Kangaroo mother care for the prevention of neonatal hypothermia: a randomised controlled trial in term neonates

OBJECTIVE

To test the hypothesis that kangaroo mother care (KMC) initiated either at birth or at 1 hour after birth reduces moderate or severe hypothermia in term neonates at (A) 1 hour after birth and (B) at discharge when compared with standard thermoregulation care.

METHODS

Term neonates born at a tertiary delivery centre in Zambia were randomised in two phases (phase 1: birth to 1 hour, phase 2: 1 hour to discharge) to either as much KMC as possible in combination with standard thermoregulation care (KMC group) or to standard thermoregulation care (control group). The primary outcomes were moderate or severe hypothermia (axillary temperature <36.0°C) at (A) 1 hour after birth and (B) at discharge.

RESULTS

The proportion of neonates with moderate or severe hypothermia did not differ between the KMC and control groups at 1 hour after birth (25% vs 27%, relative risk (RR)=0.93, 95% CI 0.59 to 1.4, P=0.78) or at discharge (7% vs 2%, RR=2.8, 95% CI 0.6 to 13.9, P=0.16). Hypothermia was not found among the infants who had KMC for at least 9 hours or 80% of the hospital stay.

CONCLUSIONS

KMC practised as much as possible in combination with standard thermoregulation care initiated either at birth or at 1 hour after birth did not reduce moderate or severe hypothermia in term infants compared with standard thermoregulation care. The current study also shows that duration of KMC either for at least 80% of the time or at least 9 hours during the day of birth was effective in preventing hypothermia in term infants.

CLINICAL TRIAL REGISTRATION

NCT02189759.

Early clinical experiences with nintedanib in three UK tertiary interstitial lung disease centres

Background

Nintedanib has been shown to slow disease progression in patients with idiopathic pulmonary fibrosis (IPF). It was approved by the National Institute for Health and Care Excellence (NICE) in January 2016 for IPF patients with a forced vital capacity (FVC) of 50–80% in the United Kingdom (UK).

Aim

To report real world data about our early clinical experience using nintedanib in 187 patients with a multi-disciplinary (MDT) diagnosis of IPF in a manufacturer funded patient in need scheme (three UK centres) prior to NICE approval.

Methods

All patients with a MDT diagnosis of IPF from December 2014 to January 2016 commenced on nintedanib were included. Demographic details, adverse events (AEs) and where available lung function results were retrospectively collected from clinical letters.

Results

187 patients (76% males) with a median age of 72 years (49–89) were treated with nintedanib. The average pre-treatment FVC was 81.1 ± 19.8% and diffusion capacity of the lungs for carbon monoxide was 43.9 ± 15% (n = 82). Fifty percent of patients started nintedanib because they were ineligible for pirfenidone due to an FVC > 80%. The median treatment course was 8 ± 4 months. The majority of patients experienced 1–3 AEs with nintedanib (52%, n = 97). The most frequent AEs were diarrhoea (50%), nausea (36%), reduced appetite (24%), tiredness (20%) and gastro-oesophageal reflux (18%). The majority of AEs resulted in no change in treatment (64%, n = 461). 21% (n = 150) of AEs resulted in a dose reduction and 13% (n = 94) necessitated discontinuation of treatment. 1 in 5 patients discontinued treatment either temporarily or on a permanent basis during the monitoring period. In a select cohort of patients, a statistically significant greater proportion of patients remained stable or improved and a lower proportion declined, as depicted by FVC changes of > 5% after nintedanib commencement (P < 0.05 using Chi squared test).

Conclusions

Nintedanib is well tolerated and has an acceptable safety profile. Only 8% of those reporting diarrhoea discontinued treatment either on a temporary or permanent basis. There were no signals with respect to increased cardiovascular morbidity or major bleeding risk. This is in keeping with the INPULSIS clinical trial findings but in a real world cohort.

Stroboscopic detection of nuclear resonance in an arbitrary scattering channel

The theory of heterodyne/stroboscopic detection of nuclear resonance scattering is developed, starting from the total scattering matrix as a product of the matrix of the reference sample and the sample under study. This general approach holds for all dynamical scattering channels. In the forward channel, which has been discussed in detail in the literature, the electronic scattering manifests itself only in an energy-independent diminution of the scattered intensity. In all other channels, complex resonance line shapes of the heterodyne/stroboscopic spectra are encountered, as a result of the interference of electronic and nuclear scattering. The grazing-incidence case will be evaluated and described in detail. Experimental data of classical X-ray reflectivity and their stroboscopically detected resonant counterpart spectra on the [(nat)Fe/(57)Fe]10 isotope periodic multilayer and antiferromagnetic [(57)Fe/Cr]20 superlattice are fitted simultaneously.

