The effect of steering on the physiological energy cost of wheelchair propulsion

Previous studies of the energy cost of wheelchair propulsion have used ergometers or tracks requiring little steering. We have measured minute ventilation (VE), oxygen consumption (VO2), carbon dioxide output (VCO2) and heart rate (HR) during exercise in a two arm, hand-rim propulsion wheelchair on a treadmill, and on three tracks of increasing tortuosity in eight able-bodied subjects. During propulsion at 0.6 m/sec, VE, VO2, and VCO2 were significantly greater on the track with the maximal steering component than on that with the minimal steering component, or on the treadmill with no steering component. Heart rate was significantly higher on the maximal compared to minimal steering component track. Exercise at speeds varying from 0.2 to 1.0 m/sec showed that VO2 and VCO2 were significantly higher on the medium steering component track than on the treadmill at speeds of 0.6 m/sec and above. We conclude that the effort of steering contributes significantly to the energy cost of wheelchair propulsion particularly at higher speeds.     

First example of anti-Kx in a person with the McLeod phenotype and without chronic granulomatous disease

BACKGROUND: Kx is lacking in the RBCs of patients with the McLeod syndrome. This condition is sometimes associated with chronic granulomatous disease (CGD). If given allogeneic RBCs, CGD patients with the McLeod phenotype may produce anti-Kx and anti-Km, and only phenotypically matched McLeod blood would be compatible. McLeod phenotype persons without CGD have made anti-Km but not anti-Kx (2 examples), and thus both McLeod and K(O) blood would be compatible. CASE REPORT: RBCs from a transfused patient with the McLeod phenotype but not with CGD (non-CGD McLeod) were typed for the Kell blood group antigens, and the plasma was analyzed for the presence of antibody by agglutination. The molecular basis was determined by analyzing for XK protein on RBC membranes by Western immunoblotting, by sequencing the XK gene, and by RFLP. RESULTS: The RBCs did not react with anti-Kx + anti-Km and showed weakening of Kell system antigens. The patient's plasma reacted moderately (2+) with RBCs of common Kell type and strongly (4+) with K(O) RBCs and RBCs of common Kell type treated with dithiothreitol, and did not react with McLeod RBCs. XK protein was absent from the RBC membranes. The XK gene had a point mutation in the donor splice site of intron 1 (G>C). CONCLUSION: This is the first report describing the molecular alteration in a non-CGD McLeod patient who has made anti-Kx. The immune response of people with the McLeod phenotype can vary, and K(O) blood may not always be compatible.     

The leukocyte adherence-inhibition assay as a diagnostic test for multiple sclerosis: study of a substance found in MS blood.

We have modified and adapted two well-accepted cancer immunology research techniques to study blood leukocyte phenomena of MS patients. The LAI test of Halliday and Miller and the 3 molar potassium chloride (3M KCl) tumor antigen extraction technique of Dean and McCoy were adapted to extract from pooled MS whole blood an MSRM. The LAI test results of 53 of 58 MS patients (91%) were considered positive, but only three of 75 control subjects (4%) were positive when tested against the MSRM. This indicates that patients with MS had a greater specific reactivity to the MSRM than did the control subjects (healthy individuals and patients with disease other than MS). The specificity and reproducibility of this reaction were tested with materials prepared from various malignant diseases. Sensitized leukocytes showed consistently higher reactivity to antigen extracts prepared from corresponding types of tumors than to extracts prepared from tumors of other histological types. Our results indicate that (1) the LAI test is able to corroborate the neurological diagnosis of MS and (2) there is a blood constituent found only in the MS patient.     

Auto-anti-A1: another cause of ABO discrepancy

Anti-A1 was found in the serum of a patient of blood group A1 who had never received a blood transfusion. The patient's serum caused agglutination of his own red blood cells. The anti-A1 could be totally absorbed by red blood cells from the patient and from other A1 individuals. The anti-A1 was inhibitable by soluble group A-specific substance and was denatured by 2-mercaptoethanol. The A and H serum transferases were normal. The presence of auto-anti-A1 in the serum of an A1 individual is yet another cause of ABO discrepancy.     

Influence of three-day antimicrobial therapy and lactobacillus vaginal suppositories on recurrence of urinary tract infections.

Forty-one adult women with acute lower urinary tract infections (UTI) were randomly treated for three days with norfloxacin or trimethoprim/sulfamethoxazole (TMP/SMX). Infection was eradicated in 100% of norfloxacin-treated patients and in 95% of TMP/SMX-treated patients. UTI recurred in 29% of patients treated with norfloxacin and in 41% of those treated with TMP/SMX. Post-therapy vaginal administration of lactobacillus suppositories resulted in a recurrence rate of UTI of only 21%, while in patients given sterilized skim-milk suppositories the recurrence rate was 47%. This study indicates that lactobacillus vaginal suppositories are safe and may be effective in reducing the recurrence of UTI following antimicrobial therapy.     

