Extended-Release Naltrexone and Case Management for Treatment of Alcohol Use Disorder in the Emergency Department

STUDY OBJECTIVE

To assess the feasibility of initiating treatment for alcohol use disorder with extended-release naltrexone and case management services in the emergency department (ED) and measure the intervention's impact on daily alcohol consumption and quality of life.

METHODS

This is a 12-week prospective open-label single-arm study of a multimodal treatment for alcohol use disorder consisting of monthly extended-release naltrexone injections and case management services initiated at an urban academic ED. Participants were actively drinking adult patients in ED with known or suspected alcohol use disorder and an AUDIT-C score more than 4. The main feasibility outcomes included the rates of participant enrollment, retention in the study, and continuing treatment after study completion. Efficacy outcomes were the change in daily alcohol consumption (drinks per day; 14 g ethanol per drink), measured by a 14-day timeline followback, and the change in quality of life measured with a single-item Kemp quality of life scale.

RESULTS

One hundred seventy-nine patients were approached, and 32 were enrolled (18%). Of the 32 enrolled patients, 25 (78%) completed all visits, and 22 (69%) continued naltrexone after the trial. The mean baseline daily alcohol consumption was 7.6 drinks per day (interquartile range, 4.5, 13.4), and the mean quality of life was 3.6 (SD 1.7) on a 7-point scale. The median daily alcohol consumption change was -7.5 drinks per day (Hodges-Lehmann 95% confidence interval -8.6, -5.9). The mean quality of life change was 1.2 points (95% confidence interval 0.5, 1.9; P<.01).

CONCLUSION

We found that initiation of treatment of alcohol use disorder with extended-release naltrexone and case management is feasible in an ED setting and observed significant reductions in drinking with improved quality of life in the short term. Multicenter randomized controlled trials are needed to further validate these findings.

Preventing the Burnout Syndrome by Creating a Healthy & Healing Environment

Occupational burnout is a significant global problem that has impacted clinical outcomes, patient safety, and patient-centered care across healthcare settings (World Health Organization) [WHO], 2019. The classic definition of burnout, as defined by Dr. Christina Maslach, is “a psychologic syndrome involving emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment (Maslach & Jackson, 1982). Burnout affects cognitive, behavioral and emotional aspects of human behavior. It also interferes with how individuals process and interact with others at an individual and organizational level. Others have noted that burn-out individuals tend to focus on negative things rather than positive emotions (Bianchi & Laurent, 2015). Nurse and physician burnout was recognized before the COVID-19 pandemic as a growing problem. Evidence now suggests that more than 50% of nurses, physician assistants and physicians report syndromes of burnout. The problem has become even more pronounced when the work environment contributes stressors associated with technological advancements, EMRs, increased patient acuity, and financial cost cutting measures. It is now recognized that individuals and organizations burnout. As a public health issue, burnout and well-being are multifactorial and recognize that individuals and organizations contribute significant factors to the burnout syndrome. It appears that burnout rates are rising across specialties and settings resulting in increase of costs to individuals and organizations (National Academy of Medicine [NAM]), 2018. What is needed is a clear map to make decisions on clinical burnout. Healthcare workers (HCW) need confidential access to wellness activities, support systems and mental health consultation. A new model is needed to further refine the work-life balance and create a caring corporate culture. Healthcare leaders need to rethink how to support employees across disciplines when it comes to burnout and well-being.

Screen for Small-Molecule Modulators of Circadian Rhythms Reveals Phenazine as a Redox-State Modifying Clockwork Tuner

A high-throughput cell-based screen identified redox-active small molecules that produce a period lengthening of the circadian rhythm. The strongest period lengthening phenotype was induced by a phenazine carboxamide (VU661). Comparison to two isomeric benzquinoline carboxamides (VU673 and VU164) shows the activity is associated with the redox modulating phenazine functionality. Furthermore, ex vivo cell analysis using optical redox ratio measurements shows the period lengthening phenotype to be associated with a shift to the NAD/FAD oxidation state of nicotinamide and flavine coenzymes.

Long term outcome of single ventricle physiology with pulmonary restriction not undergoing Fontan repair

Background

Patients with univentricular physiology who do not complete the palliation to Fontan are a heterogeneous group with unknown long term outcome.

Aims

This study aimed at describing the clinical course and long-term survival of patients with SV physiology with restricted pulmonary flow that had not undergone a Fontan type of repair.

