Serious infections in adults due to group B streptococci: Clinical and serotypic characterization

Serious infections in adults due to group B streptococci have been infrequently reported. We describe 24 such patients. Bacteremic pyelonephritis, pneumonitis and endometritis were the most common clinical syndromes observed. Group B streptococcal infections tended to occur in patients with underlying illnesses, particularly genitourinary disorders and diabetes mellitus. Mortality was surprisingly low (8 per cent). Type III was the serotype most commonly isolated, and there was no significant correlation of different serotypes with specific organ-system involvement. Group B streptococcal isolates from these patients were uniformly sensitive to penicillin, ampicillin, cephalothin, chloramphenicol, erythromycin and clindamycin; all were highly resistant to kanamycin. Eighty-seven per cent were resistant to tetracycline. Although consistently sensitive to penicillin, the minimal inhibitory concentrations were significantly higher for group B than group A streptococci (p < 0.0005).     

Validation of the Korean version of the Bayer activities of daily living scale

The Bayer-activities of daily living (B-ADL) is a brief and internationally applicable ADL instrument which has been validated in three European countries. The B-ADL has been developed to provide a tool for the assessment of functional deficits in performance of every day tasks as they are observed in mild to moderate stages of dementia. The B-ADL has been constructed for use in clinical trials as well as in clinical practice. From an international perspective the major application is the evaluation of treatment effects in clinical studies and the current study was to validate the Korean version of the B-ADL. The B-ADL was administered to a total of 129 subjects with varying degrees of cognitive decline. A substantial cross-sectional correlation between B-ADL and MMSE scores was found. The internal consistency of B-ADL was above 0.98. A factor analysis revealed that a one factor solution accounted for most of the total variance. The B-ADL global score significantly increased as the severity of dementia, assessed by global deterioration scale increased from stage 1 to 5. Test-retest reliabilities of B-ADL global score and each item were very high. All of these results were very similar to those from three European countries except for the proportion of 'non-applicability' in some ADL items. These findings provide evidence that the Korean version of B-ADL can be useful not only for clinical purposes but also for international multicentre studies.     

Indirect estimation of pediatric Health Related Limits for serum thyrotropin using the ADVIA Centaur analyzer

OBJECTIVES: To determine pediatric reference values for thyrotropin using Advia Centaur analyzer. DESIGN AND METHODS: The study was conducted in a large regional hospital on TSH results obtained from 5741 females and 4332 males aged 0-17 years. After the exclusion of the results outside 4 standard deviations, we calculated the Health Related Limits (HRLs) following the indirect Kairisto's procedure and using the software GraphROC. RESULTS: The lower HRL of TSH concentration was 0.70 mU/L in the years 0-11 and 0.50 mU/L in the following years. The upper TSH HRL was 6.9 mU/L in males vs. 5.7 mU/L in females in the first year and 6.7 mU/L vs. 5.3 in the period 1-2 years. The upper HRLs in females and males were similar in the following years and the upper HRL in the 13-17 years class was 3.8 mU/L. CONCLUSIONS: The indirect methods appear reliable for calculating the pediatric HRLs for TSH.     

Immediate and delayed effects of a brief period of calcium loading,induced by the calcium channel agonist Bayer K 8644, on the ultrastructure and sarcolemmal integrity of murine diaphragm in vitro

Exposure of in vitro mouse diaphragm to the dihydropyridine Ca²⁺ channel agonist Bayer K 8644 (Bay) and partial depolarisation for 120 min induced severe structural damage within 30–60 min and membrane permeabilisation (60–120 min). Exposure to Bay and depolarisation for 30 min (brief Ca²⁺ loading) followed by washout for 90 min produced similar effects, even though significant membrane damage does not occur until the second hour of incubation. Development/expression of necrosis during the washout period was not inhibited by manoeuvres designed to combat the effects of any remaining Bay, or by use of a Ca²⁺-free, 1 mM EGTA medium for washout. Exposure to Bay for 15 min followed by washout did not induce damage. Electron microscopic examination revealed that the mitochondria of cells fixed after 30 or 120 min exposure to Bay and depolarisation were in the orthodox (swollen) configuration, but that mitochondria in muscles that had undergone washout with Ca²⁺-free-EGTA saline were electron dense. Further incubation of these muscles in Ca²⁺-containing medium caused readoption of the swollen configuration. We conclude that membrane permeabilisation can occur after removal of the Ca²⁺ load, and that mitochondrial Ca²⁺ overload is not necessary for Ca²⁺-induced damage/death to occur.This work was supported by the Wellcome Trust, Grant no. 030661/Z/89     

Notice of Correction

There has been a decrease in the use of whole blood and red cell transfusions during and after open-heart operations in the greater Kansas City area from an average of slightly more than 9 units per patient from 1969 through 1971, to just over 3 units per patient from 1975 through 1977. In 1977, 1,256 patients, or 71% of 1,769 patients, underwent coronary artery bypass exclusively and had an average transfusion utilization of 2.6 units. All other open-heart operations averaged 4.7 units per patient.Hemodilution and the acceptance of hematocrits between 25 and 30% in open-heart operations are probably the main factors responsible for lower transfusion use per patient, while the increased proportion of patients undergoing coronary artery bypass accounts for a further decrease in the average amount of blood used per patient. It is of note that blood transfused to patients having an open-heart operation was not significantly fresher than blood for routine use, yet hemostasis was not a problem as evidenced by the small use of fresh-frozen plasma in 67 patients (3.8%) and platelet concentrates in 42 patients (2.4%).     

