Parietal Cell and Intrinsic Factor Antibodies in a Finnish Rural Population Sample

Parietal cell and intrinsic factor antibodies were studied in the sera of 156 inhabitants of Pornainen. Parietal cell antibodies were found in 8 per cent of the ‘random sample’, consisting of 135 subjects, and in 34 per cent of the ‘high risk group’ consisting of 29 subjects with decreased gastric secretion. Intrinsic factor antibodies were found in 3 cases in the ‘high risk group’. Two of these had manifest and one latent pernicious anaemia. It seemed that the determination of gastric antibodies may be of some value in screening for severe atrophic gastritis and pernicious anaemia.     

Isolated abnormal value during the 3-hour glucose tolerance test: which value is associated with macrosomia?

Objective.?The aim of this retrospective review was to evaluate obstetric outcomes in patients with an isolated abnormal value on the oral glucose tolerance test (OGTT) at 0, 1, 2, and 3?h.

Methods.?From January 2003 through June 2009, all consecutive pregnant women who presented to Baskent University were screened for gestational diabetes mellitus (GDM). Patients with one abnormal value based on findings of the OGTT were grouped according to increased levels of glucose at 0, 1, 2, and 3?h (Group 1?>?95 mg/dl for fasting glucose concentration, Group 2?>?180 mg/dl for the serum glucose concentration in the first hour, Group 3?>?155 mg/dl for the serum glucose concentration in the second hour, Group 4?>?140 mg/dl for serum glucose concentration in the third hour). The four groups were compared for classic GDM risk factors. The primary outcome measures were large for gestational age (LGA) (birthweight?>95th percentile for gestational age using population birth weight centile charts) and macrosomia.

Results.?The incidence of LGA baby (Group 1, 10%; Group 2, 3.8%; Group 3 20.3%; Group 4, 13.2%; p?=?0.008) was significantly highest in Group 3 and macrosomia (Group 1, 30%; Group 2, 5.1%; Group 3, 18.6%; Group 4, 15.8%; p?=?0.039) was significantly higher in Groups 1 and 3.

Conclusions.?Our results suggest that even with relatively mild degrees of glucose intolerance at 2?h, no treatment is associated with LGA babies.     

Salivary gland transplantation for dry eye disease: Indications,techniques, and outcomes

The transplantation of salivary glands to the eye serves as a substitute for restoring tear volume in patients with severe dry eye disease. The lacrimal gland and salivary glands share similar acinar-ductal organization with some differences in the nature of secretions. This review summarizes the comparative anatomy of salivary and lacrimal glands, various salivary gland transplantation techniques, their indications, outcomes and complications along with future perspectives. Autologous microvascular submandibular gland transplantation (SMGT) into the temporal fossa with duct placement into the conjunctival fornix improves tear volume considerably but provides a hyposmolar tear film, which can induce corneal edema (in 3.5-40% of eyes). The transplanted submandibular graft improves tear volume and stability but visual acuity and conjunctival inflammation remain unchanged. The transplanted submandibular gland maintains stable function in the long-term and can have hypersecretion in 24–60% secondary to persistent autonomic innervation. Partial SMGT, gland reduction surgery, topical atropine gel or Botulinum Toxin A injection are options for treatment of postoperative epiphora. Minor salivary gland transplantation (MSGT) into the upper and/or lower conjunctival fornix results in an average improvement of 2–4 mm in Schirmer values compared to 16 to > 30 mm observed in eyes after SMGT. Reflex epiphora is rarely a problem in MSGT. Both MSGT or SMGT can improve the ocular surface and quality of life of patients with severe, debilitating dry eye disease. However, postoperative visual acuity and outcomes of corneal transplantation are still inconsistent. More studies and additional technical improvements are needed to further improve the results of these procedures.     

Test–Retest Reliability of the Preroad DriveABLE Competence Screen

ABSTRACT

Objective: To determine the test–retest reliability of a computerized preroad screen of prerequisite skills required for safe driving. Subjects & Methods: Driveable Screen administered to 39 individuals referred for driving evaluation due to cognitive decline or stroke. The Screen provides three recommendations—driving cessation, indeterminate, no evidence of reduced competence. Predicted probability of failing the road test is also generated. Results: Reliability according to the recommendation was substantial for the entire group (K = 0.654; CI = 0.459–0.848) and subgroup with stroke (K = 0.742; CI = 0.540–0.944). The numbers of participants with cognitive decline was too small to allow subgroup analyses. Of the nine participants with test–retest disagreement in recommendation, Test 2 was always better (McNemar's X² = 9.00, p = 0.01). Excellent reliability was found on probability of failing the Road Test (Intraclass Correlation Coefficient = 0.908; CI = 0.832–0.950). The test–retest reliability of the subtests ranged from fair to substantial. Conclusions: The Screen demonstrates sufficient test–retest reliability to encourage its use. However, the finding of significantly better scores on Test 2 for a portion of participants raises concern regarding its validity with repeat testing.     

