Understanding longer-term disability outcomes for Māori and non-Māori after hospitalisation for injury: results from a longitudinal cohort study

OBJECTIVES

The objectives are to (1) describe disability outcomes at 24 months after injury and (2) identify factors contributing to disability outcomes at 24 months after injury, for Māori and non-Māori who have been hospitalised for injury.

STUDY DESIGN

This is a prospective cohort study.

METHODS

Prospective Outcomes of Injury Study participants were injured New Zealanders aged 18-64 years and recruited from New Zealand's no-fault injury insurer, the Accident Compensation Corporation's entitlement claims register. Data about a number of pre-injury, injury-related and early post-injury characteristics were collected from interviews held at 3 and 24 months after injury. Disability was measured using the World Health Organization Disability Assessment Schedule (WHODAS). Modified Poisson regression modelling was used to estimate relative risks (RRs) of disability for Māori and non-Māori who were hospitalised for injury.

RESULTS

Analyses were restricted to 375 Māori and 1824 non-Māori participants for whom complete data were available. Of these, 105 (28%) Māori and 446 (24%) non-Māori were hospitalised for their injury. Of these hospitalised groups, 26% of Māori and 10% of non-Māori were experiencing disability (WHODAS ≥10) at 24 months after injury. Māori who were hospitalised for injury and who were not working for pay before their injury (RR = 2.7; 95% confidence interval [CI] 1.4-4.9), who were experiencing disability before their injury (RR = 3.1; 95% CI 1.6-5.8) or who reported trouble accessing healthcare services for their injury (RR = 2.6; 95% CI 1.3-5.2) were independently at increased risk of disability 24 months after injury. Non-Māori who were hospitalised for injury and who had inadequate household income before injury (RR = 2.4; 95% CI 1.4-4.1), less than the secondary school qualifications (RR = 2.0; 95% CI 1.1-3.8), were not working for pay before injury (RR = 2.8; 95% CI 1.5-5.1), were experiencing disability before their injury (RR = 3.0; 95% CI 1.7-5.2), had ≥2 chronic conditions (RR = 3.5; 95% CI 2.0-6.4) or had body mass index ≥30 kg/m²/undisclosed (RR = 2.4; 95% CI 1.3-4.4) were at increased risk of disability 24 months after injury.

CONCLUSIONS

Variables predicting disability 24 months after injury for Māori, also predict disability 24 months after injury for non-Māori, with one notable exception-trouble accessing healthcare services. Our findings show that having access to healthcare services for injury plays an important role after injury and must be focussed on to ensure that the burden of poor injury-related outcomes and injury-related inequities are reduced and ultimately eliminated.

Prevalence and molecular characterization of Hepatozoon canis in dogs from urban and rural areas in Southeast Brazil

The objective of this survey was to investigate the prevalence of Hepatozoon infection in dogs in the rural and urban areas of Uberlândia, Brazil by PCR and molecular characterization. DNA was obtained from blood samples collected from 346 local dogs from both genders and various ages. Seventeen PCR products from positive blood samples of urban dogs and 13 from the rural dogs were sequenced. Partial sequences of the 18S rRNA gene indicated that all 30 dogs were infected with Hepatozoon canis similar in sequence to H. canis from southern Europe. Four local dog sequences were submitted to GenBank (accessions JN835188; KF692038; KF692039; KF692040). This study indicates that H. canis is the cause of canine hepatozoonosis in Uberlândia and that infection is similarly widespread in rural and urban dogs.

Eddy viscosity in dense granular flows

We present a seminal set of experiments on dense granular flows in the stadium shear geometry. The advantage of this geometry is that it produces steady shear flow over large deformations, in which the shear stress is constant. The striking result is that the velocity profiles exhibit an S shape, and are not linear as local constitutive laws would predict. We propose a model that suggests this is a result of wall perturbations which span through the system due to the nonlocal behavior of the material. The model is analogous to that of eddy viscosity in turbulent boundary layers, in which the distance to the wall is introduced to predict velocity profiles. Our findings appear pivotal in a number of experimental and practical situations involving dense granular flows next to a boundary. They could further be adapted to other similar materials such as dense suspensions, foams, or emulsions.