Development of a new method to characterize (SMBV) antigen formulations using surface plasmon resonance technology

Supra Molecular Biovectors (SMBV) are nanoparticles composed by a polysaccharidic core surrounded by a lipid bilayer. They are designed for drug delivery and vaccine and can be administrated by nasal route. The association rate and the stability of association between active principle (AP) or antigens (Ag) with SMBV can be evaluated using the plasmon resonance technology using a BIAcore X system and a HPA hydrophobic sensor chip. AP, Ag and/or adjuvant molecule solutions are injected over SMBV saturated HPA sensor chip surface. Using a very small quantity of material, this technique allows us to quickly have an overview of complex formulations using SMBV. It is also the fastest screening technique to select the best SMBV for each Ag and the best formulation process.

Coarsening of antiferromagnetic domains in multilayers: the key role of magnetocrystalline anisotropy

The domain structure of an antiferromagnetic superlattice is studied. Synchrotron Mössbauer and polarized neutron reflectometric maps show micrometer-size primary domain formation as the external field decreases from saturation to remanence. A secondary domain state consisting mainly of at least 1 order of magnitude larger domains is created when a small field along the layer magnetizations induces a bulk-spin-flop transition. The domain-size distribution is reproducibly dependent on the magnetic prehistory. The condition for domain coarsening is shown to be the equilibrium of the external field energy with the anisotropy energy.

Phase I study of a third-generation selective estrogen receptor modulator, LY353381.HCL, in metastatic breast cancer

PURPOSE

We conducted this phase I trial to determine the safety and toxicity profile of LY353381.HCl-a novel, potent, third-generation selective estrogen receptor modulator (SERM)-because this benzothiophene derivative demonstrated an SERM profile in preclinical studies.

PATIENTS AND METHODS

We studied 32 patients with recurrent or metastatic breast cancer. Patients were treated in four cohorts with oral daily doses of 10, 20, 50, and 100 mg. Pharmacokinetic sampling was performed during the first 72 hours following the first dose on day 1 and during the 24 hours after the day 57 dose. Eligibility criteria included Eastern Cooperative Oncology Group performance status of 0 to 2; no significant major organ dysfunction; and at least 3 weeks elapsed since most recent hormonal therapy, chemotherapy, and estrogen replacement therapy.

RESULTS

The median patient age was 56 years (range, 30 years to 76 years). The median number of prior chemotherapies for metastatic disease was one (range, zero to four), while the median number of prior hormone regimens for metastatic disease was two (range, zero to five). Receptor status was estrogen receptor (ER) positive and progesterone receptor (PR) positive, 19 patients; ER positive and PR negative, eight patients; ER positive and PR unknown, two patients; and ER and PR unknown, three patients. Dose-limiting toxicity was not observed. Treatment was well tolerated with mild to moderate hot flashes in 18 of 32 patients (56%) at all dose levels. Transvaginal ultrasound performed at baseline and after 12 weeks of treatment showed no endometrial thickening. Of the 32 patients evaluable for response, six patients had stable disease for at least 6 months with a median duration of 7.7 months (range, 6.2 months to 33.8 months). The pharmacokinetics of LY353381.HCl were generally linear with respect to time and studied dose range.

CONCLUSION

As predicted in preclinical testing, daily oral LY353381.HCl is safe, is well tolerated at all tested dose levels, and may be clinically beneficial in patients with extensively pretreated metastatic breast cancer. Further studies with LY353381 to evaluate the efficacy in patients with or without prior exposure to tamoxifen and fewer overall prior regimens are under way.

