Studies on lead exposure in patients of a neighborhood health center: Part II. A comparison of women of childbearing age and children.

The second part of this study deals with blood lead (PbB) levels in 541 pregnant women and 351 nonpregnant women of childbearing age residing in the health center's catchment area. Each blood sample was analyzed for erythroprotoporphyrin (EP) and PbB. Comparisons of these data were made with national data on women of childbearing age and with children in our catchment area, as well as with children nationally. Mean PbB and prevalence rates at greater than or equal to 10 and greater than or equal to 15 micrograms/dL were higher in the nonpregnant women of the catchment area than in the pregnant women. For comparison with women nationally, the data on these two groups were combined because national data did not clearly distinguish between pregnant and nonpregnant women. The women in the catchment area showed mean PbB and prevalence rates at the two ranges noted above that were not only higher than in white women but also generally higher than in black women nationally. Thus, this rank order was similar to that reported earlier for children. The comparisons between women and children living in the same environment showed that the children have significantly higher mean PbBs and prevalence rates at the two ranges than the women. The physiological and environmental bases for these differences are discussed. As in the study on children, the EP is also not adequate as a screening procedure for identifying women with PbB levels greater than or equal to 25 and greater than or equal to 15 micrograms/dL.     

Cloning, expression, and occurrence of the Brucella Cu-Zn superoxide dismutase.

Recently, the complete amino acid sequence of a protein expressed in Escherichia coli from cloned Brucella abortus DNA was reported. On the basis of amino acid homology, this protein was identified as a copper-zinc superoxide dismutase (Cu-Zn SOD) (B. L. Beck, L. B. Tabatabai, and J. E. Mayfield, Biochemistry 29:372-376, 1990). We demonstrate in this paper that the sequenced protein is the same as the previously studied salt-extractable protein BCSP20. The plasmid-encoded protein expressed from recombinant E. coli is identical to the Brucella-derived BCSP20 in molecular mass, N-terminal amino acid sequence, and cross-reactivity with homologous and heterologous rabbit sera against either the recombinant gene product or the Brucella-derived protein. A survey of the expression of the Cu-Zn SOD protein in Brucella biovars representing all species was done by Western blotting (immunoblotting) using antisera raised against the recombinant E. coli-derived protein. With the exception of B. neotomae and B. suis biovar 2, the Cu-Zn SOD protein was detectable in all Brucella species and biovars tested, including eight biovars of B. abortus.     

Oral immunization of mice with attenuated Salmonella typhimurium containing a recombinant plasmid which codes for production of a 31-kilodalton protein of Brucella abortus.

Salmonella typhimurium chi 4064, an attenuated delta cya delta crp mutant of S. typhimurium SR-11, was used as a carrier for the plasmid pBA31-R7. This plasmid codes for the expression of a 31-kilodalton (kDa) protein from Brucella abortus (BCSP31). Recombinant S. typhimurium chi 4064(pBA31-R7) expressed BCSP31 in vitro as shown by Western blot (immunoblot) analysis. The plasmid was stable in vitro and in vivo and did not affect the ability of the mutant to invade and colonize the small intestine, mesenteric lymph nodes, liver, or spleen of BALB/cByJ mice. Animals orally immunized with S. typhimurium chi 4064(pBA31-R7) developed serum and intestinal antibody responses to the B. abortus 31-kDa protein and to salmonella endotoxin as measured by enzyme-linked immunosorbent assay. Mice orally immunized with S. typhimurium chi 4064pBA31-R7 did not develop a delayed-type hypersensitivity following a footpad injection with recombinant BCSP31. Antigen-specific blastogenic data also support these in vivo results. All data indicate that this route of antigen delivery is effective for stimulating antibody-mediated immunity but that the B. abortus 31-kDa protein is a poor immunogen for inducing a cell-mediated immune response in BALB/cByJ mice.     

