The relationship of leukocyte anisocytosis to holotranscobalamin, a marker of cobalamin deficiency

INTRODUCTION

After measurement of the mean volumes of leukocyte subpopulations as well as the distribution widths (DW) of these volumes has become available, we investigated whether such morphometric leukocyte parameters are associated with a commonly used marker of cobalamin deficiency, i.e., holotranscobalamin (HoloTC). Further, we determined reference intervals for these parameters in an elderly population.

METHODS

Consecutive subjectively healthy and volunteering individuals ≥60 years were included. Using the UniCel DxH 800 Coulter Cellular Analysis System MoMV, mean neutrophil volume (NeMV), mean lymphocyte volume (LyMV), monocyte anisocytosis (MoV-DW), neutrophil anisocytosis (NeV-DW), and lymphocyte anisocytosis (LyV-DW) were assessed together with other parameters including HoloTC.

RESULTS

A total of 150 individuals were included in the study. Reference intervals were not dependent on age and gender. MoV-DW (P = 0.002) and NeV-DW (P = 0.02) were significantly lower, and LyMV was significantly higher (P = 0.04) in participants with a HoloTC concentration <28 pm. In contrast, MCV, MoMV, NeMV, and LyV-DW were not associated with HoloTC concentrations. The area under the curve (AUC) in the receiver operating characteristic analysis for detecting a HoloTC <28 pm was 0.81 [95% confidence interval (CI) (0.73, 0.87)] for MoV-DW and 0.73 (0.66, 0.80) for NeV-DW.

CONCLUSION

In this collective of subjectively healthy elderly individuals, monocyte anisocytosis, neutrophil anisocytosis and mean lymphocyte volume were associated with decreased HoloTC.

290 MODULATION OF ARYLHYDROCARBON RECEPTOR ACTIVITY DURING IN VITRO MATURATION OF BOVINE OOCYTES

The arylhydrocarbon receptor (AhR), a ligand activated transcription factor, has been extensively characterized from a toxicological point of view due to its ability to mediate the adverse effects of a variety of halogenated aromatic hydrocarbons. Recent reports on AhR knockout mice suggest that the AhR may play a role in ovarian physiology. We have previously demonstrated that AhR activity (as indicated by the up-regulation of the target gene cytochrome p450 1A1: CYP1A1) is stimulated during bovine oocyte IVM in the absence of exogenous ligands. Furthermore, exposure to specific AhR antagonists, besides down-regulating the expression of CYP1A1, significantly impairs the ability of the oocyte to complete maturation until the metaphase II stage (Pocar et al. 2004 Endocrinology 145, 1594–1601). The aim of the present study was to further investigate the mechanisms underlying the AhR activation during IVM. Several reports point to a critical role of phosphorylation in the regulation of the AhR-complex. Furthermore, the mitogen-activated protein kinase (MAPK, extracellular regulated kinase (ERK 1 and 2)) cascade has been shown to play a crucial role in regulating meiotic cell cycles during bovine oocyte maturation. A total of 572 bovine cumulus-oocyte complexes were used to investigate the potential role of the MAPK in modulating the activity of the AhR during IVM. The effect of the broad-spectrum serine/threonine kinase inhibitor, 6-dimethylaminopurine (6-DMAP), on the induction of CYP1A1 during oocyte maturation was investigated. As expected, exposure to 6-DMAP induced meiotic arrest (at the stage of germinal vesicle/germinal vesicle breakdown) and down-regulated the expression level of phosphorylated ERK 1 and 2. Interestingly, a significant down-regulation of the target genes CYP1A1 and CYP1B1 (9.5% and 26.8% of control, respectively) and an up-regulation of the AhR (199.4% of control) were observed at the mRNA level. This phenomenon was partially reversible after a period of further 24 h of culture in the absence of 6-DMAP. In this condition, besides a recovery of oocyte maturation and phosphorylation status of ERK 1 and 2 to levels comparable to control, a significant up-regulation of CYP1A1 mRNA was observed (68.3% of control). Finally, to confirm the role of serine/threonine kinases in modulating the activity of AhR during resumption of meiosis, we exposed the oocytes to cycloheximide, a protein synthesis inhibitor, also known to arrest oocyte maturation. Furthermore, although cycloheximide exposure induced meiotic arrest, no significant differences in the expression levels of AhR or its target genes compared to control were observed. Each experiment was replicated at least three times. Data were assessed using ANOVA followed by Duncans multiple rance test. The criterion for significance was set at P < 0.05. In conclusion, our results strongly suggest that 6-DMAP-sensitive kinase(s) is (are) involved in the regulation of AhR during bovine oocyte maturation. Further analyses are necessary to understand the biological significance of these observations.