A MAR-like antibody in a DCWe/DCWe person

BACKGROUND: MAR (RH51), a high-incidence antigen in the Rh blood group system, is absent from RBCs with a double dose of CW or CX or a single dose each of CW and CX antigens, as well as from rare Rh phenotypes including D- - and Rh(null). The MAR antigen is associated with the presence of Ala36 and Gln41 on the RhCe protein. The original example of anti-MAR, described in 1994, was made by a DCWe/DCXe woman. It was possible that the antibody directed against a high-incidence antigen in the Rh system made by a DCXe/DCXe woman (CM) in 1983 was anti-MAR. CASE REPORT: A 52-year-old, multiply transfused, white woman (CJ) with pre-existing anti-c, -E, and -Jk(a) presented for preoperative work-up for her fifth open heart procedure. The strength of the reaction of her RBCs with anti-CW suggested a double dose of CW antigen. Her serum, which unexpectedly was strongly reactive with c-, E-, Jk(a-) RBCs by PEG indirect antiglobulin test, was incubated with E-c-, Jk(a-) RBCs, and an eluate was prepared. This eluate reacted 3+ with E-c-, Jk(a-) RBCs but did not react with Rh(null) (n = 5), - - (3), DCW- (2), Dc- (1), or DCWe/DCWe (1) RBCs. Two related DCXe/DCXe and two unrelated DCWe/DCXe RBC samples were weakly agglutinated. The patient's RBCs were negative with the original anti-MAR but reacted as strongly as the positive control RBCs with the antibody made by the DCXe/DCXe person. CONCLUSION: This is the first example of a MAR-like antibody made by a DCWe/DCWe woman. The specificity cannot be called anti-MAR, because some MAR-negative samples react, albeit weakly. The original anti-MAR, made by a DCWe/DCXe woman, did not react with DCWe/DCWe, DCWe/DCXe, or DCXe/DCXe RBCs. It is apparent that the specificity of "anti-MAR" differs slightly, depending on the CW/CX status of the antibody maker.     

The glyceryl [14C]tripalmitate breath test: a reassessment

Several reports have been published commending the use of 14C-labelled triglyceride breath tests in the assessment of fat malabsorption. We report further studies using gyceryl [14C]tripalmitate. Corrections for age, weight or metabolic rate failed to improve the test's ability to discriminate between malabsorbers and control subjects. A correction for respiratory quotient improved the linear correlation observed between the breath test results and daily faecal fat excretion. The significance of these findings is discussed and a number of problems identified which, at present, are preventing the introduction of breath tests for fat malabsorption into routine clinical practice.     

The management of constipation in people with advanced cancer

Constipation represents a significant problem for people with advanced cancer. It ranks in the top three most uncomfortable symptoms experienced, causing pain and anorexia that ultimately result in misery. The negative impact upon the quality of life of the patient and their carers is significant. The key to the provision of effective care lies in the informed application of the nursing process, underpinned by a sound knowledge base in relation to the management of constipation. Theoretical knowledge enables appropriate preventative interventions to be planned in collaboration with other members of the multidisciplinary team. When preventative measures are not applied or are unsuccessful, informed assessment and care planning enables appropriate interventions to be applied in order to resolve constipation. This article will discuss the causes and management of constipation. The discussion focuses on assessment, setting goals with the patient and their carers, planning appropriate nursing interventions to support medical interventions and evaluating clinical outcomes.     

Contribution of polymerase chain reaction and radioimmunoprecipitation assay in the confirmation of human T-lymphotropic virus infection in French blood donors. Retrovirus Study Group of the French Society of Blood Transfusion

BACKGROUND: To verify the criteria for human T-lymphotropic virus (HTLV) seropositivity in Western blot (WB) proposed by the Retrovirus Study Group of the French Society of Blood Transfusion, 186 blood donations that were repeatedly reactive in HTLV enzyme-linked immunosorbent assay, selected according to their WB pattern, were tested by polymerase chain reaction (PCR) and radioimmunoprecipitation assay (RIPA). STUDY DESIGN AND METHODS: In two commercially available WBs, 12 samples were confirmed as positive (rgp21+p19+p24) and 174 were interpreted as indeterminate (one or two reactivities to these proteins). The primer pairs used for the PCR allowed the amplification of type I (HTLV-I) or type II (HTLV-II) (or both) sequences. The RIPA was performed with two 35S-labeled cell lines: HTLV-I infected HUT 102/B2 and HTLV-II-infected MoT. RESULTS: Of the 12 positive samples, 11 were classified as HTLV-I-positive and one as HTLV-II-positive. Among the 174 indeterminate samples, three (WB pattern: rgp21+, p19+, p24-) were HTLV-I positive in PCR (one of them was positive in RIPA also); the other 171 were HTLV negative. CONCLUSION: In the study of a population in which 97 percent of HTLV infections are due to HTLV-I, these data support the three-protein criteria (rgp21, p19, and p24) for a positive blot reading. No HTLV infection was observed when rgp21 did not react. Consequently, p19 and/or p24 band patterns represent false reactivity and do not require PCR or RIPA confirmation. To discriminate between false- and true-positive results in the absence of MTA-1 or K55 reactivity, PCR and/or RIPA is required only when rgp21 reactivity is associated with one gag band (p19 or p24).