Familial risk ratio of sarcoidosis in African-American sibs and parents

While sarcoidosis is thought to aggregate in families, little is known about the risk to relatives of sarcoidosis patients. To estimate the familial risk ratio (lambda) of sarcoidosis in sibs and parents of cases, the authors studied 179 African-American families ascertained through an index sarcoidosis case diagnosed at Henry Ford Hospital in Detroit, Michigan. Among those relatives enrolled between 1997 and 1999, 12 of 327 (3.7%) sibs and 11 of 161 (6.8%) parents reported a history of sarcoidosis. The lambda in this sample of relatives, estimated by computing an age, sex, and race standardized incidence ratio, was 2.24 (95% confidence interval: 1.16, 3.92) for sibs and 2.82 (95% confidence interval: 1.41, 5.05) for parents. For sibs and parents combined, lambda was 2.49 (95% confidence interval: 1.58, 3.73). Results stratified by proband characteristics indicated that lambda was greater for relatives of younger (lambda = 2.93, 95% confidence interval: 1.52, 5.12) and male (lambda = 3.98, 95% confidence interval: 1.99, 7.12) probands. A higher lambda was also found for male family members and sibs born later in the birth order. A Monte Carlo method was also used to estimate lambda, with similar results obtained. Overall, these results indicate that, in African Americans, sibs and parents of sarcoidosis cases have about a 2.5-fold increased risk for sarcoidosis and that heterogeneity in disease risk may exist among family members.

Proofs of the structure of lipid coated nanoparticles (SMBV) used as drug carriers

PURPOSE

Supramolecular Biovectors (SMBV) consist of cross-linked cationic nanoparticles surrounded by a lipid membrane. The purpose was to study the structure of the lipid membrane and to characterise its interaction with the nanoparticles in order to differentiate SMBV from other polymer/lipid associations.

METHODS

The interaction of lipids with the nanoparticle surface was studied using zeta potential. Fluorescence Energy Transfer (FET) and Fluorescence Microscopy. SMBV were compared to liposomes and mixtures nanoparticles/liposomes. Finally the structure of SMBV was visualised by Electron Microscopy.

RESULTS

Zeta potential measurements showed that lipids on SMBV had a pronounced shielding effect on the surface charge. This was not the case for mixtures of nanoparticles and liposomes. FET experiments confirmed these results indicating that, for SMBV, the lipids are much closer to the nanoparticle surface. SMBV Fluorescence microscopy on model microparticles showed a lipid crown on SMBV that was confirmed by electron microscopy on SMBV nanoparticles.

CONCLUSIONS

Results show that in case of SMBV lipids are strongly adsorbed on the polysaccharide core surface probably due to ionic/hydrophobic interactions. The resulting supramolecular structure is a spherical cationic polysaccharide particle surrounded by a phospholipid/cholesterol layer.

A controlled daytime challenge of motor performance and vigilance in sleep bruxers

Many etiological factors have been suggested for sleep bruxism. Among these, elevated mental and physical alertness has been proposed to characterize sleep bruxers. The present study tests the hypothesis that, during the day-time, sleep bruxers are more vigilant and more prone to react to a motor command than are control subjects. Seven sleep bruxers, diagnosed polysomnographically according to validated research criteria, were matched for age and gender to seven control subjects. A simple reaction time task was selected to assess daytime vigilance and motor responsiveness. The following physiological measures were recorded: reaction time, error rate, electroencephalography, electrocardiography, electromyography, and video detection of body movements. Analysis of these variables showed no differences between groups. During the test, bruxers and controls showed a parallel decrease in EEG vigilance and heart rate over time. Frequency of orofacial and body movements was the same in both groups, and no clenching activity was observed during the experimental test. Subjects' visual analog scale ratings revealed that both controls and bruxers were more competitive after the test than before, and bruxers were slightly more anxious than controls before and after the test. Together, the results indicate that sleep bruxers are neither more vigilant nor more prone to react to a motor command during the daytime than are control subjects.