Role of 16S rRNA Helix 44 in Ribosomal Resistance to Hygromycin B

Hygromycin B is an aminoglycoside antibiotic active against prokaryotic and eukaryotic ribosomes. Ribosomal alterations in bacteria conferring resistance to hygromycin B have not been described, prompting us to use a single rRNA allelic derivative of the gram-positive bacterium Mycobacterium smegmatis for investigation of the molecular mechanisms involved in ribosomal resistance to hygromycin B in eubacteria. Resistance mutations were found to localize exclusively in 16S rRNA. The mutations observed, i.e., 16S rRNA U1406C, C1496U, and U1498C (E. coli numbering), are in close proximity to the hygromycin B binding site located in conserved helix 44 of 16S rRNA. The 16S rRNA positions involved in hygromycin B resistance are highly conserved in all three domains of life, explaining the lack of specificity and general toxicity of hygromycin B.

Short-term effects of atorvastatin on C-reactive protein

AIM

To study the short-term effect of atorvastatin on C-reactive protein (CRP) in patients with or at risk for coronary heart disease.

METHODS AND RESULTS

One hundred and fifty-five randomly selected patients from the SWiss Intervention Trial for lowering CHolesterol (SWITCH) were assessed for high sensitivity CRP, total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides at baseline, and after 1 and 3 months of treatment with atorvastatin at various doses to reach pre-defined lipid target values. The median decrease of cholesterol was 28% after 1 month and 35% after 3 months. LDL-cholesterol was decreased by 37% and 45%, HDL-cholesterol was increased by 7% and 8%, respectively. Patients with a low CRP baseline concentration (lowest quartile <1.34 mg. l(-1)) displayed no significant change, whereas patients in the other quartiles showed a significant decrease, of 22% to 40% (P -value <0.05 to <0.001) at 1 month and of 32% to 36% after 3 months compared to baseline. The decrease in CRP lowering was thus fully established by 1 month and this response was independent of lipid and lipoprotein changes as well as atorvastatin doses.

CONCLUSION

Atorvastatin significantly decreases CRP concentrations after 4 weeks of therapy. These results may be important with respect to the early benefit of statin therapy.

Multicentre evaluation of a new point-of-care test for the quantitative determination of D-dimer

Imprecision studies, interference testing and multicentre method comparisons using patient samples were carried out with of a new point-of-care test for D-dimer (CARDIAC D-Dimer). The CV of the within-series and the day-to-day imprecision with blood samples and control materials were between 7% and 13%. Compared with Tina-quant D-Dimer, CARDIAC D-Dimer showed a good correlation and accuracy (n=353; r=0.91; y=1.06x-0.03), compared with STA LIATEST D-Dimer some poorer accuracy (n=304; r=0.91; y=1.12x-0.03). No interference was detected for different hematocrit values (16% to 51%) and in investigations with hemoglobin (up to 0.13 mmol/l), biotin (up to 30 microg/l), bilirubin (up to 340 micromol/l), intralipid (up to 31.1 mmol/l) and rheumatic factor (up to 79 IU/ml). Overdosing or underdosing by 10 microl did not affect the test result. The diagnostic sensitivity of CARDIAC D-Dimer for the detection of acute venous thromboembolic diseases was 100% in our study. With CARDIAC D-Dimer reliable quantitative D-dimer results can be easily obtained. Because of the good analytical and clinical agreement with Tina-quant D-Dimer, it should be suitable for ruling out venous thromboembolic diseases.

[Music therapy for chronic headaches. Evaluation of music therapeutic groups for patients suffering from chronic headaches]

PROBLEM

This paper presents a new approach to music therapeutic treatments. We developed a short time treatment ( 8 group sessions) for patients suffering from chronic headaches. The multimodal concept of this headache treatment and particularly the effect of a sound trance on headache patients are explained and evaluated in this paper.

METHODS

An evaluation study was done with 34 patients, who belonged to four therapy groups. In order to evaluate this treatment the patients were interviewed and had to fill out several self-rating scales about pain and some psychological variables (e. g. depression) before, directly after and 6-12 months after the treatment. This treatment group (n=26) was compared to a small waiting group (n=9). A case study elucidated the psycho-social anamnesis, and the process and outcome of the music therapy.

RESULTS

The case study shows that the sound trance caused a loss of the affect control or at least reduced it. This experience enabled the patients to develop creative solutions, which resulted in a pain relief 6-12 month later. The comparison of the statistic means directly before and after the treatment did not reveal many therapeutic effects. Yet, 6-12 months later many patients reported less days at which they suffered from headaches; and they also significantly improved their ability of pain control.