Methods

From the prospectively maintained databases of the adult congenital cardiac units of five tertiary referral centers, data from all SV physiology patients were obtained. Patients completing a Fontan type palliation or developing Eisenmenger physiology and segmental pulmonary hypertension were excluded. Baseline data were recorded on the first visit at adult congenital heart disease (ACHD) unit. The primary end point was death.

Results

101 patients (50.5% females) were identified. Mean age at end of follow up was 39.3±11.3 years. Of these, 45 (44.6%) were unoperated (group 1, restricted forward pulmonary flow with or without pulmonary banding), 38 (37.6%) had undergone a cavopulmonary shunt as a definitive palliation (group 2) and 18 (17.8%) had aortopulmonary shunts (group 3). The main diagnosis was double inlet left ventricle (DILV) (N: 52, 51.5%) and most of the ventricle was left (82.2%). The principal reason for not performing a Fontan repair was mean pulmonary artery pressure &gt;18 mmHg. At initial visit at the ACHD unit patients were 32.2±11.1 years of age. 35% of the patients were in NYHA class III-IV, with no differences between groups. However, patients in group 2 had worse oxygen saturation (p=002) and higher haemoglobin (p=0.037). After a mean follow-up of 7.3±4.1 years, mortality was 20.8% (21 patients), being sudden death (7p, 6.9%) the most frequent cause. Patients in group 3 showed worse ventricular function (p=0.0001) and a trend to higher mortality that did not reach statistical significance (HR 2.7, CI 95% 0.91–8.14, P=0.07).

Conclusions

Patients with single ventricle physiology not undergoing Fontan repair are a population of high risk, with sudden death as main driver of mortality. Patients palliated with aortopulmonary shunts are prone to worse ventricular function and a trend to higher mortality.

Funding Acknowledgement

Type of funding source: Public hospital(s)

A strategy for dual inhibition of the proteasome and fatty acid synthase with belactosin C-orlistat hybrids

The proteasome, a validated cellular target for cancer, is central for maintaining cellular homeostasis, while fatty acid synthase (FAS), a novel target for numerous cancers, is responsible for palmitic acid biosynthesis. Perturbation of either enzymatic machine results in decreased proliferation and ultimately cellular apoptosis. Based on structural similarities, we hypothesized that hybrid molecules of belactosin C, a known proteasome inhibitor, and orlistat, a known inhibitor of the thioesterase domain of FAS, could inhibit both enzymes. Herein, we describe proof-of-principle studies leading to the design, synthesis and enzymatic activity of several novel, β-lactone-based, dual inhibitors of these two enzymes. Validation of dual enzyme targeting through activity-based proteome profiling with an alkyne probe modeled after the most potent inhibitor, and preliminary serum stability studies of selected derivatives are also described. These results provide proof of concept for dual targeting of the proteasome and fatty acid synthase-thioesterase (FAS-TE) enabling a new approach for the development of drug-candidates with potential to overcome resistance.

Polystyrenesulfonate-catalyzed synthesis of novel pyrroles through Paal-Knorr reaction

BACKGROUND

The classical Paal-Knorr reaction is one of the simplest and most economical methods for the synthesis of biologically important and pharmacologically useful pyrrole derivatives.

RESULTS

Polystyrenesulfonate-catalyzed simple synthesis of substituted pyrroles following Paal-Knorr reaction has been accomplished with an excellent yield in aqueous solution. This method also produces pyrroles with multicyclic polyaromatic amines.

CONCLUSIONS

The present procedure for the synthesis of N-polyaromatic substituted pyrroles will find application in the synthesis of potent biologically active molecules.

Barriers to screening and treatment of breast cancer: Data analysis from Edgecombe County

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Background: Edgecombe County in NC was described as the 3rd highest location breast cancer mortality according to the Susan G. Komen report (2007). The major issues detected were low education, lack of healthcare providers, and large numbers of uninsured individuals. Our analysis sought to further characterize the circumstances unique to this region and measures to improve mortality.

Methods: Between October 2008 and January 2009, 493 surveys were conducted throughout the county. The surveyors randomly approached female residents of Edgecombe County who completed a questionnaire, which was analyzed for this study.

