Heterogeneity of anti-U demonstrable by the use of papain-treated red cells

When red cells (RBCs) are treated with papain, one form of the U antigen, which we have named UPS (U papain-sensitive), is almost completely removed or denatured. A second form, UPR (U papain-resistant), remains unaltered on the treated RBCs. Tests on 42 examples of anti-U showed that two contained only anti-UPS, 19 contained only -UPR, and 21 contained separable -UPS and -UPR. In those sera containing both antibodies, anti-UPR was always the stronger of the two. These findings suggest 1) that UPS is located on the Ss sialoglycoprotein (glycophorin B) at a position distal to a papain-sensitive site or that the cleavage point is within the portion of the SGP that comprises UPS, and 2) that UPR is located between the papain-sensitive site and the RBC membrane. The UPS determinant was not denatured by neuraminidase, L-cysteine, trypsin, ficin, or alpha-chymotrypsin, and it was only partially denatured by pronase. The finding that RBCs treated with para-chloromercuribenzoic acid or para-chloromercuriphenyl sulfonic acid did not react with anti-UPR but did continue to react with anti-UPS suggests that the in situ configuration of UPR, but not UPS, is dependent on the presence of one or more disulfide bonds. RBCs of the S-s-U+(weak) phenotype were shown to carry markedly reduced amounts of both UPS and UPR.     

The Importance of Early Carotid Endarterectomy in Symptomatic Patients

INTRODUCTION

Early carotid endarterectomy (CEA) in symptomatic patients may prevent repeat cerebral events. This study investigates the relationship between waiting time for CEA and the incidence of repeat cerebral events prior to surgery in symptomatic patients.

PATIENTS AND METHODS

A prospective database of consecutive patients undergoing CEA between January 2002 and December 2006 was reviewed. Repeat event rates prior to surgery were calculated using Kaplan–Meier analysis and predictive factors identified using Cox regression analysis.

RESULTS

A total of 118 patients underwent CEA for non-disabling stroke, TIA and amaurosis fugax. Repeat cerebral events occurred in 34 of 118 (29%) patients at a median 51 days (range, 2–360 days) after the first event. The estimated risk of repeat events was 2% at 7 days and 9% at 1 month after first event (Kaplan–Meier survival analysis). Age (HR 1.059; 95% CI 1.014–1.106; P = 0.009] was identified as a predictor of repeat events. Patients underwent surgery at median 97 days (range, 7–621 days) after the first event. Eleven of 60 (18%) patients waiting ≤?97 days for surgery and 23 of 58 (40%) patients waiting >?97 days had repeat events. (P = 0.011, chi-squared test).

CONCLUSIONS

Delays in surgery should be reduced in order to minimise repeat cerebral events in patients with symptomatic carotid stenosis, particularly in the elderly population.     

Hepatitis B Immunisation in Health Care Workers

Background

Hepatitis B virus (HBV) infection is an important occupational risk in health care workers (HCW). In spite of HBV vaccine availability in Armed Forces, the high prevalence of HBV infection in HCW continues to be a problem. The study was undertaken to study the HBV vaccine-compliance among HCW.

Methods

A cross-sectional study was conducted at a tertiary care hospital. HCW were requested to fill up the pre set questionnaire to assess the HBV vaccination coverage.

Result

Amongst 254 HCW, only 57.7% were vaccinated against HBV. The vaccine compliance was lowest among housekeeping professionals. The mean age at vaccination was high (30.5 years). Amongst the vaccine non-compliant subjects, 34.3% were above 30 years of age. 32.2% HCW completed primary vaccination after spending more than 10 years in the profession. Accessibility of HBV vaccine, knowledge and perception of HBV risk were important factors in vaccine non-compliance.

Conclusion

Due to low and delayed HBV vaccine-compliance, HCW continue to be at the risk of occupational HBV. Health education highlighting occupational risk of HBV, accessibility of vaccine and mandatory vaccination of HCW is recommended to increase HBV vaccine compliance among HCW.Key Words: Health care workers, Hepatitis B virus, Occupational risk, Hepatitis B vaccine     

Maxillary expansion in cleft lip and palate using Quad helix and rapid palatal expansion screw

Background: Management of patients with cleft lip and palate (CLP) includes orthodontic treatment prior to bone grafting. Palatal expansion is done using slow or rapid palatal expansions (RPE). Controversy still exists regarding choice of expansion appliances used. This study was conducted to find out whether the Quad helix appliance represents a reasonable alternative to using conventional rapid maxillary expansion appliance among cleft lip and palate patients.     

