved in only four of 11 patients. Patients with persistent slow In this study the authors assessed the flow had significantly higher mortality at the first 30-day follow-up than patients with TIMI-3 flow (33% versus 1.8%, p<0.001). CONCLUSION: In this small nonrandomized study significant improvement in coronary flow was achieved by using intravenous abciximab after observing slow flow or no reflow phenomenon during primary PTCA. More frequent use of this drug in this milieu might help in preventing the development of this complication. Larger studies are warranted to confirm this life-saving beneficial effect of bail-out administration of abciximab during primary angioplasty. (Int J Cardiovasc Intervent 2000; 3:35–39)     

Ethnoveterinary Application of Morinda Citrifolia Fruit Puree on a Commercial Heifer Rearing Facility with Endemic Salmonellosis

We have previously reported that Morinda citrifolia (noni) puree modulates neonatal calves developmental maturation of the innate and adaptive immune system. In this study, the effect of noni puree on respiratory and gastrointestinal (GI), health in preweaned dairy calves on a farm with endemic salmonellosis was examined. Two clinical trials were conducted whereby each trial evaluated one processing technique of noni puree. Trials 1 and 2 tested noni versions A and B, respectively. Puree analysis and trial methods were identical to each other, with the calf as the experimental unit. Calves were designated to 1 of 3 treatment groups in each trial and received either: 0, 15 or 30 mL every 12 hr of noni supplement for the first 3 weeks of life. Health scores, weaning age, weight gain from admission to weaning, and weaned by 6 weeks, were used as clinical endpoints for statistical analysis. In trial 1, calves supplemented with 15 mL noni puree of version A every 12 hr had a higher probability of being weaned by 6 weeks of age than control calves (P = 0.04). In trial 2, calves receiving 30 mL of version B every 12 hr had a 54.5% reduction in total medical treatments by 42 days of age when compared to controls (P = 0.02). There was a trend in reduced respiratory (61%), and GI (52%) medical treatments per calf when compared to controls (P = 0.06 and 0.08, respectively). There were no differences in weight gain or mortality for any treatment group in either trial.     

The feasibility of a less invasive method to assess endometrial maturation—comparison of simultaneously obtained uterine secretion and tissue biopsy

Objective  To compare the assessment of endometrial maturation parameters in endometrial secretion samples obtained by a novel minimally invasive technique with those assessed in tissue biopsies.
Design  Prospective study.
Setting  University Hospital.
Population  Healthy female volunteers attending a gynaecological outpatient clinic.
Methods  Endometrial secretion fluid and tissue sampling 5 days after a spontaneous ovulation assessed with ultrasound.
Main outcome measures  Progesterone (P) receptor, Ki-67 expression and the Noyes criteria were used to date endometrial biopsies. In the endometrial fluid samples, glycodelin A (GdA), leukaemia inhibitory factor (LIF) and P levels were analysed, and protein content and electrophoresis patterns were determined.
Results  All data were correlated to estradiol (E₂) and P serum concentrations. The dating according to histology and immunohistochemical staining patterns correlated significantly with GdA levels ( r = 0.376, P = 0.048) in endometrial fluid samples as well with serum levels of E₂ ( r = 0.568, P = 0.001) and P ( r = 0.408, P = 0.023). No correlation was observed between tissue dating and LIF levels and protein content in endometrial fluid samples.
Conclusions  The measurement of GdA in endometrial secretion samples may provide a less invasive method for assessing endometrial maturation in potential conception cycles without disrupting implantation.     

Service users' experiences of obtaining and giving information about disorders of sex development

Objective  To quantify participants' experiences of obtaining and giving information about disorders of sex development (DSD).
Design  Cross-sectional survey study that asked people about their current and past experiences relating to DSD disclosure.
Setting  A large tertiary referral centre for DSD management in the UK.
Population  One hundred of 126 people with a confirmed diagnosis of DSD who were invited to participate in the study formed the usable sample.
Methods  All people who attended clinic for follow-up during the study period and members of a patient support group whose annual meeting fell within the study period were asked to complete the Middlesex Communication Survey.
Main outcome measures  The Middlesex Communication Survey.
Results  Younger participants were more likely to report having been appropriately informed about their diagnosis than older people. Nearly half of the former had been fully informed about their diagnosis by age 15 years, compared with 0% of the older age group. In terms of information sharing, mothers were most likely to be the person with whom the participant had shared (almost/all) DSD information (74%), followed by current partners (71%). Information relating to genital surgery, presence of testes and clitoral anomalies were the least likely aspects to have been unambiguously shared with even the most informed person.
Conclusions  Our results suggest that difficulties in obtaining DSD information from care providers were common, and that communication has improved for younger participants. The study also confirmed that many people with DSD continue to struggle with confiding, even in those closest to them, about aspects of their diagnosis. Care protocol needs to centralise psychological adaptation, which should also be a primary focus for future research.