Comparison of efficacy of induction therapy in low immunologic risk African‐American kidney transplant recipients

African‐Americans (AA) have higher acute rejection rates and poorer long‐term graft survival rates when compared with non‐AA. It is yet to be demonstrated that the type of induction therapy modifies outcomes in this ‘high‐risk’ population. This retrospective analysis compares the efficacy of induction therapy [antilymphocyte antibodies (ALA) versus interleukin‐2 receptor antagonists (IL‐2RA)] in the AA population. Some 189 AAs were included. There was no difference in acute rejection at one year between the groups (ALA (12%) or IL‐2RA (12%), P = 0.89). Type of induction therapy had no significant effect on death‐censored (P = 0.61) or uncensored graft survival (P = 0.32). There was no difference between CMV or BK virus infections between the groups (P = 0.14 and 0.94 respectively). Type of induction therapy does not appear to affect acute rejection rates or long‐term graft survival in low‐risk AA kidney transplant recipients.     

Acute effect of lidocaine on coronary blood flow and myocardial function

The acute effects of lidocaine on coronary blood flow, hemodynamic parameters, and wall function were studied in 14 anesthetized pigs. Lidocaine was infused intravenously as a bolus (dosage range from 1.5 to 4.0 mg/kg). At ten to thirty seconds after infusion, coronary blood flow reached 154 +/- 38% (mean +/- SD) of the baseline resting flow (p less than 0.001). The double product, an estimate of myocardial oxygen demand, decreased from a baseline value of 9221 +/- 2174 to 8008 +/- 1923 mmHg beats/min (p less than 0.01). Sixty seconds postinfusion myocardial function decreased from baseline wall thickening of 46 +/- 25% to 41 +/- 17% (p = 0.04). An acute bolus of lidocaine appears to transiently increase coronary blood flow, by decreasing coronary vascular resistance, and also decrease myocardial function. Thus, an acute lidocaine bolus may favorably alter the myocardial oxygen supply/demand ratio.     

EFFECT OF LIGNOCAINE ON CORONARY BLOOD FLOW, SYSTOLIC MYOCARDIAL FUNCTION AND MYOCARDIAL HIGH ENERGY PHOSPHATE STORES IN SWINE

1. To investigate the effect of lignocaine upon coronary blood flow, myocardial systolic wall function and high energy phosphate stores, lignocaine was administered as a rapid intravenous injection to 14 open chest anaesthetized swine. 2. Before and after injection, measurements were made of coronary blood flow by electromagnetic flow probe, per cent wall thickening by ultrasonic crystals, adenosine triphosphate (ATP) and creatine phosphate (CP) content by myocardial biopsy, and arterial pressure by central aortic catheter. The animals were divided into two groups based on whether or not they received a continuous low-dose infusion of lignocaine prior to the study. Group I received the continuous low-dose infusion of lignocaine and group II did not. 3. With a 2 mg/kg lignocaine injection, peak diastolic coronary flow rose significantly in groups I and II by 27 +/- 7 and 29 +/- 7% respectively. This was followed by a significant decline in per cent wall thickening in groups I and II of -11 +/- 2 and -19 +/- 6% respectively. In group I myocardial CP content decreased after lignocaine injection by 58 +/- 6% and ATP tended to rise even though systolic and diastolic pressure did not change significantly. In group II neither CP nor ATP changed significantly, but systolic and diastolic blood pressure decreased significantly. 4. Repeat lignocaine injections were given over a wider dosage range (0.5-4.0 mg/kg) to determine dose-response for lignocaine versus coronary blood flow. Coronary blood flow increased and per cent wall thickening decreased as doses of lignocaine were increased. 5. It was concluded that rapid intravenous lignocaine injection appeared to cause a dose-dependent coronary dilatation and systolic dysfunction. Pre-treatment with low-dose continuous infusion of lignocaine appeared to result in a decrease in CP and a rise in ATP when compared with no pre-treatment--despite a similar effect on myocardial function and coronary blood flow.     

A comprehensive quality assurance system for practicing dentists

A comprehensive outcome-oriented quality assurance methodology manual has been developed for use by practicing dentists. The audit consists of four parts. Provision for immediate feedback to providers in order to monitor behavior change is a critical part of the review process as is the emphasis on the appropriateness of care dimension, a relatively unexplored area of quality assurance activity.     

Use of S-[2,3-Bispalmitoyiloxy-(2R)-Propyl]-R-Cysteinyl-Amido-Monomethoxy Polyethylene Glycol as an Adjuvant Improved Protective Immunity Associated with a DNA Vaccine Encoding Cu,Zn Superoxide Dismutase of Brucella abortus in Mice

This study was conducted to evaluate the immunogenicity and protective efficacy of a DNA vaccine encoding Brucella abortus Cu,Zn superoxide dismutase (SOD) using the Toll-like receptor 2/6 agonist S-[2,3-bispalmitoyiloxy-(2R)-propyl]-R-cysteinyl-amido-monomethoxy polyethylene glycol (BPPcysMPEG) as an adjuvant. Intranasal coadministration of BPPcysMPEG with a plasmid carrying the SOD-encoding gene (pcDNA-SOD) into BALB/c mice elicited antigen-specific humoral and cellular immune responses. Humoral responses were characterized by the stimulation of IgG2a and IgG1 and by the presence of SOD-specific secretory IgA in nasal and bronchoalveolar lavage fluids. Furthermore, T-cell proliferative responses and increased production of gamma interferon were also observed upon splenocyte restimulation with recombinant SOD. Cytotoxic responses were also stimulated, as demonstrated by the lysis of RB51-SOD-infected J774.A1 macrophages by cells recovered from immunized mice. The pcDNA-SOD/BPPcysMPEG formulation induced improved protection against challenge with the virulent strain B. abortus 2308 in BALB/c mice over that provided by pcDNA-SOD, suggesting the potential of this vaccination strategy against Brucella infection.     

Guidelines for internal peer review in the cardiac catheterization laboratory

The Laboratory Performance Standards Committee of the Society for Cardiac Angiography and Interventions has proposed guidelines for establishing an internal peer review program in the cardiac catheterization laboratory. The first step is to establish a committee and a data base. This data base should include quality indicators that reflect: physician qualifications, outcomes of procedures, and processes of care. The outcomes must be risk-adjusted to account for the variable severity of illness. Data should be collected by catheterization laboratory personnel and entered into a laboratory-specific computerized data base. These data must be analyzed and organized into profiles that reflect the quality of care. Based on this information, the Committee would institute the following interventions to improve physician performance: education, clinical practice standardization, feedback and benchmarking, professional interaction, incentives, decision-support systems, and administrative interventions. The legal aspects of peer review are reviewed briefly. Cathet Cardiovasc Diagn 40:21–32, 1997. © 1997 Wiley-Liss, Inc.     

Characterization of chronically implanted ventricular endocardial pacing leads

The expected implant lifetime of pacemaker generators has been extended with the introduction of lithium power sources. Consequently, the pacing lead may become the component that determines the total implant lifetime of the pacemaker. This fact emphasizes the necessity for accurate assessment of the integrity of a chronically implanted lead. In this study, chronic threshold and impedance data from 61 patients having the same type of ventricular endocardial lead for up to 10 years were retrospectively analyzed. The mean acute current threshold was 0.81 +/- 0.33 mA. The chronic current threshold had a range of between 1 and 5 mA, which was approximately two to five times greater than the acute implant value. Chronic voltage threshold and impedance were 0.7 to 4 V and 335 to 775 omega, respectively. The findings of this study provide general guidelines for chronic lead parameters and illustrate some of the difficulties encountered in gathering and interpreting long-term lead data.