Creaming and plasma clearance rate of intravenous fat emulsion in critically ill patients

Intravenous fat emulsion incubated with serum or plasma in vitro may result in the aggregation of fat (creaming). Twenty critically ill patients were tested for in vitro creaming of the fat emulsion Intralipid. An intravenous fat tolerance test was used to determine the plasma clearance rate of Intralipid in each patient. Eleven patients (55%) were found to be creamers. These patients had a higher mean plasma clearance rate of Intralipid than non-creamers (5.73 +/- 0.56 vs. 2.77 +/- 0.37% per min; p < 0.001); however, the rates of both groups were within the range reported in normal healthy subjects. Mean C-reactive protein concentration was significantly higher (p < 0.01), and albumin levels were lower (p < 0.01) in creamers compared to non-creamers. Ionized calcium levels did not differ between the two groups. The results of this study indicate that in vitro creaming is common in acutely ill patients. The clinical significance of creaming is probably minimal since creamers tolerated 50 to 100 g/day of intravenous fat emulsion while receiving total parenteral nutrition. Creaming was uncommon when the fat was mixed with blood in vitro.     

A treatment algorithm for pneumothoraces complicating central venous catheter insertion

BACKGROUND: We investigated the role of observation or insertion of a small French pigtail catheter with Heimlich valve as alternative management to a tube thoracostomy for iatrogenic pneumothorax complicating central venous catheter (CVC) insertion. METHODS: A retrospective review of 9,637 consecutive patients who had had subclavian CVCs inserted on an outpatient basis identified 100 patients with pneumothoraces. Treatment consisted of (1) observation, (2) outpatient insertion of a Heimlich valve, or (3) inpatient tube thoracostomy. RESULTS: The median pneumothorax size was 10% (range 1% to 100%). Fifty-eight patients had observation as initial treatment, and this strategy was successful in 35 (60%). Thirty-four patients were treated initially with Heimlich valves, and this strategy was successful in 29 (85%). Tube thoracostomy as initial therapy was successful in 7 (88%) of 8 patients. Patients in who initial treatment failed were treated with insertion of a Heimlich valve or tube thoracostomy. CONCLUSION: In appropriately selected patients, pneumothorax after insertion of a subclavian CVC can be successfully managed in the outpatient setting with observation. Patients in whom observation fails can be treated with insertion of a Heimlich valve. Tube thoracostomy can be reserved for refractory PTX or emergent situations.     

A Three-Dose Intramuscular Injection Schedule of Anthrax Vaccine Adsorbed Generates Sustained Humoral and Cellular Immune Responses to Protective Antigen and Provides Long-Term Protection against Inhalation Anthrax in Rhesus Macaques

A 3-dose (0, 1, and 6 months) intramuscular (3-IM) priming series of a human dose (HuAVA) and dilutions of up to 1:10 of anthrax vaccine adsorbed (AVA) provided statistically significant levels of protection (60 to 100%) against inhalation anthrax for up to 4 years in rhesus macaques. Serum anti-protective antigen (anti-PA) IgG and lethal toxin neutralization activity (TNA) were detectable following a single injection of HuAVA or 1:5 AVA or following two injections of diluted vaccine (1:10, 1:20, or 1:40 AVA). Anti-PA and TNA were highly correlated (overall r² = 0.89 for log₁₀-transformed data). Peak responses were seen at 6.5 months. In general, with the exception of animals receiving 1:40 AVA, serum anti-PA and TNA responses remained significantly above control levels at 28.5 months (the last time point measured for 1:20 AVA), and through 50.5 months for the HuAVA and 1:5 and 1:10 AVA groups (P < 0.05). PA-specific gamma interferon (IFN-γ) and interleukin-4 (IL-4) CD4⁺ cell frequencies and T cell stimulation indices were sustained through 50.5 months (the last time point measured). PA-specific memory B cell frequencies were highly variable but, in general, were detectable in peripheral blood mononuclear cells (PBMC) by 2 months, were significantly above control levels by 7 months, and remained detectable in the HuAVA and 1:5 and 1:20 AVA groups through 42 months (the last time point measured). HuAVA and diluted AVA elicited a combined Th1/Th2 response and robust immunological priming, with sustained production of high-avidity PA-specific functional antibody, long-term immune cell competence, and immunological memory (30 months for 1:20 AVA and 52 months for 1:10 AVA). Vaccinated animals surviving inhalation anthrax developed high-magnitude anamnestic anti-PA IgG and TNA responses.