Quantification of Lipopolysaccharides in Human Bile with or without Gram-Negative Bacteria

Lipopolysaccharide (LPS) was assayed in 78 samples of human common-duct bile, obtained at endoscopic retrograde cholangiography. The LPS was assayed by a chromogenic limulus amebocyte lysate (LAL) test, after dilution of bile samples in heparinized plasma and inactivation of inhibitors. The assay was not influenced by other biliary constituents, as demonstrated by the recovery of standards. Bile pigments did not influence the results. The LAL test was positive in 60 of the samples, 59 of which had a positive culture for gram-negative bacteria or Candidasp. The levels of LPS were significantly correlated to the total number of bacteria (n = 16, R = 0.55, p < 0.05). The median LPS level was 35,250 ng/l and showed a very large variation (140 ng/l to 27.8 mg/l). In four of the samples gram-negative bacteria were present, but no LPS could be detected. The study demonstrates the presence of LPS in great quantities in human bile and supports the feasibility of using the LAL test on bile samples. The presence of LPS (within the detection limit) appears to be associated with local microbial colonization.     

Characterization of carbapenem resistance mechanisms in Klebsiella pneumoniae and in vitro synergy of the colistin–meropenem combination

Abstract

In this prospective study, consecutive isolates of Klebsiella pneumoniae were tested for different mechanisms of carbapenem resistance using the modified Hodge test (MHT), Rosco Neo-Sensitabs (ROSCO). Phenylalanine arginine beta-naphthylamide assay (PABN) inhibitor-based test was done on isolates in which the mechanism of resistance was not identifiable by the ROSCO. Among 105 selected isolates, carbapenemase production was noted in 100 (95%) by MHT and ROSCO showed 97 (92·4%) inhibition with dipicolinic acid signifying the production of MBL. PCR amplification was positive in 90 (86%) isolates for bla_NDM-1 and 46 (44%) isolates for bla_OXA-48. 54 (51%) isolates were positive for bla_CTX-M and all belonged to bla_CTX-M group 1. Isolates co produced bla_OXA-48 (31/105, 30%) and bla_CTX-M (40/105, 38%) in combination with the carbapenemase (bla_NDM-1) gene. Five colistin-resistant isolates were positive for bla_OXA-48. Eight isolates did not show inhibition with any of the inhibitor containing disks and found to be positive for bla_OXA-48. Isolates were tested for colistin-meropenem synergy and detection rate was higher by the checkerboard (48%) than E-test method (35%). Our study necessitates continuous surveillance to recognize the predominant machinery of resistance in a particular geographical region to formulate effective control measures.     

Narcissistic Personality Disorder and Pathological Mourning

This paper describes an approach to psychoanalysis conducted as a “talking cure” whereby the analyst privileges the patient's maturational capacity for speaking about experience. An optimal analytic process becomes a method of exploration and investigation through inquiry rather than interpretation. Interpretations facilitate talking, particularly those thoughts and feelings that are unwanted and unbidden. Accordingly, the analyst's chief concern is the resolution of resistances to speaking in contrast to an effort that aims to resolve resistances to insight or understanding. Insight, when it occurs, is a result of the change process and one's burgeoning capacity for talking with another who is interested in understanding. In this way making the unconscious conscious is worked through progressive speech and the enrichment of experience that results. Complementary to this effort is the analyst's subjective reflection on and use of countertransference states. Several features of the analytic process are described and elaborated: the centrality of the patient's voice, the value and function of inquiry, the analyst's crucial function as the sentient other for the patient's unconscious processes, and the leverage provided by the analyst's living into the transference experientially accompanied by personal acts of emotional freedom. A case example is provided to illustrate this approach.     

凝血检验标本采集与处理过程中的质量控制分析

目的观察分析凝血检验标本采集与处理过程中的质量控制。方法选择凝血检验标本采集与处理强化质控措施实施后(2018年3月至2019年2月)和实施前(2017年3月至2018年2月)在本院行凝血检验的健康体检者各41例,分别作为观察组和对照组。收集两组待检查者的标本采集、处理过程记录,比较两组标本不合格发生率。结果观察组凝血检验标本不合格发生率(2.44%,1/41)显著低于对照组(19.51%,8/41),差异有统计学意义(P<0.05)。结论强化质控措施可有效提升凝血检验标本采集与处理过程规范性,降低不合格标本风险,有助于保障凝血检验准确性和有效性,临床应用价值较高。