The FcɛR2/CD23 antigen: A hallmark of chronic lymphocytic leukemia B cells

Summary The effect of different stimuli on the expression of the low-affinity receptor for the Fc fragment of IgE (FcɛR2/CD23) on peripheral blood B cells from patients with chronic lymphocytic leukemia (CLL) was investigated. CLL B cells cultured for 3 days in medium alone showed a progressive decrease of the FcɛR2/CD23 expression, while the addition to the cell cultures of IgE or interleukin-4 had a slackening effect on the decrease of the FcɛR2/CD23. In contrast, in the presence of interferon-γ the proportion of FcɛR2/CD23⁺ cells was more rapidly reduced compared to CLL B cells cultured in medium alone. Stimulation of CLL B cells withStaphylococcus aureus Cowan I (SAC) bacteria, which are able to enhance the expression of FcɛR2/CD23 on normal B cells, induced a rapid loss of the FcɛR2/CD23 from CLL B cells.     

Use of complementary and alternative therapies in outpatients with Parkinson's disease in Argentina

We interviewed 300 patients (54.7% male; mean age was 65.8 ± 9.5) attending the Movement Disorders Clinic at the Buenos Aires University Hospital to determine the prevalence of CATs use and their association with demographic, social, or disease‐specific characteristics among patients with Parkinson's disease (PD) in Buenos Aires, Argentina. We found that 25.7% of the PD patients interviewed (77/300) stated they had used CATs to improve their PD symptoms whereas 38.0% (114/300) had used some CATs without any relation to PD, at least once in life. At the moment of the interview, CATs prevalence use was 50.6% in the former group and 25.0% in the latter. The use of CATs was much more frequent among women and more common in the 50‐ to 69‐year age group. Friends and neighbors of the patients had most frequently recommended these therapies. No major association was observed between CATs use and the duration of the disease, side of initial involvement, PD phenotype, or the Hoehn and Yahr staging. Acupuncture, homeopathy, yoga, and therapeutic massage were the most widely used therapies. After the initiation of conventional treatment the use of massage, yoga, and acupuncture in patients using CATs to improve PD significantly increased. Neurologists should be aware and inquire about the use of CATs to rule out potentially harmful effects. © 2010 Movement Disorder Society     

Mortality after major amputation in diabetic patients with critical limb ischemia who did and did not undergo previous peripheral revascularization: Data of a cohort study of 564 consecutive diabetic patients

BackgroundTo evaluate the survival after major lower limb amputation, at a level either below (BKA) or above (AKA) the knee, in diabetic patients admitted to hospital because of critical limb ischemia (CLI).MethodsFrom January 1999 to December 2003, 564 diabetic patients were consecutively admitted to our Foot Center because of CLI and followed up until December 2005. A revascularization procedure was performed in 537 patients (95.2%): in 420 with peripheral angioplasty, in 117 with peripheral bypass graft. Neither endoluminal nor surgical revascularization was practicable in 27 (4.8%) patients.ResultsMajor amputation was performed in a total of 55 (9.8%) patients. Among the clinical and demographic variables evaluated, age was significantly lower (67.3±10.1 vs. 76.7±10.4, P<.001), duration of diabetes was higher (17.1±11.1 vs. 13.4±10.0, P=.013), and current smoking was more frequent (38.5% vs. 25.0%, P<.001) in revascularized amputees. The amputation free median time for revascularized patients was 5.11 months, and for nonrevascularized patients, 0.33 months. The log-rank test for equality of survivor function without amputation between amputees with or without revascularization was 31.76 (P<.001).Among the 55 amputees, 11 (28.2%) out of the 39 revascularized patients and 13 (81.2%) out of the 16 nonrevascularized patients died. The log-rank test for equality of survivor function was 6.83 (P=.009).The Cox model performed to evaluate the association between the recorded variables and the mortality showed a significant hazard ratio only with age (hazard ratio for 1 year 1.11, P=.003, confidence interval 1.04–1.19).ConclusionsOur data suggest that the revascularization allows to postpone the major amputation, and that the survival of revascularized amputees is better than that of nonrevascularized amputated patients. All these data offer further encouragement to revascularize all diabetic patients with CLI.     

A Comparison of the Ability of Two Upper Extremity Assessments to Measure Change in Function

Study DesignRetrospective Measurement Comparison.IntroductionUpper extremity musculoskeletal disorders affect millions, thus, discerning optimal assessments for measuring change in upper extremity function is critical.Purpose of the StudyTo compare responsiveness (ability to measure change) of the Disabilities of Arm, Shoulder, and Hand (DASH) and Upper Extremity Functional Index (UEFI).MethodsStatistical analyses included Rasch analysis to place the instruments on the same scale, analysis of variance to compare change scores, correlations to compare change scores with global ratings, and the use of receiver operating characteristic (ROC) curves to determine meaningful change scores and overall error.ResultsChange scores on the DASH and UEFI and correlations between change scores and global ratings were similar. Areas under the ROC curves for the DASH and UEFI were 67% and 65%, respectively.ConclusionsNeither assessment has a clear advantage over the other when measuring clinical change.Level of EvidenceNot applicable.     

Die Behandlung der Condylus-radialis-humeri-Fraktur im Kindesalter

Objective

Surgical treatment of lateral humeral condyle fractures with reduction and retention in order to prevent lasting malalignment, pseudarthrosis, and joint instability.