TGFBR1 SNP’s are a genetic marker potentially useful for colorectal cancer screening

e14591

Background: Colonoscopy (CS) used for colorectal cancer (CRC) screening is relatively expensive and intrusive. We have shown that CRC in Caucasian patients have a high frequency of certain TGFBR1 SNP’s relative to normal controls. Here we extend the results to these SNP frequencies in normal tissue of the patients and the concordance of three different SNP’s in the TGFBR1 gene across patients and subjects. Methods: Tumor samples were obtained from 188 CRC patients and from 98 healthy control. After gDNA extraction, selected amplicons were amplified by PCR, followed by melting curve analysis. The statistical evaluation of the genotype frequency for the different SNPs comparing CRC patients with controls was carried out using logistic regression. Results: Results previously reported were confirmed:- a highly significant association between TGFBR1 SNP genotype and colorectal cancer (P<0.000001). For example, with the TGFBR1 SNP rs334348, the frequency of the GG genotype was 43% for patients but 11% for controls, while the AA frequency was only 18% for patients and 43% for controls. All CRC patients and controls were typed for three SNP's in the TGFBR1 gene and the concordance was found to be perfect. That is, only 3 of the 27 possible genotypes were observed:- (i) rs334348, AA; rs334349, AA; rs1591, CC; (ii) rs334348, AG; rs334349, AC; rs1591, CT; and (iii) rs334348, GG; rs334349, CC; rs1591, TT. Blood and tumor samples from patients had the same identical SNP pattern. Conclusions: The perfect concordance of the three SNP types in tumors and leukocytes shows that it reflects the underlying genotype of the patient rather than a somatic mutation in the tumour. Thus SNP type is a characteristic of subjects and a potential genetic marker for CRC susceptibility. We suggest that subjects aged 50 years or older be offered a test for a TGFBR1 variant. In case of a positive result, subjects should be informed that they are at risk of CRC, and strongly encouraged to have a colonoscopy. For this suggestion to become a definitive recommendation a cost-effectiveness analysis of the use of TGFBR1 SNP typing would be useful ( although such typing is inexpensive) and a prospective study of colonoscopy with TGFBR1 typing is mandatory.

The human epidermal growth factor receptor (EGFR) gene in European patients with advanced colorectal cancer harbors infrequent mutations in its tyrosine kinase domain

BACKGROUND

The epidermal growth factor receptor (EGFR), a member of the ErbB family of receptors, is a transmembrane tyrosine kinase (TK) activated by the binding of extracellular ligands of the EGF-family and involved in triggering the MAPK signaling pathway, which leads to cell proliferation. Mutations in the EGFR tyrosine kinase domain are frequent in non-small-cell lung cancer (NSCLC). However, to date, only very few, mainly non-European, studies have reported rare EGFR mutations in colorectal cancer (CRC).

METHODS

We screened 236 clinical tumor samples from European patients with advanced CRC by direct DNA sequencing to detect potential, as yet unknown mutations, in the EGFR gene exons 18 to 21, mainly covering the EGFR TK catalytic domain.

RESULTS

EGFR sequences showed somatic missense mutations in exons 18 and 20 at a frequency of 2.1% and 0.4% respectively. Somatic SNPs were also found in exons 20 and 21 at a frequency of about 3.1% and 0.4% respectively. Of these mutations, four have not yet been described elsewhere.

CONCLUSIONS

These mutation frequencies are higher than in a similarly sized population characterized by Barber and colleagues, but still too low to account for a major role played by the EGFR gene in CRC.

