Preterm Labor: CD55 in Maternal Blood Leukocytes

Problem Intrauterine inflammation is a frequent and significant factor associated with the pathogenesis of preterm labor/birth (PTL/PTB). However, it remains unclear whether the intrauterine inflammatory responses activate the maternal peripheral circulation. We explored the association between PTL/PTB and the ‘activation’ of the peripheral circulatory system by determining whether CD55 mRNA expression within peripheral WBCs differed between PTL and control patients not in labor. Method of Study RNA was purified from white blood cells collected from pregnant women with preterm labor (n = 45), and from pregnant (n = 30) control women. CD55 gene expression was evaluated by quantitative PCR. Results The mean CD55 mRNA level within the PTL group (0.77 ± 0.03) was 1.48‐fold higher than that observed (0.52 ± 0.02) within the control group (P < 0.0001); 71% of PTL patients and only 6.7% of control subjects expressed elevated CD55 mRNA. The receiver operating characteristics (with 95% CI) of CD55 as a marker for PTL were as follows: Sensitivity, 69% (53–82%); Specificity, 93% (78–99%); Positive Predictive Value, 94% (80–99%); and Negative Predictive Value, 67% (51–80%). In the patient population that delivered prematurely (before 37 weeks), 81% expressed elevated CD55 mRNA levels with a mean of 0.78 ± 0.03 and 95% CI of 0.71–0.84. The receiver operating characteristics were as follows: Sensitivity, 73% (54–88%); Specificity, 86% (71–95%); Positive Predictive Value, 81.5% (62–94%); and Negative Predictive Value, 80% (64–91%). Conclusion Here we report for the first time that CD55 mRNA expression was elevated in the peripheral WBCs of subjects with preterm labor compared with control gestationally‐matched pregnant woman and that elevated leukocyte CD55 may be a useful predictor of subsequent PTB.     

Effects of Tumour Necrosis Factor-alpha on Developing Cerebellar Granule and Purkinje Neurons In Vitro

Tumour necrosis factor-alpha (TNF-α) has been widely implicated in both neurodevelopment and neurodegeneration, yet its effects on individual populations of cerebellar neurons as they develop have not been fully elucidated. Therefore, we established primary neuronal cultures of developing murine cerebellar Purkinje neurons and postnatal cerebellar granule cells to determine the consequences of TNF-α exposure for their survival. We discovered that TNF-α did not affect the viability of cerebellar granule neurons at any of the ages studied, even though TNF-α and its receptors, TNFR1 and TNFR2, are widely expressed in the postnatal cerebellum. In addition, TNF-α was neither able to ameliorate, nor enhance, cell death in cerebellar granule cells elicited by a variety of stimuli including homocysteine and alcohol exposure. In contrast, in cultures established at embryonic day 16, TNF-α enhanced the number of cerebellar Purkinje neurons in vitro but this effect was not observed in embryonic day 19 cultures. Thus, TNF-α has differential and highly specific effects on different populations of cerebellar neurons as they develop.     

Bacterial degradation of microcystin toxins in drinking water eliminates their toxicity.

Microcystin-LR and -LA were readily biodegraded by a bacterium, Sphingpoyxis sp. LH21, in a treated reservoir water. Detection of the microcystins was conducted using high-performance liquid chromatography (HPLC), protein phosphatase 2A (PP2A) inhibition assay and a cell-based cytotoxicity assay. The HPLC results correlated well with the two assays. The decrease in cytotoxicity, coupled with the associated decrease in microcystin concentrations, indicated that no cytotoxic by-products were being generated, highlighting the applicability of biodegradation as a feasible treatment option for effective microcystin removal.     

Experiences of Traumatic Events and Associations with PTSD and Depression Development in Urban Health Care-seeking Women

Posttraumatic stress disorder (PTSD) is an anxiety disorder that occurs after a traumatic event and has been linked to psychiatric and physical health declines. Rates of PTSD are far higher in individuals with low incomes and who reside in urban areas compared to the general population. In this study, 250 urban health care-seeking women were interviewed for a diagnosis of PTSD, major depressive disorder, and also the experience of traumatic events. Multivariate logistic regressions were used to determine the associations between traumatic events and PTSD development. Survival analysis was used to determine if PTSD developed from assaultive and nonassaultive events differed in symptom duration. Eighty-six percent of women reported at least one traumatic event, 14.8% of women were diagnosed with current PTSD, and 19.6% with past PTSD. More than half of women with PTSD had comorbid depression. Assaultive traumatic events were most predictive of PTSD development. More than two thirds of the women who developed PTSD developed chronic PTSD. Women who developed PTSD from assaultive events experienced PTSD for at least twice the duration of women who developed PTSD from nonassaultive events. In conclusion, PTSD was very prevalent in urban health care-seeking women. Assaultive violence was most predictive of PTSD development and also nonremittance.     

Human immunodeficiency virus infection in urban adolescents: can we predict who is at risk?

Few studies have evaluated the extent of human immunodeficiency virus (HIV) in the adolescent population. However, there has been growing concern that sexual and drug experimentation common in this age group may increase their risks of transmitting the virus. Between October 1, 1987, and January 31, 1989, a blinded, unlinked HIV seroprevalence study was conducted among all adolescents aged 13 through 19 receiving ambulatory care at Children's National Medical Center and having blood drawn for other routine medical indications. Overall, seroprevalence in this group of patients was 0.37% (3.7/1000), with the highest prevalence in females (4.7/1000) and patients 18 through 19 years of age (5.6/1000). Of adolescents considered at high risk who were offered and accepted voluntary HIV testing during the same time period, 4.1% (41/1000) were positive. Inasmuch as this represents only 38% of all of the positive tests obtained in the blinded testing phase of the study, it may indicate that a substantial proportion of HIV-positive adolescent patients may be missed by using standard criteria and methods of identifying risk and/or that those most at risk may be reluctant to be tested for HIV infection. The results suggest that HIV infection is present in this population of urban adolescents and that the seroprevalence rate is higher than in other nonselect groups. Moreover, using traditional risk factors as screening criteria may not identify the majority of those infected. Trends need to be followed and further studies conducted in an attempt to define which adolescents are at highest risk for HIV infection.     

The national outcomes management project: A benchmarking collaborative

Traditional evaluation of heath care quality usually involves the measurement of the structure, process, and outcome of care. Most quality improvement programs involve a cycle that includes a setting of goals, a measurement of either process or outcomes, and a real-time or retrospective feedback of the results of data measurement. Benchmarking, a well-known efficient business technology, can lead to practice innovations necessary to survive in an environment that has a need for decreasing cost and increasing quality. The purpose of this article is to present a novel use of benchmarking in managed ambulatory behavioral health care and its application in a model collaborative outcome management project at more than 16 sites and nine states in the United States.