Results: Of the total population 354 women were older than age 40. In this group 82.5% had recent mammograms and 79.8% clinical breast examinations. Also, 91.7% had a Primary Physician who recommended mammograms in 85% of the cases. Only 27.1% had family history of breast cancer and, of those, 86.2% were recommended mammograms. Most were educated (58.6%), had low income (76%) and health insurance (87.4%). Nearly equal numbers of Caucasians and African Americans completed the survey (50.6% vs. 47.6%). Just 8.1% had transportation problems and 3.6% were aware of free mammograms in the health department. Statistical analysis by the Fisher’s Exact Test evaluated the relationship between the likelihood of having a screening mammogram and different variables. Women who attended church were more likely to undergo mammograms (p=0.00054), as were women with insurance (p=0.024). Family histories of breast cancer, lack of transportation, low income or deficient education were not significant determinants to obtain a mammogram. A logistical regression model demonstrated that attendance to church and insurance were the two factors statistically significant in terms of obtaining a mammogram.

Conclusions: The main issues identified by our analysis were low-income, low health care literacy and lack of awareness regarding breast cancer programs. Our results were discordant with some of the Susan Komen report data, particularly that the majority of participants had a mammogram. Transportation and religious beliefs were not barriers to screening of breast cancer.

Immunoglobulin allotypes among the Bicolanos of Sorsogon province, Luzon, Philippines: implications of phenotypes for filariasis

Immunoglobulin (Ig) allotypes are polymorphic genetic systems that show distinct racial arrays, thus making them powerful tools for studies of genetic admixture and biological relationships. In the province of Sorsogon, southern Luzon, Philippines, allotyping was completed on 252 persons residing in two neighboring villages. The people demonstrated 14 GM and 3 KM phenotypes. The frequency of homozygous KM3, KM1 and heterozygous KM1,3 was identical in these villages; however, half of the GM phenotypes present in one village were significantly less frequent in the other village. The frequency of KM and GM haplotypes was different from those reported in Filipino aboriginal groups, but similar to a population on Samar Island, the only other Filipino group for which Ig allotype data exist. Variability in the prevalence of parasitic disease such as lymphatic filariasis may in part reflect differences in genetic susceptibility, resulting from allotypic heterogeneity between villages.

International health services management education: an overview of major efforts and lessons learned during the 1990s

In this paper, the authors examine select major pedagogical and methodological issues concerning health care management executive training and academic program development in the former Soviet sphere of influence during the 1990s. Experience from programs offered during the 1990s has direct implications for the continued development of health care management programs and faculty in the United States. In essence, each of the nations that were involved represented an experimental setting for the introduction and improvement of management skills in the health care sector and the development of professional health care managers. Evaluative findings should help to inform future efforts to construct and deliver effective international and domestic management educational programs.

The pillars of health management education: lessons from the CEE experience

AUPHA faculty members have had the opportunity to provide health care executive training and to work in partnership with academic institutions in Central and Eastern Europe and in the New Independent States of the former Soviet Union. This article presents some observations on health management education that demonstrate the similarity in issues faced by programs in the U.S. and in CEE. The health management educational partnership program was designed to provide technical assistance to emerging health management programs in the CEE. The partnership program has been mutually beneficial for several reasons. The role of physicians in leadership and the management educational needs that result provide one example of an issue that health management educational programs must address. The emergence of the roles of other health professions and growing contribution that they will make has its parallel in the American ascendance of the role of interdisciplinary team in clinical decision making. The partnership and executive training experiences have caused U.S. partners to focus consciously on pedagogical methods. The nature of the issues faced by emerging CEE health management programs suggests that mutual support among programs in the region after the partnership program is necessary in order to provide a forum for debate. The focus of the debate should continue to be on the role of management in health reform, content of curriculum, research focus and pedagogical methods appropriate for health care management undergraduate and graduate programs. The result will be a strengthening of the health management academic discipline in the region. The future of the AUPHA should predicated on the same principles, the roots from which it has grown.

Double-blind placebo-controlled study of concurrent administration of albendazole and praziquantel in schoolchildren with schistosomiasis and geohelminths

A double-blind placebo-controlled study of the concurrent administration of albendazole and praziquantel was conducted in>1500 children with high prevalences of geohelminths and schistosomiasis. The study sites were in China and the Philippines, including 2 strains of Schistosoma japonicum, and 2 different regions of Kenya, 1 each with endemic Schistosoma mansoni or Schistosoma haematobium. Neither medication affected the cure rate of the other. There was no difference between the side effect rate from albendazole or the double placebo. Praziquantel-treated children had more nausea, abdominal pain, and headache but these side effects were statistically more common in children with schistosomiasis, suggesting a strong influence of dying parasites. The subjects were followed for 6 months for changes in infection status, growth parameters, hemoglobin, and schistosomiasis morbidity. In all 4 sites, a significant 6-month increase in serum hemoglobin was observed in children who received praziquantel, strongly supporting population-based mass treatment.