Response acquisition by Siamese fighting fish (Betta splendens) with delayed visual reinforcement

Male Siamese fighting fish, Betta splendens, swam through a ring in an aquarium, breaking a photocell beam and initiating an unsignaled, resetting delay interval. Following delays of 0 s, 10 s, or 25 s, a 15-s mirror presentation released an aggressive display by the fish. Swimming through the ring increased in the absence of either a period of acclimatization to the reinforcer (analogous to magazine training when appetitive reinforcers are used) or explicit training of the response by the experimenters. Response rates were a decreasing function of delay duration. Other fish exposed to a schedule of response-independent mirror presentations failed to acquire and maintain the response. The results demonstrate the robustness and generality of the phenomenon of response acquisition with delayed reinforcement. They further qualify earlier observations about behavioral mechanisms involved in the phenomenon.

Comparative single- and multiple-dose pharmacokinetics of levodopa and 3-O-methyldopa following a new dual-release and a conventional slow-release formulation of levodopa and benserazide in healthy volunteers

The objective was to assess the single- and multiple-dose pharmacokinetics of levodopa and 3-O-methyldopa following administration of a new dual-release and conventional slow-release formulation of levodopa/benserazide in the dose ratio of 4:1. In an open-label, two-way cross-over study, 20 healthy volunteers were randomized to receive first either Madopar DR or Madopar HBS for 8 days. Then they crossed over to the other formulation. A first dose of 200 mg levodopa and 50 mg benserazide ('250' mg) was given on day 1, '125' mg t.i.d. on the subsequent 6 days (days 2-7), followed by '250' mg on day 8. The two treatment periods of 8 days were separated by a wash-out period of at least 7 days. Blood samples were taken at specific times over a 12-hour period (day 1) or a 36-hour period (day 8). Plasma concentrations of levodopa and 3-O-methyldopa were measured by high-performance liquid chromatography for pharmacokinetic evaluation. The pharmacokinetics of levodopa after a single-dose administration (day 1) of Madopar DR and Madopar HBS were significantly different as reflected by the respective mean values of maximum plasma concentration (C(max) 1.99 vs. 0.82 mg x l-1), time to reach maximum concentration (t(max) 0.7 vs. 2.6 h) and area under the plasma concentration-time curve (AUC(0- infinity ) 4.52 vs. 3.18 mg x h x l-1). The respective values after multiple doses (day 8) were: C(max) 1.98 vs. 0.93 mg x l-1, t(max) 0.7 vs. 2.3 h and AUC(0-infinity ) 4.84 vs. 3.96 mg x h x l-1. The relative bioavailability (Madopar DR vs. Madopar HBS) was 1.73 on day 1 and 1.32 on day 8. Bioequivalence could not be demonstrated for log-transformed data of AUC and C(max) within a predefined range of 80-125 and 70-143%, respectively. In conclusion, the observed differences in C(max), t(max) and AUC are consistent with a faster rate and higher extent of levodopa absorption after administration of Madopar DR. Statistical evaluation of these kinetic data showed that Madopar DR is not bioequivalent to Madopar HBS.

Effects of environment on enhancing functional plasticity following cerebral ischemia

Given the brain's capacity to recover from injury, plasticity may be enhanced following cerebral ischemia through environmental manipulation. Thus, the purpose of this study was to (1) determine the effects of early exposure to an enriched environment following ischemia on functional plasticity and (2) examine the relationship between morphological and behavioral plasticity. Adult female rats (n = 38) were divided into ischemia and control groups. Each group was further randomized to either standard (SC) or enriched conditions (EC). After 4 days of environmental exposure, rats were tested for 6 days in the water maze. Control and ischemia rats exposed to EC have increased total dendritic length (P < 0.05) as well as increased number of dendritic segments in the apical (P < 0.05) region of the hippocampal area compared to those housed in SC; furthermore, increased dendritic spine density in the apical (P < 0.05) region was also seen. Behavioral testing showed that ischemia rats exposed to SC have longer swim latencies (P < 0.05) and greater directional heading errors (P < 0.05) than ischemic rats exposed to EC; the latter group performed similar to controls. It is concluded that EC may be a potentially useful therapy in the recovery of spatial memory impairments seen after ischemia.