Anandamide levels in cerebrospinal fluid of first-episode schizophrenic patients: impact of cannabis use

BACKGROUND: Previous studies have shown that cerebrospinal fluid (CSF) from schizophrenic patients contains significantly higher levels of the endogenous cannabinoid anandamide than does CSF from healthy volunteers. Moreover, CSF anandamide levels correlated inversely with psychotic symptoms, suggesting that anandamide release in the central nervous system (CNS) may serve as an adaptive mechanism countering neurotransmitter abnormalities in acute psychoses. In the present study we examined whether cannabis use may alter such a mechanism. METHODS: We used liquid chromatography/mass spectrometry (LC/MS) to measure anandamide levels in serum and CSF from first-episode, antipsychotic-na?ve schizophrenics (n=47) and healthy volunteers (n=81). Based on reported patterns of cannabis use and urine delta9-tetrahydrocannabinol (delta9-THC) tests, each subject group was further divided into two subgroups: 'low-frequency' and 'high-frequency' cannabis users (lifetime use < or = 5 times and > 20 times, respectively). Serum delta9-THC was investigated to determine acute use and three patients were excluded from the analysis due to detectable delta9-THC levels in serum. RESULTS: Schizophrenic low-frequency cannabis users (n=25) exhibited > 10-fold higher CSF anandamide levels than did schizophrenic high-frequency users (n=19, p=0.008), healthy low-frequency (n=55, p<0.001) or high-frequency users (n=26, p<0.001). In contrast, no significant differences in serum anandamide levels were found among the four subgroups. CSF anandamide levels and disease symptoms were negatively correlated in both user groups. CONCLUSIONS: The results indicate that frequent cannabis exposure may down-regulate anandamide signaling in the CNS of schizophrenic patients, but not of healthy individuals. Thus, our findings suggest that alterations in endocannabinoid signaling might be an important component of the mechanism through which cannabis impacts mental health.     

NT-pro-BNP is associated with long-term outcome in a heterogeneous sample of cardiac inpatients

BACKGROUND: B-type natriuretic peptides (NP) are excellent predictors of mortality in selected patients with heart failure and coronary heart disease. Up to now, the association of NPs with cardiovascular outcome has not been evaluated in multi-morbid populations with a broad spectrum of cardiovascular disease. METHODS: NT-pro-BNP was measured at discharge in 615 inpatients from a cardiology department of a university hospital. The association of discharge NT-pro-BNP with long-term outcome was examined during a median follow-up time of 1130 days. RESULTS: NT-pro-BNP was significantly elevated in patients who died, developed ischemic stroke, or were hospitalized due to acute heart failure, but not in patients who developed myocardial infarction or underwent coronary angioplasty compared to patients without any endpoint. Patients with supramedian NT-pro-BNP values (>339 pg/ml) had significantly worse outcomes with respect to the combined endpoint (CE) of death, heart failure hospitalization, and stroke than patients with inframedian NT-pro-BNP values. After adjusting for age, gender, renal function, NYHA class, presence of diabetes, coronary 3-vessel disease, systolic and valvular dysfunction, NT-pro-BNP was a significant predictor of the CE. The AUC for NT-pro-BNP to predict the CE was 0.79 in the total population, 0.81 in patients with coronary heart disease or acute heart failure, and 0.74 in patients with other diagnoses. A NT-pro-BNP cut-off value of 240 pg/ml revealed a negative predictive value of more than 93% in all three groups. CONCLUSION: In a heterogeneous population of hospitalized cardiac patients, NT-pro-BNP measured at discharge predicts a poor cardiovascular outcome, independently of the cardiologic diagnosis and traditional risk factors.     

Mechanical behavior of hydroxyapatite biomaterials: an experimentally validated micromechanical model for elasticity and strength

Hydroxyapatite (HA) biomaterials production has been a major field in biomaterials science and biomechanical engineering. As concerns prediction of their stiffness and strength, we propose to go beyond statistical correlations with porosity or empirical structure-property relationships, as to resolve the material-immanent microstructures governing the overall mechanical behavior. The macroscopic mechanical properties are estimated from the microstructures of the materials and their composition, in a homogenization process based on continuum micromechanics. Thereby, biomaterials are envisioned as porous polycrystals consisting of HA needles and spherical pores. Validation of respective micromechanical models relies on two independent experimental sets: biomaterial-specific macroscopic (homogenized) stiffness and uniaxial (tensile and compressive) strength predicted from biomaterial-specific porosities, on the basis of biomaterial-independent ("universal") elastic and strength properties of HA, are compared with corresponding biomaterial-specific experimentally determined (acoustic and mechanical) stiffness and strength values. The good agreement between model predictions and the corresponding experiments underlines the potential of micromechanical modeling in improving biomaterial design, through optimization of key parameters such as porosities or geometries of microstructures, in order to reach the desired values for biomaterial stiffness or strength.