Immunity and morbidity in schistosomiasis japonicum infection

Schistosomiasis japonica differs significantly from Schistosoma mansoni infection in several epidemiologic, immunologic, and operational characteristics for control. Because of numerous nonhuman hosts, transmission remains high despite aggressive case finding and treatment of human cases. Diagnosis of infection using the Kato-Katz stool technique is less sensitive and specific in this than in other species of human schistosomes, making case finding and treatment a less effective approach to control. Clinically, morbidity induced by S. japonicum appears unrelated to intensity of infection, and is more severe than that of S. mansoni in terms of liver pathology and stunting of child growth and development. Both hepatic enlargement and fibrosis appear to be reversible and preventable with aggressive treatment but several operational characteristics for control of infection due to S. japonicum make the community impact of case-finding and treatment with praziquantel less pronounced than would have been predicted by the analysis of individual cases. In the Philippines, rebound morbidity following reinfection mandates short treatment intervals between screening and treatment to have a significant impact on morbidity, while in China inapparent infection (infection not diagnosed by a single stool examination) appears to be a common cause for persistent hepatic pathology. The authors conclude that for S. japonicum, mass treatment or targeted mass treatment is a more cost-effective approach than case-finding and treatment for control.

Function and expression of a human idiotypic network in Schistosomiasis japonica

The cross-reactive idiotype (Hu-SJ-CRIM) is defined by polyclonal human anti-idiotypic antibodies derived from chronically S. japonicum infected patients. The present study shows that serum levels of Hu-SJ-CRIM expressed by antibodies to S. japonicum soluble egg antigen (SEA) are associated with acute infection and hepatosplenic disease. Xenogeneic anti-idiotypic antisera (anti-Hu-SJ-CRIM) suppressed human lymphocyte blastogenesis to SEA in vitro by 47-82% (P < 0.05). These anti-idiotypic antibodies also suppressed in vitro granuloma formation induced by SEA coated heads in a dose dependent manner. This immunosuppression was antigen specific in that mitogen (PHA) or non-related antigen (PPD) induced blastogenic responses were not suppressed. Surprisingly, anti-idiotypic antibodies (anti-SJ-CRIM), which describe the mouse correlate CRIM were not suppressive in the human blastogenesis or in vitro granuloma formation assays. These data indicate a dichotomy in the function and specificity of the idiotype/anti-idiotype human and murine immune networks in S. japonicum infection. Thus, only the patient derived molecules and serology form the basis for an immunoregulatory network in Schistosomiasis japonica.

Dental erosion and acid reflux disease

OBJECTIVE

To determine the relation between gastroesophageal reflux disease and dental erosion using ambulatory 24-hour esophageal pH testing.

DESIGN

Cross-sectional observational study.

SETTING

Tertiary referral center.

PATIENTS

The dental group consisted of 12 patients with idiopathic dental erosion who were identified by dentists and screened for gastroesophageal reflux disease using 24-hour pH testing. The gastroenterology group consisted of 30 patients who had 24-hour pH testing in the esophageal laboratory and who were referred for dental evaluation (10 did not have reflux, 10 had distal reflux, and 10 had proximal reflux).

MEASUREMENTS

24-hour esophageal pH monitoring using a pH probe in the distal and proximal esophagus. Complete dental examination with particular attention to the presence and severity of dental erosion; plaque; gingival damage; and decayed, missing, and filled teeth. Analysis of saliva for pH, flow rates, buffering capacity, and calcium and phosphorus levels. Standardized questionnaire to ascertain possible causes of dental erosion and presence of reflux symptoms.

RESULTS

Ten of the 12 patients in the dental group (83% [95% CI, 52% to 98%]) had gastroesophageal reflux on esophageal pH monitoring. Nine had distal and 7 had proximal reflux. Seven had reflux in the upright position only, 1 had reflux in the supine position only, and 2 had both upright and supine reflux. No saliva abnormalities were found. Ten patients had typical symptoms of gastroesophageal reflux, but dietary or mechanical problems that may have been causing dental erosion were not identified. In the gastroenterology group, upright reflux was seen in 5 of the 10 patients with distal reflux and in all 10 patients with proximal reflux. In addition, 40% of patients in the gastroenterology group (12 of 30) had dental erosion (4 of the 10 with distal reflux [40%], 7 of the 10 with proximal reflux [70%], and only 1 of the 10 without reflux [10%]; P = 0.02 for those with reflux compared with those without reflux). The cumulative dental erosion score correlated with proximal upright reflux when all 24 study patients with erosion were analyzed (r = 0.55 [P < 0.01]); this correlation was even stronger in the subgroup of 12 patients with abnormal amounts of proximal upright reflux (r = 0.84 [P = 0.001]).