The influence of T cell receptor and cytokine genes on sarcoidosis susceptibility in African Americans

The pathogenesis of sarcoidosis, a multisystem granulomatous disorder, is mediated through immunoregulatory pathways. While sarcoidosis clusters in families, inherited risk factors remain undefined. In search of possible sarcoidosis susceptibility genes, we examined anonymous polymorphic genetic markers tightly linked to six different candidate gene regions on chromosomes 2q13, 5q31, 6p23-25, 7p14-15, 14q11 and 22q11. These candidate regions contain T cell receptor, interleukin (IL) and interferon regulatory factor (IRF) genes. Our study population consisted of 105 African-American sarcoidosis cases and 95 unrelated healthy controls. The allelic frequency distribution of two out of the six markers, IL-1 alpha marker (p = 0.010) on 2q13 and the F13A marker (p = 0.0006) on 6p23-25, was statistically significantly different in cases compared with controls. The two alleles most strongly associated with sarcoidosis were IL-1 alpha*137 (Odds Ratio (OR) = 2.60; 95% confidence interval (CI) = 1.36-4.98) and F13A*188 (OR = 2.42; 95% CI = 1.37-4.30). Individuals that had both of these alleles were at a six-fold increased risk for sarcoidosis (OR = 6.19; 95% CI = 2.54-15.10). Restricting the analysis to cases with at least one first or second-degree relative affected with sarcoidosis increased the OR to 15.38. IL-1 levels are elevated in sarcoidosis and the F13A marker is tightly linked to a gene that codes for a newly identified interferon regulatory factor protein (IRF-4), which is thought to play a role in T cell effector functions. Our results suggest genetic susceptibility to sarcoidosis may be conferred by more than one immune-related gene that act synergistically on disease risk.

The Blau syndrome gene is not a major risk factor for sarcoidosis

BACKGROUND

A genetic predisposition to sarcoidosis has long been postulated, although no specific susceptibility genes are known. Candidate genes for the two granulomatous inflammatory disorders with clinical similarities to sarcoidosis, Blau syndrome and Crohn's disease, have been localized to a 40 centimorgan region spanning the chromosome 16 centromere.

PATIENTS AND METHODS

Using a sample of 35 African-American sibling pairs, who both had clinically confirmed sarcoidosis, we tested for genetic linkage between the 16p12-q21 interval (the likely location of the Blau syndrome gene) and sarcoidosis.

RESULTS

We found no evidence for linkage to any of the eight markers we tested in the 16p12-q21 interval. Ninety percent of the 16p12-q21 region had a LOD score < -2 for a dominant gene conferring a relative risk of 3 or greater for sarcoidosis. One hundred percent of the region had a LOD score < -2 for a dominant gene with a relative risk of 3.5 or greater or recessive gene with relative risk of 2.5 or greater. Based on simulation results we could not exclude a dominant gene with relative risk < 5 at the 0.05 significance level, nor a recessive gene with relative risk < 3, over the entire 16p12-q21 interval.

CONCLUSIONS

While the clinical similarities between Blau Syndrome and sarcoidosis suggest genetic homogeneity between the disorders, we found no evidence for linkage of sarcoidosis to the Blau syndrome locus. Our exclusion results suggest that the Blau Syndrome gene does not have a major effect on sarcoidosis susceptibility.

Angiotensin-converting enzyme gene polymorphism and risk of sarcoidosis

The angiotensin-converting enzyme (ACE) has been implicated in the pathophysiology of sarcoidosis. Serum ACE levels in normal and sarcoidosis patients are influenced by an insertion (I)/deletion (D) polymorphism in the ACE gene. To elucidate the role of this ACE gene polymorphism in sarcoidosis, we conducted a case-control study in African Americans and Caucasians. The ACE gene (I/D) polymorphism did not differ between 60 Caucasian cases and 48 control subjects (p = 0.577). In contrast, a comparison of 183 African-American cases and 111 control subjects resulted in a marked difference in genotypic distributions (p = 0.005). In African Americans, the risk for sarcoidosis was 1.30 (95% confidence interval [CI] = 0.72 to 2. 36) for ID heterozygotes, and 3.17 (95% CI = 1.50 to 6.71) for deletion/deletion (DD) homozygotes. The risk associated with the DD homozygotes was even greater in African Americans when cases were restricted to those with a positive family history (odds ratio = 4. 83; 95% CI = 1.86 to 12.59). Further analyses of African-American cases showed that the ACE genotype was not associated with disease severity, extrathoracic involvement, or overall radiographic change 2 to 4 yr after diagnosis. We did find a moderate association between the II genotype and radiographic progression (OR = 2.97; 95% CI = 1.01 to 8.76). Our results suggest the ACE genotype may play a more important role in sarcoidosis susceptibility and progression in African Americans than Caucasians.