Bayer ADVIA 2120全自动血细胞分析仪的性能评价

目的:对Bayer ADVIA 2120全自动血细胞分析仪作初步性能评价。方法:按国际血液学标准化委员会(ICSH)标准,对几项主要参数进行性能评价。结果:全血样本的白细胞(WBC)、红细胞(RBC)、血红蛋白(Hb)、平均红细胞体积(MCV)和血小板(PLT)的总重复性均低于4%,批内和日间的重复性分别小于3%和4%,携带污染率WBC、RBC、Hb、MCV和PLT均小于1.0%,线性范围宽。与Coulter MAXM全自动血细胞分析仪比较,r值分别为0.981、0.993、0.994、0.992和0.941。白细胞分类(DC)对幼稚粒细胞和异型淋巴细胞的筛选能力较强,对有核红细胞的筛选能力稍差。结论:Bayer ADVIA 2120全自动血细胞分析仪精密,线性好,携带污染率低,与其他厂商的仪器可比性好,有较强的筛选能力,是一台适合临床应用的性能良好的全自动血细胞分析仪。     

Relationships between platelet counts, platelet volumes and reticulated platelets in patients with ITP: evidence for significant platelet count inaccuracies with conventional instrument methods

The platelet count has a primary role in the diagnosis and treatment of idiopathic thrombocytopenic purpura (ITP). This study analysed the accuracy of ITP patient platelet counts determined by Abbott CD-Sapphire (impedance/optical) and Bayer Advia 120 (optical) analyses, compared with a reference immunoplatelet method. Instrument platelet estimates showed broad equivalence in the higher range of observed values, but significant discrepancies against the immunoplatelet count were seen when platelet counts were <10 x 10(9)/l. CD-Sapphire mean platelet volume (MPV) results revealed increased (>12 fl) platelet volumes in eight of eight ITP patients with counts of <20 x 10(9)/l compared with 6/6 and 5/13 patients with platelet counts of 20-50 and >50 x 10(9)/l. In contrast, Bayer Advia MPV values showed no relationship with the platelet count. Increased reticulated platelets were associated with an increasing CD-Sapphire MPV (R(2) = 0.61) and a decreasing platelet count. High (>40%) reticulated platelet values were seen in 9/9 patients with immunoplatelet counts of <20 x 10(9)/l compared with 0/19 patients with platelet counts above 20 x 10(9)/l. There may be a need for caution in the interpretation of platelet counts in ITP patients obtained with conventional instrument methods, and therapeutic decisions should ideally be validated by reference immunoplatelet procedures.     

Manufacturing challenges in the commercial production of recombinant coagulation factor VIII

Summary. Advances in gene technology have led to the development of a method to manufacture recombinant coagulation Factor VIII (rFVIII) for haemophilia A. Because rFVIII is a large and complex protein, its commercialization has required that many challenges in manufacturing, purification and processing be overcome. In order to license the first generation of rFVIII (Kogenate^®) in 1993, Bayer Corporation invested over 10 years in research and manufacturing development. Seven additional years were subsequently devoted to research and manufacturing improvements in order to accomplish the recent licensing of a second rFVIII product (KOGENATE^® Bayer or Kogenate^® FS). This product differs from its predecessor, in that human albumin is removed from the purification and the formulation steps. In addition, fewer chromatography steps are involved resulting in greater yields per mL of conditioned medium, and a solvent‐detergent viral inactivation step replaces the heat‐processing step used for the previous product. Despite these changes in the manufacturing, the protein backbone and carbohydrate structure of the final rFVIII molecule are identical. The complexity of the production processes is reflected by over 100 000 manufacturing data entries and by 600 quality control tests for each batch of rFVIII. Manufacturers are continuing to develop the next generation of rFVIII, which will be produced without the addition of any human or animal proteins or byproducts. Investments in research, development and manufacturing technology are expected to result in the development of new products with enhanced safety profiles, and in an increase in the production capacity for products that are chronically in short supply.     

Equivalent recognition of free and act-complexed PSA in a monoclonal-polyclonal sandwich assay is conferred by binding specificity of the monoclonal antibody

The Bayer Immuno 1^TM PSA Assay measures free and ACT-complexed PSA on an equimolar basis, although it uses a monoclonal antibody (MM1) for capture and polyclonal antibodies for detection. Competitive inhibition studies using antibodies directed at various epitopes on PSA and PSA-ACT demonstrated that the capture antibody, MM1, does not bind to free PSA simultaneously with antibodies against Epitope E which is exposed only in free PSA. Affinity studies showed that the affinity constants of MM1 for both free PSA and PSA-ACT are similar. One explanation for the properties of MM1 is that it precludes the binding of antibodies to Epitope E due to steric hindrance. Alternatively, the binding of MM1 causes a conformation change within the free PSA molecule, so that Epitope E is altered in a way that causes a loss of binding affinity. The unusual properties of MM1 are responsible for the equimolar response of this monoclonal-polyclonal sandwich assay for free and ACT-complexed PSA. J. Clin. Lab. Anal. 12:242–249, 1998. © 1998 Wiley-Liss, Inc.