Conditions for albumin dimerisation in nephrotic urines. Dependence on an ultrafilterable factor

At ?14°C the albumin in the urine of some patients with a nephrotic syndrome polymerises into dimer and higher polymers. This occurs at low ionic strengths within 1–3 days and in the pH range 5–10. For polymerisation both an altered albumin molecule and a low molecular weight ultrafilterable fraction in the urine are necessary. The appearance of both is probably related to steroid therapy. The ultrafiltrate fraction has molecular mass <700, and is not peptide, amino acid, fatty acid or highly charged ion.     

Fluctuating asymmetry of dynamic smiles in normal individuals

The aim of this study was to quantify the fluctuating dynamic facial asymmetry during smiling in a group of ‘normal’ adults, using three-dimensional (3D) motion facial capture technology. Fifty-four male and 54 female volunteers were recruited. Each subject was imaged using a passive markerless 3D motion capture system (DI4D). Eighteen landmarks were tracked through the 3D capture sequence. A facial asymmetry score was calculated based on either a clinically derived midline or Procrustes alignment; scores were based on the Euclidean distance between landmark pairs. Facial asymmetry scores were determined at three time points: rest, median, and maximum frame. Based on the clinically derived midline and on Procrustes alignment, the differences between male and female volunteers, as well as those at the three different time points, were not clinically significant. However, throughout a smile, facial and lip asymmetry scores increased over the duration of the smile. Fluctuating facial asymmetry exists within individuals, as well as between individuals. Procrustes superimposition and the clinically derived midline produced similar asymmetry scores and both are valid for symmetrical faces. However, with facial asymmetry, Procrustes superimposition may not be a valid measure, and the use of the clinically derived midline may be more appropriate, although this requires further investigation.     

Bilateral Anterior Thigh Thickness: A New Diagnostic Tool for the Identification of Low Muscle Mass?

ObjectivesTo develop an ultrasonographic scanning protocol that included an assessment of muscle size [the proposed Bilateral Anterior Thigh Thickness (BATT)] and quality (echogenicity) to support the diagnosis of sarcopenia in a clinical setting. To determine the relationship of BATT and ultrasound echogenicity with physical function parameters of sarcopenia and test the reliability of ultrasound echogenicity measurements.DesignObservational study.Setting and participantsThe BATT criteria were determined from a reference population of 113 healthy younger adults and tested in 39 healthy older adults and 31 frail older adults.MethodsUltrasonography was used to measure the thickness of rectus femoris and vastus intermedius bilaterally; the thickness measurements were summed to calculate the BATT. Diagnostic criteria for low muscle size were calculated from the reference population. Echogenicity was assessed using freeze-frame images. All individuals underwent anthropological, frailty, and physical performance assessments.ResultsThe mean (standard deviation) BATTs for the subsamples were as follows: healthy young women (n = 54), 60.6 mm (±11.1); healthy young men (n = 59), 75.8 mm (±10.71); healthy older women (n = 27), 38.4 mm (±7.18); healthy older men (n = 13), 47.5 mm (±10.8); frail older women (n = 17), 29.2 mm (±11.4); and frail older men (n = 14), 27.3 mm (±13.9). The calculated cutoffs for low muscle size in older adults using the BATT criteria were 38.5 mm in women and 54.4 mm in men in this population. The BATT was correlated with grip strength (ρ = 0.750, P < .001 for women; ρ = 0.619, P < .001 for men) and walk speed (ρ = ?0.599, P < .001 for women; ρ = ?0.324, P = .003 for men). Ultrasound echogenicity increased with age and frailty. Lay sonographers were able to reliably reproduce the same muscle thickness measurements but not the same muscle echogenicity measurements.Conclusions/ImplicationsThe data support the use of ultrasonography to identify low muscle size in sarcopenia. Ultrasonography provides a pragmatic diagnostic tool that is noninvasive, without radiation exposure, and usable in both community and hospital settings. The proposed BATT criteria could be used to identify low muscle size in clinical practice and research, and in this study have excellent correlation with physical parameters of muscle health. However, this now needs testing in a validation cohort. Ultrasound echogenicity has been demonstrated to be an important surrogate marker of muscle health, but difficulties with reproducibility preclude its widespread clinical use.     