Childhood obesity and risk of cardiovascular disease: a review of the science

Childhood obesity has been connected to hyperlipidemia, diabetes, hypertension, and atherosclerosis (Klish, 1998). Both genetic and environmental influences play a role in the development of obesity. Prevention of obesity in childhood is the best chance of instituting lifestyle change for the reduction of cardiovascular morbidity and mortality. Children at high risk for obesity-related cardiovascular disease (CVD) should receive family-based individualized treatment. Nurse practitioners practicing in the primary care setting are in an ideal position to address children and families with regard to lifestyle modification of diet and exercise.

Physiological reduction in fasting plasma glucose concentration in the first trimester of normal pregnancy: the diabetes in early pregnancy study

Previous studies indicate that fasting plasma glucose decreases during gestation, but the timing and extent are not consistent from study to study. We had an opportunity to examine this question in the normal pregnancy cohort of women studied in the Diabetes in Early Pregnancy Study. Subjects were monitored to identify pregnancy by human chorionic gonadotropin testing, enrolled within 21 days of conception, and screened to rule out gestational diabetes at the juncture of the second and third trimesters. All subjects were instructed to fast overnight for 10 to 12 hours. Three hundred sixty-one women were studied between 6 and 12 weeks of gestation. A median decrease in plasma glucose of 2 mg/dL was observed between weeks 6 and 10 (P=.007). In a smaller group of subjects evaluated through the third trimester, little further glucose reduction was observed. A reduction in glycosylated hemoglobin levels between 10 and 20 weeks (P=.002) followed the earlier reduction in first trimester glucose levels. Analysis by body mass index (BMI) showed a smaller first trimester reduction with increasing BMI, and none among severely obese women (BMI > 29.9 kg/m2). The decline in fasting plasma glucose in pregnancy begins early in the first trimester, well before fetal glucose requirements can contribute to the decline in the glucose level. Thereafter, plasma glucose levels decrease little. These results suggest that in the setting in which this study was performed (an overnight fast) maternal physiologic adjustments account for a reduction in plasma glucose early in the first trimester of pregnancy, and possibly even later in gestation as well.

[Reducing the rate of recurrent nerve paralysis by routine exposure of the nerves in thyroid gland operations]

The retrospective and comparative analysis of 734 benign operations of the thyroid gland during the years 1979-1993 without preparation and 1.022 operations between 1994 and 1996 with routine preparation of the recurrent laryngeal nerve shows a decrease of the permanent palsy rate from 5.99% to 0.88%. In 1996 0.48% pareses (2 cases in 410 operations) were seen.

OPERATIVE TECHNIQUE

Before ligature of the blood-vessels at the hilum and before dorsal mobilisation of the thyroid lobe first the inferior thyroid artery and then the recurrent laryngeal nerve are identified which is located distally of the artery at the esophago-tracheal sulcus and is prepared until its entry in the larynx.

RECOMMENDATION

We advice routine recurrent laryngeal nerve preparation in any operation of the thyroid gland. However, absolutely necessary is the identification of the nerve in the following situations: 1. Hemithyroidectomy, 2. Exstirpation of dorsal nodules of the hilum, 3. Morbus Basedow, 4. Reoperations, 5. Carcinomas.

Lack of association between antiphospholipid antibodies and first-trimester spontaneous abortion: prospective study of pregnancies detected within 21 days of conception

OBJECTIVE

To determine the role of antiphospholipid antibodies and anticardiolipin antibodies in first-trimester losses, addressing experimental pitfalls that preclude excluding the possibility that these antibodies reflect merely the selection bias of studying couples only after they have already experienced losses.