CONCLUSION

Dental erosion is a common finding in patients with gastroesophageal reflux disease and should be considered an atypical manifestation of this disease.

Erythromycin enhances gastric emptying in patients with gastroparesis after vagotomy and antrectomy

We studied the effect of erythromycin on gastric emptying in nine patients with gastroparesis following truncal vagotomy and antrectomy, and assessed their clinical response to chronic oral erythromycin. Gastric emptying was evaluated using a solid-phase radio-labeled meal. Patients were studied after erythromycin 200 mg intravenously (N = 9) and after an oral suspension of erythromycin 200 mg (N = 7) each given 15 min after ingestion of the meal. Three parameters of gastric emptying were analyzed: half-emptying time (T1/2), area under the curve, and percent gastric residual at 2 hr. Nine patients were subsequently placed on oral suspension erythromycin 150 mg three times a day before meals (range 125-250 mg three times a day) and symptoms of nausea, vomiting, postprandial fullness, and abdominal pain were assessed before and after erythromycin. Intravenous erythromycin markedly accelerated the gastric emptying (all three parameters studied) of solids (P < 0.01) in seven of nine patients with postsurgical gastroparesis [baseline T1/2 154 +/- 15 min; after intravenous erythromycin, T1/2 56 +/- 17 min (mean +/- SEM)]. Oral erythromycin enhanced (P < 0.05) the gastric emptying rate (T1/2, area under the curve) in five of seven patients (baseline T1/2 146 +/- 16 min; after oral erythromycin, T1/2 87 +/- 20 min). Of the nine patients who were placed on oral maintenance erythromycin, three showed clinical improvement after two weeks. In summary, erythromycin significantly enhances gastric emptying in many patients with vagotomy and antrectomy-induced gastroparesis; however, only a small subset of patients respond clinically to chronic oral erythromycin.

Induction of hepatic pathology in SCID-Hu mice engrafted with peripheral blood lymphocytes of patients with Schistosomiasis japonica

SCID mice were engrafted with peripheral blood lymphocytes (PBL) derived from persons currently or previously infected with Schistosoma japonicum. After immunization with soluble worm antigenic preparation, the SCID-Hu mice were analyzed for a human immune response. ELISA revealed a low titer of human antibody recognizing soluble egg antigens in 2 of 10 mice. One mouse had detectable levels of interleukin (IL)-2 and gamma-interferon, TH1 phenotype cytokines. All mice had elevated levels of IL-4, a TH2 phenotype cytokine. The human cytokine profile of the mice paralleled the patient's serum profile at clinical examination. In addition, all mice had substantial hepatic pathology, including inflammatory cell infiltrates and macrovesicular fat deposition. The data indicate that activation of PBL from patients with a history of schistosomiasis japonica infection can result in focal hepatic pathology, which may be driven by specific cytokines.

Gastrointestinal motility disorders during pregnancy

PURPOSE

To review the pathophysiology of gastrointestinal motility disorders during pregnancy, their clinical manifestations, and their management.

DATA SOURCES

Studies published from 1963 to 1992 identified by computerized literature searches of Index Medicus and MEDLINE; hand searches; contact with pharmaceutical representatives for information on drug therapy during pregnancy; and selected texts on drugs and obstetrics.

STUDY SELECTION

Selected studies were those involving controlled design of physiology related to pregnancy or to hormonal effects on the gastrointestinal tract or both, and clinical studies or previous reviews that contributed to the understanding of the gastrointestinal effects of pregnancy.

DATA EXTRACTION

Data concerning the epidemiology, causes, clinical manifestations, and complications of altered gastrointestinal motility during pregnancy as well as the strength of association between gastrointestinal disorders of pregnancy and hormonal changes were evaluated and used to develop a practical approach to evaluate and manage these patients.