Epidemiology, demographics, and genetics of sarcoidosis

Epidemiological knowledge of sarcoidosis is based mainly on studies performed more than 30 years ago. These early case-control studies produced some interesting risk factor-disease associations, but a clear causative mechanism in sarcoidosis remains unknown. Studies in military and veteran populations showed a clear preponderance of sarcoidosis in African Americans compared with Caucasians. Our recent sarcoidosis incidence study in a racially heterogeneous population found African Americans at three- to fourfold greater risk, which was less than the 10 to 17 times greater risk previously reported. Females are consistently found at greater risk than males, although the relative risk difference generally does not exceed two. The striking racial differences and numerous reports of familial clustering suggest genetic susceptibility. We have found that familial sarcoidosis is almost three times more common in African-American (17%) than Caucasian cases (6%). Future genetic studies can benefit from the extensive catalog of candidate genes that is emerging from the human genome project. The epidemiological evidence to date strongly suggests that studies seeking causes for sarcoidosis need to consider both environmental and genetic risk factors to be successful because the two likely interact with each other to produce disease.

Genetics of sarcoidosis

Hereditary susceptibility to sarcoidosis is suggested by ethnic preponderance, familial clustering, and multigenerational involvement. The genetics of sarcoidosis cannot be adequately addressed in small samples of patients; a large-scale study with stratification for patient phenotypic differences is necessary. A study that uses both genetic marker and environmental data would be able to control for and examine different causative mechanisms. Until such a well-designed, comprehensive study is carried out, we are left with interesting patterns of disease in families and uncertain allelic associations.

Characterization and phase behaviour of phospholipid bilayers adsorbed on spherical polysaccharidic nanoparticles

In this paper a new drug carrier, the Light-biovector, is described. These biovectors are composed of a neutral, anionic or cationic polysaccharidic core surrounded by phospholipids. They can be prepared with high yield and in a nearly pure form as determined by density analysis on sucrose gradients. These particles showed great stability with no sedimentation being observed after more than one year of storage. Physicochemical studies carried out with dipalmitoylphosphatidylcholine and dipalmitoylphosphatidylcholine/dipalmitoylphosphatidylglycerol mixtures showed that in Light-biovectors, the lipids are organized in bilayer surrounding the polysaccharidic core. In presence of a neutral polysaccharidic core, the gel to liquid phase transition temperature Tm of DPPC was only slightly affected as compared to liposomal dispersions of the lipid. In contrast, for cationic and anionic Light-biovectors, the Tm of the lipids was affected by the electric charge born by the polysaccharidic core, indicating that electrostatic interactions contribute to the organization of the lipid bilayer in these systems. It was also found that the association of anionic membrane to anionic polysaccharidic cores and the association of cationic membrane to cationic polysaccharidic cores was possible.

Leptospirosis in raccoons in Quebec: 2 case reports and seroprevalence in a recreational area

Raccoons may represent a source of leptospires for humans and domestic animals. We describe a case of severe interstitial nephritis associated with the serovar bratislava of Leptospira interrogans (1st report in wildlife), and the seroprevalence to 4 leptospire serovars in a recreational area in Quebec.

Racial differences in sarcoidosis incidence: a 5-year study in a health maintenance organization

Reports of racial differences in the incidence of sarcoidosis, a granulomatous disorder of unknown etiology, are primarily based on studies of military and veteran populations. To determine racial differences in sarcoidosis incidence in a metropolitan population the authors conducted a study of newly diagnosed cases that occurred between 1990 and 1994 among members of the Health Alliance Plan health maintenance organization in Detroit, Michigan. The study population was racially heterogeneous, was limited to individuals aged 20-69 years, and comprised about 5% of the Detroit metropolitan area population in that age group. Annual age-adjusted incidence, in number of new cases per 100,000, was highest in African-American females (39.1 cases). The next highest incidence was found in African-American males (29.8 cases), followed by Caucasian females (12.1) and Caucasian males (9.6). African-American females aged 30-39 years were at the greatest risk, with an annual incidence of 107/100,000. Overall, African Americans had about a threefold higher age-adjusted annual incidence (35.5/100,000) compared with Caucasians (10.9/100,000). Additional adjustment for sex, area of residence, and year of study resulted in 3.8-fold greater risk for African Americans compared with Caucasians. This study further confirmed the higher incidence of sarcoidosis in African Americans compared with Caucasians, but the racial difference was lower than previously reported. The results should be more generalizable than previous studies done with select populations and should serve as a useful frame of reference for future epidemiologic research of sarcoidosis.

