Sudden infant death syndrome and diphtheria-tetanus-pertussis-poliomyelitis vaccination status

Summary— Because diphtheria, tetanus, pertussis and poliomyelitis vaccine is routinely given during the period of highest incidence of sudden infant death syndrome (SIDS), we carried out a retrospective case-control study to assess whether such vaccination increased the risk of SIDS. The vaccination status of 118 SIDS and 332 control children, matched for sex, date of birth and age of the victims at death, was compared: the victims of SIDS were not significantly more often vaccinated than control children, the odds ratio was estimated at 1.9 with a 95% confidence interval from 0.9 to 3.9. There was a statistical difference between vaccination status of SIDS cases and controls aged less than three months. Nine percent of SIDS cases under 3 months had been vaccinated whereas the matched controls had not. In our study DTCP vaccination was not a risk factor for SIDS; although more of the SIDS infants less than 3 months of age had been vaccinated. This result however, concerns only one subgroup of the population studied and needs to be confirmed with another study of only SIDS infants less than 3 months of age, because DTCP vaccination was not a risk factor for SIDS when considering the total sample of the study.     

Is intensive care worth it? An assessment of input and outcome for the critically ill

The high cost of treatment in an ICU is clearly recognized; the ultimate benefit of that care in prolonging meaningful life is not as well quantified. We evaluated 337 mixed medical-surgical ICU patients for severity of illness and intensity of therapy and assessed their survival and quality of life 16 to 20 months after discharge. Mortality was 36.9% for emergency surgical and medical patients and 13.9% for elective surgical patients. A total of 140 patients responded to follow-up; 62.2% of patients not retired or homemakers were working full-time. Quality of life was good using both subjective and objective standards. There were few significant differences between elective surgical and other patients. Survival and life quality were related inversely to severity of illness and cost of treatment. Acute health on ICU admission predicted survival well; chronic health and age were better predictors of life quality.     

Candidacy for conversation partner training in aphasia: findings from a Dutch implementation study

Background: Aphasia rehabilitation should comprise a family-centred approach, involving main conversation partners in the rehabilitation process as soon as possible. A standardised approach to conversation partner training (CPT) became available in the Netherlands with the release of Partners of Aphasic clients Conversation Training (PACT). PACT was introduced in clinical practice in a multi-centre implementation study with 34 participating dyads.

Aims: To explore candidacy for CPT by describing the characteristics of dyads where the conversation partner engaged in CPT and to identify which characteristics had the potential to predict benefit of PACT.

Methods and Procedures: A pre-post treatment design was used in a multi-centre study. Pre- and post-CPT measures of psychosocial characteristics (caregiver burden, depression and coping) from the partner and behavioural characteristics (cognitive, linguistic and communicative) from the person with aphasia (PWA) were collected. Partner experience was assessed using four scales from the Intrinsic Motivation Inventory. Pre-post measures were analysed using paired T-tests and Wilcoxon signed ranks tests. Multiple regression analyses were used to assess potential predictors of training outcomes.

Outcomes and Results: Partners of people with moderate to severe aphasia engaged in PACT when it was first introduced in clinical practice (N = 34 dyads). Mean time post-onset was 11.5 months. Partners enjoyed the practical training in which they actively engaged through experiential learning methods. Partner scores increased significantly over the intervention time on task-oriented and avoidance-oriented coping skills and their symptoms of depression lowered significantly. Caregiver esteem was found to be a positive predictor of feelings of competence and enjoyment with the training. Older partners enjoyed the training less. More effort was given to the training by the partner when the aphasia was more severe.

Conclusions: This study found that partners are willing to engage in CPT once the PWA returned home and the dyads were engaging in more everyday conversations in their home environment. The results underline the importance of partner characteristics, such as motivation, coping style and a positive outlook on caregiving as possible selection criteria for CPT.     

Transfusion-related acute lung injury caused by an NB2 granulocyte- specific antibody in a patient with thrombotic thrombocytopenic purpura

HLA and granulocyte-specific antibodies have been implicated in the production of transfusion-related acute lung injury (TRALI). Reported here is a case that suggests that the patient's preexisting condition may play an important role in determining whether TRALI develops upon transfusion of blood products containing anti-white cell (WBC) antibodies. A 29-year-old woman with thrombotic thrombocytopenic purpura (TTP) underwent an uneventful 1.5-volume plasma exchange, which was followed by the transfusion of 2 red cell (RBC) units. At the end of the second RBC transfusion, the patient developed clinical signs and symptoms of noncardiogenic pulmonary edema. Serologic studies demonstrated that the serum from the second RBC donor had no HLA antibodies but did have a granulocyte-specific antibody (anti-NB2) that caused the agglutination of the recipient's granulocytes, which were NB2 positive. Serum from the donor of the first RBC unit and serum from the donors of units used in the exchange had no HLA or granulocyte-specific antibodies that reacted with the recipient's WBCs. Because the donor implicated in this reaction had a history of 21 blood donations, none of which had been associated with a transfusion reaction, we suggest that the patient's preexisting condition played a significant role in this episode of TRALI, owing to the granulocyte-specific antibody.     