DESIGN

Given that retrospective studies cannot exclude the possibility that such antibodies arise as a result of the fetal death, blood samples were obtained either before pregnancy or very early in pregnancy. Sera were obtained within 21 days of conception.

SETTING

Multicenter university-based hospitals (National Institute of Child Health and Human Development collaborative study).

PATIENT(S)

Subjects for the current study were 93 women who later experienced pregnancy loss (48 diabetic; 45 nondiabetic), matched 2:1 with 190 controls (93 diabetic and 97 nondiabetic) who subsequently had normal live-born offspring.

INTERVENTION(S)

Sera from these 283 women were analyzed for antiphospholipid antibodies by enzyme immunoassay. In 260 of the 283 women (87 with pregnancy losses; 173 with live-born infants), sera were also available to perform assays for anticardiolipin antibodies by enzyme immunoassay.

MAIN OUTCOME MEASURE(S)

Pregnancy losses.

RESULT(S)

No association was observed between pregnancy loss and the presence of antiphospholipid antibodies or anticardiolipin antibodies. Levels of antiphospholipid antibodies were 6-19 PL/mL in 62.4% of the pregnancies that ended in losses and > or = 20 PL/mL in 5.4%; among pregnancies resulting in live-born infants, the percentages were 56.8% and 6.8%, respectively. Of the pregnancies that ended in a loss, 5.7% had anticardiolipin antibodies > or = 16 GPL/mL, compared with 5.2% of those ending in a live birth.

CONCLUSION(S)

This prospective study suggests that anticardiolipin antibodies and antiphospholipid antibodies are not associated with an increased risk for first-trimester pregnancy loss.

Prospective study showing that antisperm antibodies are not associated with pregnancy losses

OBJECTIVE

To obtain prospective data on the relationship between presence of antisperm antibodies in maternal sera and first trimester pregnancy losses.

DESIGN

First trimester sera obtained from diabetic and nondiabetic women recruited within 21 days of conception were analyzed using the indirect immunobead test for immunoglobulin (Ig)G, IgA, and IgM antisperm antibodies. Regional binding also was considered: sperm head, midpiece, and sperm tail. Results were correlated with pregnancy outcome.

SETTING

Five university centers.

PATIENTS

One hundred eleven women who experienced pregnancy loss (55 diabetic; 56 nondiabetic) were matched 2:1 with 104 diabetic and 116 nondiabetic women (controls) who subsequently had a normal liveborn infant.

INTERVENTION

None.

MAIN OUTCOME MEASURE

Pregnancy outcome (spontaneous abortion, liveborn) correlated with presence or absence of antisperm antibodies.

RESULTS

Analyzing samples without knowledge of clinical status, no differences were observed with respect to IgG, IgA, and IgM binding when a positive test was defined as 50% of sperm showing antibody binding. Likewise, no association was found for IgG and IgM antisperm antibodies at 20% binding. The only positive finding was observed for IgA antisperm antibodies at 20% binding (Fisher's Exact test). This one positive finding merely could reflect multiple comparisons. No significant differences between groups were observed when analysis was stratified according to location of antibody binding (head, midpiece, tail tip, entire sperm). When the sample was stratified into those having and not having a prior loss, a relationship between antisperm antibodies and pregnancy loss still was not evident.

CONCLUSION

Further work is necessary to determine whether IgA antisperm antibodies truly are associated with pregnancy loss or whether antisperm antibodies play any role in repetitive aborters. Findings in this study suggest that antisperm antibodies do not play a major role in pregnancy loss.