Haemolymph from female beetles infected with Hymenolepis diminuta metacestodes retards the development of ovarian follicles in recipient Tenebrio molitor (Coleoptera)

Infection with developing metacestodes of the rat tapeworm, Hymenolepis diminuta, is known to retard the accumulation of the yolk protein, vitellin, in the terminal ovarian follicles of the intermediate host, Tenebrio molitor. It is probable that this is the result of competitive inhibition of juvenile hormone binding at a microsomal binding site in the beetle follicular epithelium. Experiments were designed to test the hypothesis that inhibitor molecules were circulating in the haemolymph of infected beetles. Whole haemolymph, collected from male or female beetles at various stages post-infection, was injected into non-infected female recipients 2 days post-emergence. Ovaries were removed 3 days later and the vitellin content of the same sized follicles measured using an ELISA. The vitellin content of follicles from recipients of haemolymph from females infected with metacestodes at stage 1 and stage 3-4 was significantly reduced (24 and 27.9%) compared to sham-infected females. However, haemolymph from females infected with mature metacestodes did not affect the vitellin content. Results were thus comparable to those obtained by monitoring ovarian vitellin levels in female T. molitor with bona fide infections. Haemolymph from infected males did not affect ovarian vitellin content. These results indicate that molecules that can modulate vitellogenesis may be present in the haemolymph of females infected with developing metacestodes but that these factors disappear later in infection.

Combination of human cytomegalovirus recombinant immediate-early protein (IE1) with 80 nm cationic biovectors: protection from proteolysis and potentiation of presentation to CD4+ T-cell clones in vitro

We have shown in a previous study that the proliferative CD4+ T-cell response to the regulatory immediate-early protein IE1 was a major component of the overall anti viral response in human cytomegalovirus (HCMV) seropositive blood donors. This viral antigen may be valuable in subunit vaccine design, since anti IE1 CD4+ T cells might provide help for production of antibodies and cytotoxic T lymphocytes (CTL) responses, and could take part in the control of viral infection. Preliminary to the elaboration of future vaccine formulations, we developed immunogenic complexes resulting from the combination of a purified recombinant protein derived from the fusion of Escherichia coli glutathione-S-transferase (GST) and a large C-terminal fragment (e4) of IE1, with new 80 nm cationic synthetic particles called Biovectors. We have shown that the antigen GST-e4 was stably complexed to vectors and that, contrary to the soluble form, it was protected from proteolysis in cell culture medium. By confocal microscopy we observed that the synthetic vectors were internalized by lymphoblastoid B cells, providing a significant enhancement of antigen delivery in antigen presenting cells (APC). Indeed, we demonstrated that the previous combination of antigen with particles, significantly enhanced the proliferation of specific CD4+ T-cell clones directed against IE1 in vitro, when either HLA-matched isolated peripheral blood mononuclear cells or EBV transformed B cell lines were used as APC. The relevance of these observations to the use of these new vectors for vaccine design against HCMV is discussed.

Specific detection of hepatitis C virus minus strand RNA in hematopoietic cells

The presence of hepatitis C virus (HCV) negative strand RNA in extrahepatic compartments based on PCR detection assays has been suggested in many reports with a very heterologous detection rate (from 0 to 100%). In this study, we have analyzed the presence of HCV negative strand in hepatic (liver biopsies, n = 20) and extrahepatic (sera, n = 32; PBMC, n = 26 and fresh bone marrow cells, n = 8) compartments from infected patients with three different reverse transcriptase (RT)-PCR-based assays using primers located in the 5' noncoding region, with or without a tag selected to display different viral loads (10(5)-3 x 10(7) genomic equivalent/ml or gram) and viral genotypes (n = 5). Using synthetic as well as biological templates, we could document extensive artifactual detection of negative strand RNA, due to self priming and mispriming events, even either 5' noncoding region primer pair was used, whereas both artifacts were dramatically reduced (mispriming) or eliminated (selfpriming) using CAP-based RT-PCR assay. Mispriming artifacts were directly correlated to the titer of positive strand RNA present in the sample. Using the CAP-PCR assay, the presence of HCV negative strand RNA was found in 75% of livers (16:20) and only 8% of PBMC, independent of the genotype involved, but could not be documented in sera (0:32) and fresh bone marrow cells (0:6). These findings suggest that caution regarding the type of RT-PCR assay used and the level of HCV positive strand RNA present in the biological sample analyzed has to be taken to avoid false identification of viral reservoirs. The findings suggest that hematopoietic peripheral cells can support HCV replication, although in a very limited number of carriers.

