Ueber eine eigenthümliche,reducirende Substanz im Harne bei innerem Gebrauch von Terpentin

Ohne Zusammenfassung     

Increase in plasma calprotectin during long-distance running

Running leads to biochemical and hematological changes consistent with an inflammatory reaction to tissue injury. We report changes in the plasma concentration of the leukocyte-derived protein calprotectin after long-distance running. Blood samples were collected from runners before and after a marathon, half-marathon, a 30-km cross-country run, a military ranger-training course and short-term maximal physical exercise until exhaustion, VO2max. Leukocyte counts, plasma calprotectin concentration and calprotectin per neutrophilic granulocyte were assayed using a new method. During the marathon, half-marathon, the 30-km run, the ranger-training course and the VO2max exercise, calprotectin levels increased 96.3-fold, 13.3-fold, 20.1-fold, 7.5-fold and 3.4-fold, respectively. These changes may reflect damage to the tissues or vascular endothelium, causing microthrombi with subsequent activation of neutrophils. These cells are known to phagocytose platelets in microthrombi and may contribute to the prevention of clinical thrombosis. The half-life of calprotectin in plasma was about 5 h. The content of calprotectin per neutrophil remained unchanged during exercise at a level similar to that in healthy blood donors: mean: 25 pg/cell, range 18.8-33.6. A reference interval (mean +/- 2 SD) of 18.6-31.4 pg/cell is suggested.     

Platelet activation and residual activation potential during storage of hyperconcentrated platelet products in two different platelet additive solutions

BACKGROUND: To improve platelet (PLT) quality, hyperconcentrated PLT concentrates (hcPCs) were compared to standard PLT concentrates (stdPCs) in two different PLT additive solutions, T-Sol and PAS-27a. PAS-27a differs from T-Sol by containing glucose, phosphate, potassium, magnesium, and bicarbonate. STUDY DESIGN AND METHODS: PLTs were harvested by apheresis twice from 14 donors; each unit was divided into two. Four units from each donor were produced: hcPCs, 2000 x 10(9) per L in T-Sol or PAS-27a; and stdPCs, 1400 x 10(9) per L in 65 percent T-Sol or PAS-27a and 35 percent acid citrate dextrose-plasma. On Days 1 through 4, swirling was scored and PLT count, mean PLT volume, pH, blood gas, glucose, and lactate were measured. Expression of CD42a, CD62P, CD63, and PAC-1 was analyzed by flow cytometry on resting PLTs and PLTs stimulated with thrombin receptor agonist peptide (TRAP). RESULTS: Glucose consumption and lactate production were significantly higher in hcPCs stored in PAS-27a than in T-Sol. Both stdPC and hcPC PLTs in T-Sol expressed CD62P and PAC-1 significantly higher than in PAS-27a. Over time the T-Sol hcPCs revealed highest expression of CD62P and CD63. A significantly higher capacity for up regulation of CD62P, CD63, and PAC-1 upon TRAP stimulation was found for stdPCs and hcPCs in PAS-27a compared to PLTs in T-Sol. TRAP-stimulated PLTs in stdPCs and hcPCs suspended in PAS-27a showed significantly higher potential for down regulation of CD42a than the T-Sol concentrates. CONCLUSIONS: PLTs appear better preserved in vitro in PAS-27a than in T-Sol, and this suggests that storage of hcPCs in PAS-27a could be extended beyond 24 hours.     