Mycobacterial Infections After Renal Transplantation

Mycobacterial infections occurred in 11 of 633 (1.7 per cent)recipients of successful renal transplants. There were no casesof tuberculosis in patients receiving chemoprophylaxis, butamongst those who did not receive prophylaxis disease occurredin six of the 27 (22 per cent) high-risk patients. The majorcause of morbidity during treatment was renal allograft rejection,largely due to reduction in immunosuppressive drug therapy.     

Fibrogenic cell phenotype modifications during remodelling of normal and pathological human liver in cultured slices

Background: The debate concerning the potential remodelling and/or reversibility of cirrhotic lesions and biliary fibrosis is still open. Aims/Methods: In this work, we have used the precision‐cut liver slice (PCLS) model, which maintains cell–cell and cell–matrix interactions to study, by immunohistochemistry, the behaviour of the different fibrogenic cells, i.e. hepatic stellate cells (HSC) and portal fibroblasts, in cultured (for 1 week) PCLS derived from normal and fibrotic human livers. Results: In normal liver, before and after culture, α‐smooth muscle (SM) actin was present only in the vessel walls. Platelet‐derived growth factor (PDGF) receptor‐β was expressed before and after culture by portal fibroblasts, and appeared after culture in HSC. Before culture, CD 34 was not expressed in parenchyma, but appeared after culture in sinusoidal endothelial cells. In cirrhotic lesions, before culture, α‐SM actin, PDGF receptor‐β and Thy‐1 were expressed in septa; after culture, α‐SM actin expression disappeared but the expression of the PDGF receptor‐β and Thy‐1 was maintained. In cholestatic liver specimens, α‐SM actin, PDGF receptor‐β and Thy‐1 expression, which was present before culture in enlarged portal areas, disappeared after culture, and apoptosis was detected. In the parenchyma of both cirrhotic and cholestatic livers, the expression of the PDGF receptor‐β and of CD 34, which was not observed before culture, was present in HSC and sinusoidal endothelial cells, respectively, after culture. Conclusions: These results indicate that during remodelling of pathological tissues in cultured liver slices, the myofibroblastic cells derived from HSC or from portal fibroblasts show different behaviours, suggesting different mechanisms of activation/deactivation.     

A novel function for programmed death ligand-1 regulation of angiogenesis

Programmed death ligand-1 (PD-L1) plays a critical role in T-cell regulatory function. Here, we report a newly discovered effect of PD-L1 on angiogenesis. We demonstrate that PD-L1 and its receptor CD80, but not PD-1, are expressed by primary murine lung and heart vascular endothelial cells and the miscrovascular endothelial cell line (MS1) at both the mRNA and protein levels in vitro. The inhibition of PD-L1 or CD80 expression in MS1 cells, by small-interfering RNA transfection, led to a significant up-regulation of vascular endothelial growth factor receptor 2 expression and cell proliferation levels in MS1 cells. Furthermore, MS1 cells were found to have a significantly lower proliferation and vascular endothelial growth factor receptor 2 expression levels when they were co-cultured with PD-L1-expressing normal corneal epithelial cells, as compared to MS1 cells co-cultured with PD-L1(-/-) corneal epithelial cells. In a suture-induced corneal angiogenesis model, we observed a significantly higher level of angiogenic response in PD-L1(-/-) knockout mice as compared to wild-type mice, although there was no significant difference in the expression of inflammatory cytokines (interleukin-1α, interleukin-1β, or tumor necrosis factor-α) or the infiltration of innate immune cells (neutrophils and macrophages) between the two groups. We conclude that the expression of PD-L1 in both vascular endothelial cells and corneal epithelial cells regulates corneal angiogenesis.     

Laparoscopic Right Hemicolectomy for Ileocolic Intussusception Secondary to Caecal Neoplasm

Intussusception in adults is a rare cause of abdominal pain. Unlike its paediatric counterpart, intussusception in adults is associated with obvious pathology. We describe a case of ileocolic intussusception extending to the splenic flexure. We were able to reduce the intussusception partially and pedicle was stapled carefully. The specimen was delivered through a small incision and right hemicolectomy was performed adhering to oncological principles. We recommend laparoscopic-assisted surgery is considered for adult intussusceptions.     

Use of the Internet by Patients Undergoing Elective Hernia Repair or Cholecystectomy

INTRODUCTION

Patient-directed information available on the internet is not always regulated; it may be confusing and sometimes just overwhelming. We aimed to establish the proportion of patients undergoing two common surgical procedures, who searched the internet for information about their operations and to assess the usefulness of the information they received.

PATIENTS AND METHODS

A total of 105 consecutive patients undergoing elective abdominal wall hernia repair (n = 54) or laparoscopic cholecystectomy (n = 51) in a single surgical firm were included in the study. Patients were counselled about their operation in pre-operative assessment clinics and standard trust information leaflets were provided without any mention of this study. Patients were then asked to complete a questionnaire on the morning of their operation.

RESULTS

All patients completed the questionnaire. Of the patients, 59% stated that they had access to the internet and 77% of these accessed the internet over 2 h a week. Of the patients with internet access, 31% used it to acquire additional information about their operations and 58% used internet search engines. Of the patients who searched the internet regarding their operations, 26% were confused and/or worried by the information they received.

CONCLUSIONS

A significant proportion of patients undergoing common surgical procedures used the internet and about one-third of them specifically sought information about their operation on the internet. Such information can cause worry and confusion in patients. Our study highlights the need for regulated, comprehensible, patient information on hospital websites to which patients should be directed.