Low dose intradermal vaccination against hepatitis B in mentally retarded patients

Ninety-two patients and 28 staff members of an institute for mentally retarded patients were immunized intradermally with 2 microgram doses hepatitis B vaccine (HB-Vax), initially at month 0 and 1, and after evaluation followed by two booster injections at month 5 and 10, respectively. Blood samples were taken at months 2 and 11. Seroconversion rates of the two groups were similar on both occasions. Titre distributions for mentally retarded patients and staff members corrected for age, side effects and sex using multiple regression were significantly different at month 2 (p = 0.05) but not at month 11. Geometric mean titres for mentally retarded patients and staff members were 39 and 67 at month 2, respectively, and 1082 and 672 IU l-1 at month 11, respectively. Percentage anti-HBs/a(w) differed significantly between patients and staff members. Side effects, largely local (pigmentation), were observed with a frequency of about 35% in both mentally retarded patients and staff members. Since 92% of the mentally retarded patients had anti-HBs titres greater than 10 IU l-1 and approximately equal to 80% greater than 100 IU l-1, low dose vaccination, four injections by intradermal route, seems to be a suitable cost-reducing immunization system in institutes for mentally retarded patients.     

Choosing patient-tailored hemodynamic monitoring

This article is one of ten reviews selected from the Yearbook of Intensive Care and Emergency Medicine 2010 (Springer Verlag) and co-published as a series in Critical Care. Other articles in the series can be found online at . Further information about the Yearbook of Intensive Care and Emergency Medicine is available from .     

CD4+ T lymphocytes enumeration by an easy-to-use single platform image cytometer for HIV monitoring in resource-constrained settings

BACKGROUND: HIV monitoring in resource-constrained settings demands affordable and reliable CD4(+) T lymphocytes enumeration methods. We developed a simple single platform image cytometer (SP ICM), which is a dedicated volumetric CD4(+) T lymphocytes enumeration system that uses immunomagnetic and immunofluorescent technologies. The instrument was designed to be a low-cost, yet reliable and robust one. In this article we test the instrument and the immunochemical procedures used on blood from HIV negative and HIV positive patients. METHODS: After CD4 immunomagnetic labeling in whole blood, CD4(+) T lymphocytes, CD4(+dim) monocytes and some nonspecifically labeled cells are magnetically attracted to an analysis surface. Combining with CD3-Phycoerythrin (PE) labeling, only CD3(+)CD4(+) T lymphocytes are fluorescently labeled and visible in a fluorescent image of the analysis surface. The number of CD4(+) T lymphocytes is obtained by image analysis. Alternatively, CD3 immunomagnetic selection in combination with CD4 immunofluorescent labeling can also be applied for CD4(+) T lymphocytes enumeration. RESULTS: The SP ICM system was compared with two single platform flow cytometer (SP FCM) methods: tetraCXP and TruCount methods. The SP ICM system has excellent precision, accuracy and linearity for CD4(+) T lymphocytes enumeration. Good correlations were obtained between the SP ICM and the SP FCM methods for blood specimens of 44 HIV(-) patients, and of 63 HIV(+) patients. Bland-Altman plots showed interchangeability between the SP ICM and the SP FCM methods. CONCLUSIONS: The immunolabeling methods and the instrumentation are simple and easy-to-handle for less-trained operators. The SP ICM system is a good candidate for CD4(+) T lymphocytes enumeration in point-of-care settings of resource-constrained countries.     

Cardiac output measured by a new arterial pressure waveform analysis method without calibration compared with thermodilution after cardiac surgery

OBJECTIVES: To investigate whether measuring cardiac output and its course after cardiac surgery by a new analysis technique of radial artery pressure waves, without need for calibration (FloTrac/Vigileo [FV]; Edwards Lifesciences, Irvine, CA), conforms to the standard bolus thermodilution method via a pulmonary artery catheter (PAC). DESIGN: Prospective study. SETTING: Intensive care unit of university hospital. PARTICIPANTS: Twenty patients for up to 24 hours after cardiac surgery. INTERVENTIONS: Simultaneous and triplicate PAC thermodilution and FV cardiac output measurements at 1 and 3 hours after surgery and the following morning. MEASUREMENTS AND MAIN RESULTS: Fifty-six simultaneous measurement sets were obtained. Mean cardiac output (PAC) ranged between 2.8 and 10.3 L/min and for the FV method between 3.3 and 8.8 L/min. The coefficient of variation for pooled measurements was 7.3% for the PAC and 3.0% for the FV method. For pooled data, the r2 was 0.55 (p < 0.001), with a bias of -0.14, precision of 1.00 L/min, and 95% limits of agreement between -2.14 and 1.87 L/min in a Bland-Altman plot. Also, the FV method tended to overestimate cardiac output when <7 L/min and increased with time, whereas mean arterial pressure increased and PAC cardiac output did not change. Changes in cardiac output correlated (r2 = 0.52, p < 0.001). CONCLUSIONS: The FV arterial pressure waveform analysis method is a clinically applicable method for cardiac output assessment without calibration, after cardiac surgery. It performs well at low cardiac outputs but remains sensitive to changes in vascular tone.     