Indications

Absolute: fractures with a complete dislocation or those in which plaster-free control X-ray on day 4 shows a gap of > 2 mm. Relative: complete fractures of the lateral humeral condyle which demonstrate a dislocation ≤ 2 mm on follow-up.

Contraindications

Incomplete, so-called hanging fractures of the lateral humeral condyle without notable secondary dislocation on follow-up.

Surgical Technique

Open reduction of the lateral humeral condyle via a lateral approach to the elbow joint. In smaller children (< 5 years of age) fixation with Kirschner wires. In older children (≥ 5 years of age) or in cases requiring compression radial screw fixation is recommended. In all cases, suture repair of the periosteum is advisable.

Postoperative Management

Long upper-arm plaster cast until wound healing is achieved. Subsequently, upper-arm plaster cast for 3–4 weeks postoperatively. Implants are removed following consolidation (confirmed by X-ray) after approximately 2–3 months. Routine physiotherapy is normally not required.

Results

From January 1, 1999 to December 31, 2006, 85 children with a median age of 6.1 years had lateral condyle fracture of the humerus treated. 47 patients underwent surgery. Of these, 31 were treated with a combination of screw and Kirschner wire fixation, 13 with a single screw, and in three cases, the fracture was fixed with Kirschner wires only. After a median of 8.6 weeks (range, 5.0–17.1 weeks), implants were removed. Median follow-up time was 6 months (range, 2–50 months). There were no late complications in this series (e.g., lack of consolidation, pseudarthrosis). In five cases, hyposensitivity of the skin above the proximal aspect of the radial bone was noted postoperatively. This problem was solved in all instances within the following 6 months. A telephone survey with a response rate of 87% (74 patients) was undertaken in September 2007. Three children noted a minimal deficiency in strength of the injured arm in comparison to the contralateral extremity. One of these children additionally stated a minor flexion deficit of the elbow already present at the last follow-up in the outpatient clinic, which showed no progress. None of the patients had to be referred back to the outpatient clinic because of persistent problems and/or unacceptable results.     

Solid immersion lens at the aplanatic condition for enhancing the spectral bandwidth of a waveguide grating coupler

We report a technique to substantially boost the spectral bandwidth of a conventional waveguide grating coupler by using a solid immersion cylindrical lens at the aplanatic condition to create a highly anamorphic beam and reach a much larger numerical aperture, thus enhancing the spectral bandwidth of a free-space propagating optical beam coupled into a single-mode planar integrated optical waveguide (IOW). Our experimental results show that the broadband IOW spectrometer thus created almost doubles (94% enhancement) the coupled spectral bandwidth of a conventional configuration. To exemplify the benefits made possible by the developed approach, we applied the technique to the broadband spectroscopic characterization of a protein submonolayer; our experimental data confirm the enhanced spectral bandwidth (around 380-nm) and illustrate the potentials of the developed technology. Besides the enhanced bandwidth, the broadband coupler of the single-mode IOW spectrometer described here is more robust and user-friendly than those previously reported in the literature and is expected to have an important impact on spectroscopic studies of surface-adsorbed molecular layers and surface phenomena.     

The emerging of the fifth malaria parasite (Plasmodium knowlesi). A public health concern?

After examining the most recent scientific evidences, which assessed the role of some malaria plasmodia that have monkeys as natural reservoirs, the authors focus their attention on Plasmodium knowlesi. The infective foci attributable to this last Plasmodium species have been identified during the last decade in Malaysia, in particular in the states of Sarawak and Sabah (Malaysian Borneo), and in the Pahang region (peninsular Malaysia). The significant relevance of molecular biology assays (polymerase chain reaction, or PCR, performed with specific primers for P. knowlesi), is underlined, since the traditional microscopic examination does not offer distinguishing features, especially when the differential diagnosis with Plasmodium malariae is of concern. Furthermore, Plasmodium knowlesi disease may be responsible of fatal cases, since its clinical presentation and course is more severe compared with those caused by P. malariae, paralleling a more elevated parasitemia. The most effective mosquito vector is represented by Anopheles latens; this mosquito is a parasite of both humans and monkeys. Among primates, the natural hosts are Macaca fascicularis, M. nemestina, M. inus, and Saimiri scirea. When remarking the possible severe evolution of P. knowlesi malaria, we underline the importance of an early recognition and a timely management, especially in patients who have their first onset in Western Hospitals, after journeys in Southeast Asian countries, and eventually participated in trekking excursions in the tropical forest. When malaria-like signs and symptoms are present, a timely diagnosis and treatment become crucial. In the light of its emerging epidemiological features, P. knowlesi may be added to the reknown human malaria parasites, whith includes P. vivax, P. ovale, P. malariae, and P. falciparum, as the fifth potential ethiologic agent of human malaria. Over the next few years, it will be mandatory to support an adequate surveillance and epidemiological network. In parallel with epidemiological and health care policy studies, also an accurate appraisal of the clinical features of P. knowlesi-affected patients will be strongly needed, since some preliminary experiences seem to show an increased disease severity, associated with increased parasitemia, in parallel with the progressive increase of inter-human infectious passages of this emerging Plasmodium.