Acid phosphatase activity in mononuclear phagocytes and the U937 cell line: monocyte-derived macrophages express tartrate-resistant acid phosphatase

Tartrate-resistant acid phosphatase (TRAcP) is used as a marker for osteoclasts, which are believed to be derived from phagocytic cells or phagocyte stem cell precursors. To further investigate the relationship between monocytic phagocytes and osteoclasts, acid phosphatase (AcP) activity was measured by three different techniques in human peripheral blood monocytes, monocyte-derived macrophages, and the U937 cell line. We found that cytochemistry and gel electrophoresis led to similar results, but that the colorimetric assay was inconsistent. Normal human peripheral monocytes expressed both tartrate-sensitive and -resistant AcP. In culture these cells formed polykaryons and expressed TRAcP activity that was further identified as an isoenzyme associated with bone tissue. In contrast, the U937 cells did not express TRAcP activity as measured by gel electrophoresis. Both U937 cells and monocytes possess material that interferes with interpretation of the colorimetric assay of AcP. The presence of TRAcP in monocyte-derived macrophages further supports the relationship between phagocytic cells and bone osteoclasts.     

Sodium carboxyl-methyl-cellulose dressings in the management of deep ulcerations of diabetic foot.

AIMS: To test the safety and effectiveness of carboxyl-methyl-cellulose dressing (Aquacel; ConvaTec, UK) in the management of deep diabetic foot ulcers, a group of consecutive out-patients attending the foot clinic of the Department of Metabolic Diseases was studied. METHODS: Patients were selected according to the following inclusion criteria: a foot ulcer deeper than 1 cm for > 3 weeks, good peripheral blood supply (palpable peripheral pulses or ABPI > 0.9). Exclusion criteria were as follows: active infection, as evident from clinical signs (purulent discharge, redness, swelling, tenderness) and confirmed by culture exams, plasma creatinine > 2 mg/dl, recent episodes of ketoacidosis, malignancies, and any therapy or pathology which might interfere with the healing process. Twenty patients were enrolled in the study and having obtained their informed consent, their lesions were surgically debrided with the complete elimination of all necrotic tissue and debris up to the bleeding healthy tissue; then ulcers were staged and measured, and patients were randomly assigned to two different treatment groups. Patients in group A were dressed with saline-moistened gauze, while patients in group B were dressed with Aquacel according to the manufacturer's instructions. All patients in both groups received special post-operative shoes (Podiabetes; Zeno Buratto, Treviso, Italy) and crutches until complete re-epithelialization. Ulcers were all left to heal by secondary intent. After 8 weeks patients were blindly evaluated for: the rate of reduction of lesional volume (RLV), rate of granulation tissue (GT), number of infective complications (IC). Intralesional (ILTC) and perilesional (PLTC) temperatures were also recorded with a thermocouple surface digital thermometer, and the difference between the two values (Delta TC) was calculated. Healing time (HT, days), was then compared between the two groups. Data were compared by analysis of variance (ANOVA), linear regression, Kaplan-Meier survival analysis and Fisher's exact test. RESULTS: HT was significantly shorter in Group B than in Group A (P < 0.001). RLV was significantly (P < 0.01) higher in Group B patients compared with Group A, as well as GT (P < 0.05). IC were in 1/10 Group B and in 3/10 Group A (P = 0.582). In addition, both ILTC and Delta TC were higher in Group B compared with Group A ones (P < 0.01). CONCLUSIONS: Carboxyl-methyl-cellulose dressings were shown to be safe, effective and well tolerated in the management of non-ischaemic, non-infected deep diabetic foot ulcers.     