Heterogeneity of familial risk in sarcoidosis

Familial clustering of sarcoidosis and the higher prevalence and clinical severity of sarcoidosis in African Americans suggests etiologic heterogeneity. To test for heterogeneity in familial risk of sarcoidosis, we studied 3,395 siblings and parents of 558 index cases (361 African American, 197 Caucasian) diagnosed at Henry Ford Hospital between 1951 and 1994. Using the age- and sex-specific cumulative incidence of sarcoidosis in our sample, we found a statistically significant heterogeneity in familial risk of disease (P < .001). To determine if this was due to a greater risk of sarcoidosis in African Americans, we recalculated disease probabilities using age-, sex-, and race-specific disease cumulative incidence and found the same amount of heterogeneity in familial risk (P < .001). Index cases (n = 69) from high-risk families were more likely to be African American (odds ratio [OR] = 3.24; 95% confidence interval (CI) = 1.71-6.14) and to have an offspring or second- degree relative affected (OR = 6.21; 95% CI = 2.86-13.45). We conclude that the heterogeneity of familial sarcoidosis risk found in this study is supportive of multiple etiologies. Our results also show that a quantitative assessment of familial risk based on siblings and parents may be a useful screening tool for identifying families with additional affected members. Of the high-risk families, African Americans made up a greater-than-expected percentage even after accounting for differences in disease prevalence. We suggest targeting African Americans for studies of sarcoidosis that focus on Mendelian hypotheses and genetic linkage.

Need for vaccination of sewer workers against leptospirosis and hepatitis A

OBJECTIVES

This study compared the prevalence of Leptospira interrogans and hepatitis A virus (HAV) antibodies in serum samples from sewer workers and controls.

METHODS

A blood sample was obtained from 76 of the 101 municipal sewer workers (75%) of Quebec City and from two controls matched to each for age and sex. Testing was done for antibodies against serovars of Leptospira icterohaemorragiae, bratislava, hardjo, grippotyphosa, and kennewicki (pomona) and hepatitis A.

RESULTS

Sewer workers had a greater prevalence of antibodies against leptospirosis than controls (12% v 2%, P = 0.003). In contrast, antibodies to HAV were not significantly more prevalent among workers than among controls (54% v 49%, P = 0.51). Prevalence of HAV antibodies increased significantly with age both among workers and controls (chi 2 for trend, P < 0.001). In contrast with younger workers, prevalence of HAV antibodies was greater among workers > or = 40 years than among their controls (81% v 65%, P = 0.04).

CONCLUSION

Leptospirosis continues to be a problem to sewer workers but hepatitis A is apparently no longer a risk. The likely explanation is that leptospira are still abundant in the sewage system in contrast with HAV, which is only rarely to be found in sewage as a result of the generalised decrease in incidence of hepatitis A in the past three decades. The decision to vaccinate sewer workers against hepatitis A should take into account that it is impossible to avoid all contact with sewage fluid and, despite the fact that the actual incidence of hepatitis A is low, there is a real possibility of sporadic exposure during a future outbreak.

Seroepidemiologic study of three zoonoses (leptospirosis, Q fever, and tularemia) among trappers in Québec, Canada

This study was undertaken to evaluate the prevalence of antibodies against Francisella tularensis, Coxiella burnetii, and certain serovars of Leptospira interrogans among trappers in Québec, Canada. Muskrat trapping was identified as a risk factor for F. tularensis infection, whereas having a cat at home apparently protected trappers against infection by L. interrogans. High percentages of control sera were positive for antibodies against C. burnetii (15%) and L. interrogans (5%), most frequently serovar bratislava. This is the first report of human infection by serovar bratislava in North America.