Infectious processes: an infrequent cause of first trimester spontaneous abortions

A systematic assessment of infections beginning early in pregnancy is necessary to determine the true role of infections in pregnancy loss, given that infections could readily arise only after fetal demise. To this end, we have prospectively determined the frequency of infections in pregnant women who were subjects in a multi-centre US study. Insulin-dependent diabetic subjects and controlled subjects were recruited either before conception (86%) or at the latest within 21 days of conception (14%). We collected data prospectively on all important risk factors and potential confounding variables, seeing 386 diabetic subjects weekly and 432 control subjects every other week during the first trimester. At each visit we inquired about untoward events and explicitly about fever or infections. We found no clinical evidence that infection occurred more often in the 116 subjects experiencing pregnancy loss as compared to the 702 having successful pregnancies. This held both for the 2 week interval in which a given loss was recognized clinically as well as in the prior 2 week interval. Similar findings were not only observed for both the control as well as diabetic subjects but also when data were stratified by genital infection only or by systemic infection only. Our prospective data suggest that the attributable risk of infection in first trimester spontaneous abortion is small.

Low-response-rate conditioning history and fixed-interval responding in rats

Bar presses by one group of rats were conditioned under a differential-reinforcement-of-low-rate reinforcement schedule immediately prior to conditioning under a fixed-interval schedule. In a second group of rats, bar presses were conditioned first under a differential-reinforcement-of-low-rate schedule and then under a fixed-ratio schedule prior to conditioning under a fixed-interval schedule. Low response rates occurred under the fixed-interval schedule only when it was immediately preceded by low-rate conditioning. Otherwise, fixed-interval responding was similar to responding under the fixed-ratio schedule. This finding suggests that responses of laboratory animals are sensitive to immediate history, and, unlike human responses, are relatively insensitive to a history of low-rate conditioning when it is followed by high-rate conditioning.

An epidemiologic study of Pap screening histories in women with invasive carcinomas of the uterine cervix

The present study was designed to determine the Pap screening histories of 261 women, ages 20 through 69 years, who were diagnosed with an invasive carcinoma of the uterine cervix. Women who were residents of New York State, exclusive of New York City, and who received a diagnosis between July 1983 and September 1985, were selected for this study. Fifty-four percent of the patients had not received at least one Pap test within three years prior to diagnosis. Women who had not received a prior Pap smear tended to be older, less sexually active, less well educated, and to have more extensive disease at the time of diagnosis than women who had received cytologic examinations. The present study results, coupled to findings of previous reports, demonstrate the need for an intensified effort to insure that all women have access to quality Pap screening services. Particular emphasis needs to be placed on reaching older women who are less likely than younger ones to receive periodic Pap screening. Physicians need to routinely offer older patients who present with nongynecologic conditions the opportunity of receiving cytologic testing.

Neurofibromatosis and other disorders among children with CNS tumors and their families

We conducted a population-based case-control study with 338 patients, less than 15 years of age, diagnosed with a primary tumor of the central nervous system from January 1968 through December 1977 in 53 New York State counties. The study also included 676 controls selected from the birth certificate files of the New York State Department of Health. We collected information on neurofibromatosis and congenital anomalies in study subjects, their siblings and parents by telephone interview with the mother of each case and control. We obtained supplemental information on neurofibromatosis in the patients and their families from hospital medical records. This study confirmed the strong association of neurofibromatosis with risk of CNS tumors. Thirteen cases and no controls had neurofibromatosis. Two fathers and 3 mothers of cases had neurofibromatosis. Five cases had siblings with neurofibromatosis. None of the first-degree relatives of controls had neurofibromatosis. We observed a relative risk of 4.49 for history of seizures. Seizures are often among the presenting symptoms for CNS tumors. We observed no difference between cases and controls in the occurrence of congenital anomalies. There was a nonsignificant excess of congenital anomalies among siblings of cases compared with controls. This decreased to 1.13 when adjusted for number of siblings.