RESULTS OF DATA SYNTHESIS

Effects on the gastrointestinal tract during pregnancy are caused primarily by hormonal changes and not the physical effects of the gravid uterus. Motility changes occur throughout the gastrointestinal tract, including a reduction in lower esophageal sphincter pressure and its physiologic function with resulting gastroesophageal reflux and the risk for aspiration; alterations in gastric motor function associated with nausea and vomiting; and a decrease in the rate of small-bowel and colonic transit manifested primarily as abdominal bloating and constipation. These effects are mediated by progesterone, with estrogen probably acting as a primer.

CONCLUSIONS

Given the large number of pregnancies each year complicated by gastrointestinal motility disorders, many physicians (including internists and gastroenterologists) must manage these problems. Knowledge of the underlying physiologic alterations in gastrointestinal motility during pregnancy and of safe treatment options is essential to the care of the pregnant patient.

Review article: promotility drugs in the treatment of gastro-oesophageal reflux disease

Prokinetic agents are drugs that increase contractile force and accelerate intraluminal transit. They are often used in treating disorders of gastrointestinal motility including gastro-oesophageal reflux disease (GERD). The most widely studied agents include bethanechol, metoclopramide, domperidone and cisapride. These drugs act either by enhancing the effect of acetylcholine or by blocking the effect of an inhibitory neurotransmitter such as dopamine. With the exception of cisapride, the clinical efficacy of the various prokinetic agents in treating GERD has not been confirmed consistently. These agents have variable effects on oesophageal and gastric motor function and are fraught with side-effects. They are effective in relieving mild reflux symptoms but do not predictably heal oesophagitis. On the other hand, cisapride is thus far the most effective prokinetic agent studied for the treatment of GERD. It relieves reflux symptoms and promotes healing of grade I-II oesophagitis, with few side-effects or tachyphylaxis. Its most important role may be in the maintenance treatment of GERD either as a single agent or in combination therapy with an H2-antagonist after oesophagitis healing.

Human EBV-transformed lymphocytes of patients with Schistosoma japonicum infection secrete idiotypically related immunoregulatory antibodies

Lymphocytes derived from the peripheral blood of individuals infected with Schistosoma japonica were transformed in vitro with Ebstein-Barr virus (EBV). Serological characterization of antibody molecules revealed both antigen reactive (idiotypic) and anti-idiotypic transformants. One idiotypic EBV transformant, LO2C2, describes a major cross-reactive idiotype associated with anti-antigen binding molecules. Other antibody populations expressing idiotypic cross-reactivity were derived from separate individuals showing shared idiotypy in S. japonicum field study populations in the Republic of Philippines. Both idiotypic and anti-idiotypic molecules suppressed parasite antigen-driven blastogenesis of heterologous human peripheral blood lymphocytes. The data show a serologically related immunoregulatory immune network in patients in the Republic of the Philippines which is serologically distinct from idiotypy expressed in other selected S. japonicum endemic areas in the Far East.

Comparison of immune repertoires of Chinese and Philippine patients infected with Schistosoma japonicum

Chinese and Philippine patients exhibited detectable titers of serum antibodies to Schistosoma japonicum worm and egg antigens. Western blot (immunoblot) data revealed differing antigenic profiles. Antigen inhibition studies showed low and high levels of cross-reactivity with anti-worm and anti-egg antibodies, respectively, derived from both Chinese and Philippine patients. Thus, anti-egg antibodies and egg antigens are more conserved than anti-worm antibodies and worm antigens.

Screening of murine monoclonal antibodies against living schistosomula of Schistosoma mansoni by radioimmunoassay

A radioimmunoassay was developed to screen supernatants of murine monoclonal antibodies against surface antigens of living schistosomula of Schistosoma mansoni. Of 196 clones screened, 10% bound schistosomula. Of these, 74% bound only schistosomula. The remaining molecules also reacted with soluble adult worm antigens and soluble egg antigens as determined by enzyme-linked immunosorbent assay. Immunoblot analysis demonstrated that monoclonal antibody 204-3E4 reacted with a 68 kDa protein, a glycoprotein that induces substantial resistance against S. mansoni infection. Recognition of an 18 kDa antigen by 204-3F1 antibody was stage-specific with the antigen being expressed in cercariae, 3- and 24-h-old parasites but not 4-day, lung stage or adult worms. Monoclonal antibody 204-4E3 reacted with purified S. mansoni paramyosin. These data indicate that radioimmunoassay using living schistosomula is a rapid alternative method to identify murine hybridomas that secrete antibodies which react with surface antigens of S. mansoni.