Selectively reduced biliary excretion of cholyldiglycylhistamine but not of cholyltetraglycylhistamine in ethinyl estradiol-treated rats. A possible indicator of increased bile canalicular permeability

A series of bile acid derivatives were synthesized, purified and radiolabelled. These were [125I]cholylglycylhistamine [( 125I]CGH), [125I] cholyldiglycylhistamine [( 125I]CG2H), [125I]cholyltriglycylhistamine [( 125I]CG3H), and [125I]cholyltetraglycylhistamine [( 125I]CG4H). These derivatives were rapidly excreted unchanged into the bile of bile-fistula rats. In normal rats the 30-min cumulative excretion following intravenous administration was only 39.0 +/- 0.7% for [125I]CGH but greater than 80% for the three larger compounds. This marked difference in biliary recovery between CGH and the other larger compounds could be due to a threshold biliary permeability, and we postulated that the critical molecular weight threshold for effective biliary retention of such compounds falls between [125I]CGH (MW 683) and [125I]CG2H (MW 740). Increased permeability, involving a shift to a higher molecular weight threshold would then be anticipated to diminish biliary excretion of [125I]CG2H (MW 740) before exerting a major influence on the biliary excretion of [125I]CG4H (MW 854). We previously reported functional and morphological studies which suggest that ethinyl estradiol (EE) may alter the permeability of bile canalicular tight junctions. In this study we have looked for further evidence of a progressive permeability change in EE-induced cholestasis by observing the biliary excretion of CG2H and CG4H in rats. Treatment with EE (5 mg/kg/day) for 3 days (EE3) or with the injection vehicle propylene glycol for 7 days (C7) reduced biliary excretion to a significant extent when compared to 3-day controls (C3) but had no differential effect on the 30-min recoveries from bile of CG2H and CG4H, respectively: C3 (81.2 +/- 1.8% and 81.7 +/- 2.1%, P = CN): C7 (72.3 +/- 3.0% and 73.5 +/- 3.6%, P = NS): EE3 61.8 +/- 2.5% and 61.9 +/- 2.7%, P = NS). However, treatment with EE for 7 days significantly reduced the biliary recovery of CG2H (46.8 +/- 9%) compared to EE3 rats (P less than 0.0025) but there was no significant change of biliary CG4H recovery (61.0 +/- 2.5%, P = NS) compared with EE3 rats. These results are compatible with our hypothesis that EE-induced cholestasis is associated with a change of biliary permeability which, as it progresses, affects successively larger molecules.     

Multivariable analysis of predictors of unplanned hospital readmission after pancreaticoduodenectomy: development of a validated risk score

Background

Unplanned hospital readmission after pancreaticoduodenectomy (PD) is usually due to surgical complications and has significant clinical and economic impact. This study developed a risk score to predict 30-day readmission after PD.

The sedimentation coefficients of human jejunal gut hormone storage granules

Centrifugation techniques have been applied to human jejunal homogenates to determine the sedimentation coefficients of the peptide hormone storage granules and mitochondria. The manually computed mean values from three experiments were: motilin (3020), gastrin (3300), enteroglucagon (4880), gastric inhibitory poly-peptide (7240), somatostatin (7580). The mean sedimentation coefficient of the mitochondria was 12600. These results provide independent correlates of granule size determined morphologically and provide the basis for determination of changes in disease states affecting the jejunum.     

Intravenous cyclophosphamide plus methylprednisolone in treatment of systemic rheumatoid vasculitis

Systemic vasculitis in rheumatoid arthritis shows similarities to polyarteritis nodosa and may require equally aggressive therapy. Forty-five patients with systemic rheumatoid vasculitis were studied during treatment with either cyclophosphamide plus methylprednisolone given by intermittent bolus intravenous injection (21 patients) or a variety of other more conventional drug regimens (24 patients). In this open study, the intravenous treatment group had more severe initial disease, a higher incidence of neuropathy, and more frequent evidence of necrotizing arteritis on biopsy than the other treatment group. Despite this, intravenous cyclophosphamide plus methylprednisolone resulted in more frequent healing of vasculitic lesions including leg ulcers and neuropathy, a lower incidence of relapse, fewer serious complications, and a lower mortality than did other treatments. Toxic effects were similar in both study groups. Intravenous cyclophosphamide plus methylprednisolone is a useful early treatment for systemic rheumatoid vasculitis.     

A reduced time to surgery within a ‘fast track’ pathway for periampullary malignancy is associated with an increased rate of pancreatoduodenectomy

Introduction

Pancreatoduodenectomy (PD) typically follows preoperative biliary drainage (PBD) despite PBD being potentially harmful. This study evaluated a pathway to avoid PBD within the framework of the UK's NHS.