Incidence of spontaneous abortion among normal women and insulin-dependent diabetic women whose pregnancies were identified within 21 days of conception

Whether pregnant women with insulin-dependent diabetes mellitus have an increased risk of spontaneous abortion is controversial. To address this question, we enrolled 386 women with insulin-dependent diabetes and 432 women without diabetes before or within 21 days after conception and followed both groups prospectively. Sixty-two diabetic women (16.1 percent) and 70 control women (16.2 percent) had pregnancy losses (odds ratio, 0.99; 95 percent confidence interval, 0.67 to 1.46). After adjustment for known risk factors for spontaneous abortion, the rate was still not significantly higher in the diabetic group (odds ratio, 0.91; 95 percent confidence interval, 0.59 to 1.40). Nonetheless, among the diabetic women, most of whom had good metabolic control, those who had spontaneous abortions had higher fasting and postprandial glucose levels in the first trimester than those whose pregnancies continued to delivery (P = 0.01 for fasting glucose levels and P = 0.005 for postprandial levels). In the small subgroup of diabetic women with poor control, who had elevated values for glycosylated hemoglobin in the first trimester, each increase of 1 SD above the normal range was associated with an increase of 3.1 percent in the rate of pregnancy loss (95 percent confidence interval, 0.6 to 5.6). We conclude that diabetic women with good metabolic control are no more likely than nondiabetic women to lose a pregnancy, but that diabetic women with elevated blood glucose and glycosylated hemoglobin levels in the first trimester have a significantly increased risk of having a spontaneous abortion.

Suppression of humoral immune response against herpes simplex virus induced by defective strains, ts- and TK- mutants

Suppression of humoral antibody formation against HSV is not only induced by replicating Herpes simplex virus type 2 (HSV-2) but also by the defective strain ANG and the deletion mutant 1301 of Herpes simplex virus type 1 (HSV-1). Moreover, ts-mutants A, H, K, S, 1201 and 1208 of HSV-1 as well as some ts-mutants of HSV-2 and "defective-interfering" particles of HSV-1 after high multiplicity of infection-passages induced suppression. Treatment of infected mice with ACG reduced antibody-formation but did not result in suppression. UV-irradiation of the antibody producing strain Len of HSV-1 strongly reduces antibody formation and induces suppression. Experiments using a series of intertypic recombinants showed the suppressing activity to be spread over the whole genome of HSV-2. It is concluded that suppression is induced by more than one region of the genome of HSV-2 and by incomplete replication of HSV-1 and 2.

Virus-specific IgM and IgG antibody production by B cells during herpes simplex virus type 2-induced immunosuppression as analysed by an immunospot assay

The mechanism of herpes simplex virus (HSV)-2-induced immunosuppression was analysed by determination of the number of IgM and IgG antibody-secreting B cells in female BALB/c mice using an immunospot assay. Primary HSV-1 or -2 as well as homologous or heterologous booster infections at different times were performed. In accordance with earlier results on humoral antibody generation, in contrast to HSV-1, HSV-2 induced only very low numbers of antibody-producing B cells in dose-response experiments. They appeared late after infection compared to HSV-1. Despite a homologous humoral booster reaction against HSV-1 at day 8 no IgM- or IgG-secreting cells in the spleen could be detected. This non-reactivity of the spleen had vanished 10 days later, when secondary reactions of B cells could be observed. Secondary infections with a high homologous dose of HSV-2 after a low primary dose produced only a low booster response of IgG-secreting B cells. Suppression of humoral antibody production induced by HSV-2 (high dose) waned after more than 50 days, indicating that the HSV-2-induced suppression did not impair antigen presentation or memory cell generation.

Suppression of humoral antibody formation against sheep red blood cells by infections with HSV-2 and the influence of mouse cytomegalovirus. Brief report

HSV-2 infections suppress the antibody response to HSV-1 but do not impair the mouse cytomegalo virus (MCMV) antibody generating system. In contrast, the sheep red blood cell (SRBC) IgM response is impaired by preinfections with HSV-2 but not with HSV-1. From the time kinetics of this suppression it can be concluded that only a certain submechanism "spills over" to the SRBC system. MCMV suppresses the antibody formation induced by HSV-1.