Differential Tax expression in HTLV type I-infected asymptomatic carriers

tax gene expression in a family cluster of three HTLV-I-infected asymptomatic individuals was investigated. Two carriers had normal tax mRNA, Tax-specific humoral antibody, and cell-mediated immune (CMI) response. In one carrier who had only weak Tax-specific humoral and no Tax-specific CMI response, an abnormal Tax-related mRNA product was detected. This product was sequenced and found to consist of two exons derived from the LTR gag and pX regions. The abnormal mRNA has an ORF predicting a 17-kDa protein, the translation of which is initiated in the first exon. The presence of this protein, of antibody to it, and of its function remain to be elucidated.

Acute normovolemic hemodilution combined with hypotensive anesthesia and other techniques to avoid homologous transfusion in spinal fusion surgery

To avoid homologous transfusion in spinal fusion surgery, acute normovolemic hemodilution was combined with controlled hypotensive anesthesia. Patients were kept hemodiluted, not only during surgery, but also after surgery by delaying transfusion until the next morning or later. Transfusion decisions were made by clinical judgment rather than by preset value (ie, 10 g/dl). Other techniques used in this protocol were preoperative autologous blood donation and intraoperative salvage of shed blood. Only 4 of 119 patients (3.4%) required homologous blood, compared to 25 of 29 patients (86%) in 1982, at which time none of these techniques were used. The average hemoglobin on the seventh postoperative day was similar in both groups; 11.5 g/dl in the current series compared to 11.1 g/dl in the 1982 series.

Cyclosporin A in children with persistent renal transplant rejection and progressively deteriorating graft function

The effect on renal function and growth of switching from azathioprine to cyclosporin A (CyA) was prospectively evaluated in ten children with persistent renal transplant rejection. Progression of renal insufficiency during CyA therapy was compared with that before using CyA. Prednisone administration decreased after CyA was introduced and although growth retardation persisted, height velocity improved significantly. Renal function stabilized in seven patients treated with CyA for a variable time period, and four of these children remain off dialysis 0.44-1.42 years later. Renal biopsies were obtained in seven children when they were converted from azathioprine to CyA. The response to CyA could not be predicted from renal morphology or clinical features.

Evaluation of the first 18 months of a specific rehabilitation programme for those with epilepsy

This survey examined the outcome of the first 18 months of the specialized rehabilitation programme at Mt Wilga Rehabilitation Centre, which was designed to cater for the needs of those with epilepsy. Almost 60% of those who underwent the programme were employed at the time of the study, 65% had improved quality of life, approximately 45% acknowledged enhanced self-esteem, and about 45% had an improved control of epilepsy despite the fact that only 30% had their drug therapy altered and of these more than half had either the same or worse control of their seizures. The findings revealed that those patients who were admitted into the residential accommodation, rather than being provided with transport to allow daily attendance while living in their own homes, achieved greater benefit from the rehabilitative programme.

Signals of monocyte activation in patients with SLE

The Fc receptor mediated reaction, the beta-glucuronidase and the lactic dehydrogenase activities of monocytes and the serum lysozyme level were tested together with the circulating immune complex content of patients with systemic lupus erythematosus. Simultaneously with the increasing FC receptor-mediated reaction and the elevated enzyme activities of patient monocytes, the secretion of lysozyme and the immune complex content of the sera were higher than those of the controls. A positive correlation was demonstrated between the Fc receptor-mediated reaction, the beta-glucuronidase activity, the lysozyme secretion and the immune complex content of the sera. Thus, the monocytes of patients appeared to be activated by the circulating immune complexes.

Arthrographic pseudoloosening of Marmor total knee in hemophilic arthropathy: report of a case

The interpretation of loosening on the basis of contrast flow about the cement-bone interface in arthrograms of total knee arthroplasties includes special considerations. The first is that arthrography is misleading in the presence of severe cystic changes. The second is that clinical criteria should be given priority before concluding that there is loss of fixation of the prosthesis.

Oxygen availability in ischemic brain following hypocarbia and hypercarbia. Polarographical depth electrode recordings in evolving and completed experimental stroke in the monkey

Acutely implanted oxygen-recording polarographical depth electrodes were used to appraise changes in oxygen availability (O 2 a) in the brain of the Rhesus monkey. Modifications of oxygen availability induced by hypocarbia and hypercarbia in the normal and the infarcted brain are described. The most consistent finding was a reversal of the expected effects of low and high Paco 2 values during the acutely ischemic period (evolving stroke) and an incomplete return to the normal response by five days (completed stroke).