Recovery, survival, and function of transfused platelets and detection of platelet engraftment after allogeneic stem cell transplantation

BACKGROUND: Recovery and survival of transfused platelets (PLTs) are usually assessed by radioisotope labeling methods for evaluation of transfusion efficacy and new progress in the processing of PLT concentrates. Alternative, nonradioactive methods are warranted. STUDY DESIGN AND METHODS: A multicolor flow cytometry method was developed for simultaneous studies of recovery, survival, and function of transfused PLTs. Eight consecutive patients undergoing allogeneic stem cell transplantation (TX) were transfused with apheresis PLTs of nonself human leukocyte antigen (HLA) Class I types, and HLA Class I discrepancy between donor and recipient was used to identify transfused PLTs. Hematologic status and HLA Class I surface expression were analyzed immediately before transfusion, 1 and 6 hours after transfusion, and daily during the subsequent week. PLT activation was assessed by surface expression of CD63, CD62P, or CD42a, before and after stimulation with thrombin receptor agonist peptide. RESULTS: PLT recovery was 43, 41, and 31% for fresh (5‐72 hr old) and 30, 27, and 17% for stored (73‐148 hr old) PLTs, after 1, 6, and 15 to 28 hours, respectively. Survival of fresh versus stored PLTs were 160 and 105 hours, respectively. Spontaneous PLT activation and residual activation potential were almost equal for fresh and stored PLTs. PLT engraftment was detected between Day 7 and Day 9, which was significantly earlier than first sign of neutrophil engraftment (Days 11‐19; p = 0.01). CONCLUSION: Flow cytometry is an attractive alternative to radiolabeling of PLTs for simultaneous studies of survival, recovery, and function of transfused PLTs and early detection of PLT engraftment after allogeneic stem cell TX.     

The medically unexplained revisited

Medicine is facing wide-ranging challenges concerning the so-called medically unexplained disorders. The epidemiology is confusing, different medical specialties claim ownership of their unexplained territory and the unexplained conditions are themselves promoted through a highly complicated and sophisticated use of language. Confronting the outcome, i.e. numerous medical acronyms, we reflect upon principles of systematizing, contextual and social considerations and ways of thinking about these phenomena. Finally we address what we consider to be crucial dimensions concerning the landscape of unexplained “matters”; fatigued being, pain-full being and dys-ordered being, all expressive momentums of an aesthetic of resistance.     

Long-term effects of Class III treatment with rapid maxillary expansion and facemask therapy followed by fixed appliances.

In this cephalometric investigation, we compared the long-term effects of an initial phase of rapid maxillary expansion and facemask (RME/FM) therapy followed by comprehensive edgewise therapy with the effects of growth in untreated, matched controls. The treated sample consisted of 34 patients who underwent RME/FM treatment before the pubertal growth spurt (average age, 8 years 3 months at the beginning of treatment). At the final observation period (average age, 14 years 10 months), all patients were in decelerative growth phases as determined by the cervical vertebral maturation (CVM) method. After the first 10 months of active treatment, significant favorable changes in both the maxillary and the mandibular skeletal components were noted. The forward movement of the maxilla was 1.8 mm greater than in the controls, mandibular projection was reduced by almost 3 mm, and the relative sagittal intermaxillary discrepancy improved by 4.3 mm, as measured by the Wits appraisal. During the posttreatment period, the treated and untreated Class III subjects generally grew similarly, although the skeletal relationship of the maxilla to the mandible remained unchanged in the RME/FM group, whereas the controls had an increased skeletal discrepancy of 3.0 mm. Over the long term, there was a slightly greater increase in midfacial length (1.6 mm) in the treatment group than in the controls. Similarly, the distance from Point A to nasion perpendicular decreased by 1.2 mm in the treated group. The overall increase in mandibular length was 2.4 mm less in the RME/FM group than in the controls, and mandibular projection relative to nasion perpendicular was 3.0 mm less in the treated group. The change in the Wits appraisal was substantial between groups (6.1 mm), with an improvement in the intermaxillary relationship in the treated group (3.4 mm); the Wits appraisal worsened (-2.7 mm) in the untreated controls. No clinically significant differences were observed between the groups in the vertical dimension. Overjet increased significantly in the treated group relative to the controls (4.4 mm), whereas the molar relationship decreased significantly (-3.9 mm). It appears that the favorable skeletal change observed over the long term is due almost entirely to the orthopedic correction achieved during the RME/FM protocol. During the posttreatment period that includes the pubertal growth spurt, craniofacial growth in RME/FM patients is similar to that of untreated Class III controls. Aggressive over-correction of the Class III skeletal malocclusion, even toward a Class II occlusal relationship, appears to be advisable, with the establishment of positive overbite and overjet relationships essential to the long-term stability of the treatment outcome.     