An inkjet-printed polysaccharide matrix for on-chip sample preparation in point-of-care cell counting chambers

On-chip sample preparation in self-contained microfluidic devices is a key element to realize simple, low-cost, yet reliable in vitro diagnostics that can be carried out at the point-of-care (POC) with minimal training requirements by unskilled users. To address this largely unmet POC medical need, we have developed an optimized polysaccharide matrix containing the reagents which substantially improves our fully printed POC CD4 counting chambers for the monitoring of HIV patients. The simply designed counting chambers allow for capillary-driven filling with unprocessed whole blood. We carefully tailored a gellan/trehalose matrix for deposition by inkjet printing, which preserves the viability of immunostains during a shelf life of at least 3 months and enables controlled antibody release for intense and homogeneous immunofluorescent cell staining throughout the complete 60 mm² image area within 30 min. Excellent agreement between CD4 counts obtained from our fully printed CD4 counting chambers and the gold standard, flow cytometry, is demonstrated using samples both from healthy donors and HIV-infected patients.

Gellan/trehalose layers were tailored to optimize on-chip storage and release of antibodies in a simple point-of-care CD4 counting chip with excellent agreement with standard methods.     

Pulmonary artery thermodilution cardiac output vs. transpulmonary thermodilution cardiac output in two patients with intrathoracic pathology

In two adult patients, one with a severe hemorrhage and one with a partial anomalous pulmonary vein, cardiac output (CO) measurements were performed simultaneously by means of the bolus transpulmonary thermodilution technique (COao) and continuous pulmonary artery thermodilution method (CCOpa). In both cases, the methods revealed clinically significant different cardiac output values based upon the site of measurement and the underlying pathology. The assessment of cardiac output (CO) is considered an important part of cardiovascular monitoring of the critically ill patient. Cardiac output is most commonly determined intermittently by the bolus thermodilution technique with a pulmonary artery catheter (COpa). As continuous monitoring of CO is preferable to this intermittent technique, two major techniques have been proposed. Firstly, a nearly continuous thermodilution method (CCOpa) using a heating filament mounted on a pulmonary artery catheter (Baxter Edwards Laboratories, Irvine, CA), with a clinically acceptable accuracy compared with the intermittent bolus technique. Based on these results we assumed CCOpa equivalent to real CO during hemodynamically stable conditions, and secondly, a continuous cardiac output system based on pulse contour analysis (PCCO), such as the PiCCO system (Pulsion Medical System, Munchen, Germany). To calibrate this device, which uses a derivation of the algorithm of Wesseling and colleagues, an independently obtained value of CO by the transpulmonary thermodilution method (COao) is used. Clinical validation studies in patients without underlying intrathoracic pathology, comparing transpulmonary COao with the pulmonary technique (COpa), mostly yielded good agreement.     

Cord blood cells and indices: smoking–related differences between the sexes

The values of whole blood cell count, leucocyte differential, and platelet and reticulocyte counts were determined in cord blood of both male ( n = 64) and female ( n = 75) newborns of 87 non–smoking and 52 smoking mothers. Leucocytes and neutrophils in cord blood from the male newborns of smokers were significantly lower than those in their female counterparts and in male newborns of non–smokers. These results suggest that male newborns are more affected by cigarette exposure than females with regard to some haematological parameters.     

Cardiac filling volumes versus pressures for predicting fluid responsiveness after cardiovascular surgery: the role of systolic cardiac function

Introduction  

Static cardiac filling volumes have been suggested to better predict fluid responsiveness than filling pressures, but this may not apply to hearts with systolic dysfunction and dilatation. We evaluated the relative value of cardiac filling volume and pressures for predicting and monitoring fluid responsiveness, according to systolic cardiac function, estimated by global ejection fraction (GEF, normal 25 to 35%) from transpulmonary thermodilution.