Congenital abnormalities of the aortic arch: MR imaging

Thirty-four patients, 1 month to 63 years old, with known or suspected congenital abnormalities of the aortic arch underwent magnetic resonance (MR) imaging. Sixteen patients were studied retrospectively, 18 prospectively. In all retrospective studies, the aortic arch abnormality was seen with MR imaging. In the prospective studies, MR imaging enabled diagnosis in 15 of 18 (83%) patients. Twenty-nine of 34 patients underwent two-dimensional echocardiography; nine were studied retrospectively, 20 prospectively. In the prospective studies, echocardiography enabled diagnosis in 13 of 20 (65%) patients. Although two-dimensional echocardiography has a high sensitivity in the detection of aortic arch abnormalities in the neonate, arch abnormalities in the neonate, its sensitivity is lower in older children, adults, and postoperative patients. The authors' experience shows that MR imaging is an important, noninvasive modality in the evaluation of older children, adults, and postoperative patients with congenital aortic arch abnormalities.     

Symptoms and neurocognition as rate limiters in skills training for psychotic patients.

OBJECTIVE: This study aimed to replicate findings that neurocognitive capacity in schizophrenia is more predictive of acquisition of social skills than are symptoms. METHOD: Thirty-two hospitalized patients with chronic psychotic disorders were randomly assigned to community reintegration skills training or supportive group therapy. Neurocognitive functioning was assessed before treatment, and symptoms and skill levels were measured before and after treatment. RESULTS: The skills training group showed significantly greater skill acquisition. In a regression model, skill acquisition was predicted by group membership and verbal memory capacity and not by symptoms. CONCLUSIONS: With methodological advances, the authors replicated findings regarding the importance of neurocognition in determining treatment outcome in schizophrenia.     

Articular cartilage repair:Assessment and classification

To date, there has been no effort to organize assessment tools to interpret articular cartilage pathology as a continuumfrom normal to chondropenia to radiographic osteoarthritis (OA) and finally to frank OA. Today, secondary outcome variables can be measured with the Western Ontario McMaster Universities index, or its modification—Knee Injury and Osteoarthritis Outcome Score modification, the Lequesne index, the Cincinnati scale, the medical outcomes short form 36, and global assessments by visual analog scales. The emergence of magnetic resonance imaging or arthroscopy as outcome measures could significantly decrease the time for assessment and increase sensitivity to subtle cartilage changes over time. The clinician must use multimedia techniques to incorporate all comprehensive aspects of articular cartilage that may impact the intervention and quality of life.     

Incidence of endophthalmitis in a large series of 23-gauge and 20-gauge transconjunctival pars plana vitrectomy

Background  To study the incidence of endophthalmitis after 23-gauge pars plana vitrectomy and to compare it with the endophthalmitis rate after 20-gauge pars plana vitrectomy performed in the same ophthalmology department. Methods  The charts of 4,021 consecutive 20-gauge or 23-gauge pars plana vitrectomies performed at a single institution, between August 1 2003 and April 1 2008, were reviewed to search for the occurrence of postoperative endophthalmitis. This is a retrospective, interventional, comparative cohort study. Results  Endophthalmitis developed in one of 3,078 eyes after 20-gauge vitrectomy (0.03%) and in none of 943 eyes after 23-gauge vitrectomy. Conclusions  We did not find an increased risk of endophthalmitis after 23-gauge sutureless vitrectomy. No financial relationship exists. The authors have full control of all primary data, and they agree to allow Graefe’s Archive for Clinical and Experimental Ophthalmology to review their data upon request.     

The use of valproic acid in HIV-positive patients.

OBJECTIVE: To review the use of valproic acid in HIV-positive patients. DATA SOURCES: Clinical literature was accessed through a MEDLINE search (January 1966-November 1998). Key search terms included HIV, AIDS, seizures, valproic acid, and glutathione. DATA SYNTHESIS: Patients with HIV often develop neurologic manifestations; therefore, valproic acid may be considered in the management of this population. It has been demonstrated that valproate may increase viral burden by potentiating replication. An evaluation of studies addressing the use of valproic acid in HIV-positive patients was conducted. CONCLUSIONS: The potential for valproate-induced increases in viral replication exists. Although further studies are warranted, clinicians should exercise caution when using valproate in HIV-positive patients.