Evaluation of nonleukoreduced red blood cell transfusion units collected at delivery from the placenta

BACKGROUND: The objective of this study was to evaluate the suitability of cord blood (CB) as a source of red blood cells (RBCs) for autologous transfusion. STUDY DESIGN AND METHODS: CB was collected in 150-mL storage containers with citrate phosphate dextrose (CPD) as anticoagulant and stored in either saline, adenine, glucose, and mannitol (SAG-M; n = 18) or phosphate, adenine, glucose, guanosine, saline, and mannitol (PAGGS-M; n = 18) for 35 days at 4 degrees C. Hematologic status and hemolysis were studied. The lipopolysaccharide (LPS)-induced production of tumor necrosis factor (TNF)-alpha and transforming growth factor (TGF)-beta1 from CB monocytes was analyzed after incubation with addition of weekly sampled supernatants from the CB RBC units. Five additional units (PAGGS-M) were leukoreduced and thereafter analyzed as indicated above. RESULTS: Hemolysis increased significantly over time, in SAG-M more than in PAGGS-M. During storage in both media, the number of white blood cells (WBCs) decreased, and the LPS-induced production of TNF-alpha and TGF-beta1 decreased and increased, respectively. There were no significant changes in the LPS-induced production of TNF-alpha and TGF-beta1 in the leukoreduced CB RBC units. CONCLUSION: Hemolysis in CB RBC units increased significantly over time, and PAGGS-M appears to be superior to SAG-M as a preservation solution for CB RBC. The changes in LPS-induced TNF-alpha and TGF-beta1 production over time were probably caused by substances released from apoptotic and/or necrotic WBCs. Further studies are needed to identify both which substances are responsible for the changes in LPS-induced cytokine release and the clinical significance hereof.     

Evaluation of platelet activation and cytokine release during storage of platelet concentrates processed from buffy coats either manually or by the automated OrbiSac system

BACKGROUND: This study aimed to compare platelet (PLT) quality during storage of buffy coat (BC) PLT concentrates (PCs), prepared either manually or by the automated OrbiSac system (Gambro BCT). STUDY DESIGN AND METHODS: Following overnight storage at 20 to 22 degrees C, five BCs were pooled with 300 mL of PLT additive solution. Twenty-one PCs were produced manually (M-PCs) and 21 by the automated OrbiSac system (A-PCs). Swirling, PLT count, mean PLT volume, blood gas analyses, potassium, glucose, and lactate were assessed. Expression of the activation markers CD42a, CD62P, and PAC-1 was analyzed by flow cytometry on resting PLTs and PLTs stimulated with thrombin receptor agonist peptide (TRAP). Levels of CCL5 and transforming growth factor-beta1 (TGF-beta1) were measured by enzyme-linked immunosorbent assay. RESULTS: The A-PCs had significantly larger volume and higher PLT yield, PLT recovery, and white blood cell concentration than the M-PCs, whereas the red blood cell content was significantly highest in the M-PCs. pH levels were between 6.9 and 7.2 in all PCs. Neither glucose consumption nor lactate production differed significantly over time. A-PCs had, compared to M-PCs, significantly higher expression of CD62P on resting PLTs, lower capacity for up regulating CD62P on TRAP-stimulated PLTs, and higher levels of CCL5 during storage. TRAP-stimulated A-PCs had a significantly higher potential for down regulation of CD42a than M-PCs. No difference was found in TGF-beta1 levels or TRAP-induced up regulation of PAC-1. CONCLUSION: The levels of CCL5 and the expression of CD62P in resting and stimulated PLTs indicate that PLTs in A-PCs are slightly more activated than in M-PCs, but the clinical importance of this finding is yet unknown.