Clinical evaluation of a functional prothrombin time-based assay for identification of factor V Leiden carriers in a group of Italian patients with venous thrombosis.

The efficiency of a new prothrombin-based activated protein C (APC) resistance test to detect factor V Leiden (FVL) was clinically evaluated in 150 Italian patients with deep venous thrombosis. Patient samples are diluted in factor-V-deficient plasma, an APC-containing reagent, and specific factor V activator; after incubation, clotting is initiated by addition of activated-factor-FV-dependent prothrombin activator. Two prothrombin time determinations were performed under identical assay conditions except that no APC was added to one. A ratio over 4.2 for normal individuals and under 2.0 for FVL patients is expected: between 1.3 and 1.9 for FVL heterozygotes, and between 1.0 and 1.1 for FVL homozygotes. Using a predefined cut-off ratio of 2.0, a specificity and a sensitivity of 1.00 for detection of FVL mutation were found. With a cut-off ratio of 1.1, a specificity of 0.98 and a sensitivity of 1.00 were found for discrimination between FVL heterozygous (n = 60) and homozygous (n = 6). No interferences by heparins, oral contraceptives, oral anticoagulant therapy, protein C, protein S, D-dimer, homocysteine, MTHFR mutations and antiphospholipid autoantibodies were detected. In our experience, this new prothrombin time-based APC resistance assay provides improved discrimination between normal individuals and FVL carriers compared with the classical methods. Moreover, this new assay allows good discrimination between homozygous and heterozygous FVL carriers. In the authors' experience this prothrombin time-based method was not influenced by many factors compared with the classical activated partial thromboplastin time-based method.     

Extension to the ultrasonic study of supra- and subphrenic spaces of plate-shaped probes initially destined for intracavitary sonography. Research on thoraco-abdominal fluid collections in non-mobilizable patients

The authors describe an original application of real time transducers--initially intended for intracavitary sonography--in thoraco-abdominal scanning. The stic-form probe can be easily slipped under the patient. It is then possible to realize a scan with an upward beam. In the postero-anterior scan, the patient is placed in a supine position. He is motionless. We achieve a better visualization of the liquid collections, since their accumulation is declivious. The method allows a wider sonographic window for thoraco-abdominal and diaphragmatic investigation in sonography.     

Social Contexts of Mental Weil-Being in Later Life

Extending the preceding review, this commentary argues for serious attention to the social contexts of mental health of older adults in research and practice. Social gerontology research focuses primarily on summative or aggregate variables with little focus on mechanism, despite growing evidence that mechanisms as diverse as immunosuppression and expressed emotion influence mental health. Increased linkages between the macro-level and microlevel data are required to provide the theoretical models needed to shape practice. Current evidence is deemed sufficient, however, to alter the frameworks we use for both diagnosis and treatment.     

Contribution of Calcium Channel Subtypes to the Intracellular Calcium Signal in Sensory Neurons: The Effect of Injury

Background: Although the activation-induced intracellular Ca2+ signal is disrupted by sensory neuron injury, the contribution of specific Ca2+ channel subtypes is unknown.

Methods: Transients in dissociated rat dorsal root ganglion neurons were recorded using fura-2 microfluorometry. Neurons from control rats and from neuropathic animals after spinal nerve ligation were activated either by elevated bath K+ or by field stimulation. Transients were compared before and after application of selective blockers of voltage-activated Ca2+ channel subtypes.

Results: Transient amplitude and area were decreased by blockade of the L-type channel, particularly during sustained K+ stimulation. Significant contributions to the Ca2+ transient are attributable to the N-, P/Q-, and R-type channels, especially in small neurons. Results for T-type blockade varied widely between cells. After injury, transients lost sensitivity to N-type and R-type blockers in axotomized small neurons, whereas adjacent small neurons showed decreased responses to blockers of R-type channels. Axotomized large neurons were less sensitive to blockade of N- and P/Q-type channels. After injury, neurons adjacent to axotomy show decreased sensitivity of K+-induced transients to L-type blockade but increased sensitivity during field stimulation.     

Distale Humerusfrakturen

Distal humeral fractures are problematic both in children and in adults. While in children these fractures are very common and most of them have an extraarticular location, in adults their incidence is much lower and they more often compromise the joint. Good results cannot be achieved without due consideration for the complex anatomy of the elbow joint, the quality of the bone, the concomitant soft tissue lesions and the biomechanical aspects of the injury, to allow selection of appropriate therapy and a correctly structured aftertreatment. The soft tissue injuries that are frequently involved and the high rate of intra- and postoperative complications need particular attention. This paper reviews the epidemiology, the current standards in diagnosis and therapy, the possible complications and the results that can be expected in patients with fractures of this type.