CONCLUSION

The results indicate that music therapy groups are more successful than a waiting group. The study's results agree with numerous other psychological evaluation studies and shows once more that music therapists working with patients suffering from chronic headaches are able to achieve successful results particularly long-dated. Thus, creative therapeutic approaches supplement the medical treatment, as they help the patients to develop an adaptive way of coping their pain. Yet, it will need further research to confirm the benefit of music therapy for patients suffering from chronic pain.

[Dorsal mucoid cyst--ganglion-like pseudocyst of the joint space]

A myxoid cyst on the dorsum of the left index finger is presented. A connection of this pseudocyst to the underlying joint was shown by means of magnetic resonance imaging. Surgically the connecting tract to the distal interphalangeal joint was easily demonstrated and histologically a ductal structure was focally seen by means of serial sections. These structures also suggest such a connection. These findings confirm the view that this pseudocyst can be interpreted as a ganglion. Therapeutically complete excision with careful tying off of the channel to the joint appears to be the best method to avoid recurrence. The injection of sclerosing agents, a conservative treatment modality proposed by some authors, may be problematic in the light of the pathogenesis discussed here; however damage to the finger joint has not been so far observed.

Exercise-induced silent ischemia: age, diabetes mellitus, previous myocardial infarction and prognosis

The purposes of this study were 1) to determine the prognosis of silent ischemia in an unselected group of patients referred for exercise testing, and 2) to assess whether age or the presence of myocardial infarction or diabetes mellitus influences the prevalence of silent myocardial ischemia during exercise testing. The design was retrospective, with a 2 year mean follow-up period. The study group consisted of 1,747 predominantly male in-patients and outpatients referred for exercise testing at a 1,200 bed Veterans Administration hospital. The main result was that the mortality rate was significantly greater (p = 0.02) among patients with abnormal ST segment depression than in patients without ST depression. The presence or absence of angina pectoris during exercise testing was not significantly related to death. The prevalence of silent ischemia was not significantly different among patients categorized according to myocardial infarction or diabetes mellitus status, but was directly related to age. It is concluded that, in patients with an ischemic ST response to exercise testing, the presence or absence of angina pectoris during the test does not alter the risk of death. The prevalence of silent ischemia during exercise testing is not statistically different among patients with recent, past or no myocardial infarction or with insulin-dependent or noninsulin-dependent diabetes mellitus.

Application of meta-analysis using an electronic spread sheet to exercise testing in patients after myocardial infarction

Decision analysis is being applied to medical practice in order to achieve cost efficacy in health care delivery. Critical to this process is establishing the diagnostic and prognostic accuracy of medical tests and the effectiveness of interventions. Meta-analysis is an approach that applies statistical methods to groups of studies in order to extract consensus results. Electronic spreadsheets facilitate meta-analysis with their ability to store, sort, graph, and mathematically manipulate both the methodologic approaches and clinical findings of seemingly disparate studies. As an example, this application is demonstrated with an analysis of studies that were performed to evaluate the prognostic value of exercise testing in patients recovering from a myocardial infarction. The following conclusions were reached: (1) patients excluded from exercise testing have the highest mortality; (2) only subsets of patients have been tested resulting in highly selected patient samples that make findings difficult to generalize; (3) of the five exercise test responses, only an abnormal systolic blood pressure response and a poor exercise capacity predicted risk more frequently than by chance; (4) submaximal or predischarge testing has greater predictive power than postdischarge or maximal testing; and (5) exercise-induced ST segment depression only appears to be predictive of increased risk in patients with inferior-posterior myocardial infarctions. This approach to combining studies is important since even careful analysis of a single study cannot elucidate all of the complex interactions and selective biases that have occurred. However, comparison of many heterogeneous studies is at best an arduous and time-consuming task. This approach to using electronic spreadsheets to collate and analyze multiple studies facilitates recognition of the population characteristics, clinical factors, and methodologic considerations that affect outcome and allows the quick inclusion of additional studies for re-analysis and interpretation.

Duodenal fistula--a rare complication following the removal of an infected aortic graft: case report

We present a rare case of fistulation from the duodenum into the prosthesis site of an aortic Y graft removed 8 months previously owing to infection. We have verified the topographical and anatomical location of the fistulation by fistula filling and CT and MR examination. To our knowledge such a postoperative complication has not been previously documented. In evaluating and comparing our observation we discuss their significance for topographical associations and prognosis and as an indication for surgical intervention.