Suppression and enhancement of humoral antibody formation by herpes simplex virus types 1 and 2

Intraperitoneal infection of mice and rats by herpes simplex virus type 2 (HSV-2) but not type 1 (HSV-1) resulted in suppression of antibody formation on subsequent challenge with HSV-1 or HSV-2. Application of silica considerably enhanced antibody formation after primary HSV-1 infection, but only slightly after primary HSV-2 infection. Suppression induced by HSV-2 was, however, reduced significantly by injection of silica 21 days later, on the day of the second injection of HSV-2. Suppression could be detected soon after infection by HSV-2. The degree of this suppression depended on the dose of the injected virus and was abolished by u.v. irradiation of the virus prior to inoculation. Likewise the weak antibody response induced by HSV-2 was abolished for both neutralizing and ELISA antibodies. Infections with HSV-1 evoked considerable numbers of HSV-specific antibody-producing B cells, when assessed by an enzyme-linked immunospot assay. The B cell response to HSV-2, however, was very weak. Silica considerably enhanced the number of specific antibody-producing B cells only during primary HSV-1 infections. The present results in combination with earlier data demonstrate the central role of macrophages, which seem to be the primary target affected by silica, for enhancement and suppression of HSV-induced antibody generation.

[Diagnostic significance of the detection of hepatitis B virus DNA in acute and chronic hepatitis]

1065 sera from patients with acute and chronic hepatitis-B-virus-(HBV-) infections, double infections (HBV, HAV, nonA-nonB, delta-Ag) as well as patients with HBs-Ag-negative hepatitis (HAV, nonA-nonB) and healthy subjects were investigated for the presence of hepatitis-B-virus-DNA using molecular hybridisation. The sensitivity of the method was 0.1 pg HBV-DNA/100 microliters. HBV-DNA could be detected in 62% of cases of HBs-Ag-positive sera with HBe-Ag, in 8.9% with anti-HBe and in 11% of e-marker free sera. In acute hepatitis HBV-DNA was present in 44%, in chronic hepatitis in 71% of HBe-Ag-positive sera. In HBs-Ag-negative sera containing only anti-HBc, HBV-DNA, depending on the anti-HBc-titre, was present in 13-24% of cases. HBV-DNA could not be detected in patients with HBV infections (anti-HBc and anti-HBs positive) in the past or in HBV-marker-negative hepatitis. Follow-up investigations on acute and chronic HBV-infections showed that the disappearance of HBV-DNA generally preceded the disappearance of HBe-antigen by about 2-3 weeks. In chronic hepatitis the time interval can amount to several months or years. Double infections with other hepatotropic viruses (nonA-nonB and delta-virus) can lead to a temporary suppression of HBV-DNA replication.

[Cardiac pacemaker perforation of the transverse colon in the infected pacemaker system]

While perforations of pacemakers outside due to infection or pressure necrosis are no rarity on account of the constantly rising number of patients, perforations into the abdominal cavity are rarely observed. All infectious complications make great demands on the surgical therapy and often demand manifold correction operations. It is reported on the case of a pacemaker perforation into the transverse colon. Our therapeutic principles in infections and perforations of pacemakers are shortly explained.

Plasma C-peptide and diagnosis of factitious hyperinsulinism. Study of an insulin-dependent diabetic patient with "spontaneous" hypoglycemia

Factitious hyperinsulinism was suspected in a patient with an 11-year history of insulin-dependent, ketosis-prone diabetes mellitus who began to experience repetitive episodes of "spontaneous" hypoglycemia. Insulin mediation of the hypoglycemia was confirmed by documenting that urinary insulin and total extractable insulin in plasma increased during periods of hypoglycemia. Failure to detect significant amounts of human C-peptide by radioimmunoassay during periods of hypoglycemia or in response to stimulation with glucagon, leucine, or tolbutamide indicated that the insulin was not endogenous. The diagnosis of factitious hyperinsulinism was ultimately proved by the finding of radioactivity in the patient's urine after 131-I Hippuran was added to a vial of insulin found in the patient's room.