Self-Rated Frailty and Mortality in Old Men: The Manitoba Follow-up Study

BACKGROUND

While a multitude of definitions and operationalizations of frailty have been developed, rarely have these considered the perspective of the older adult themselves. This knowledge gap was addressed by examining older adults' self-rating of frailty.

OBJECTIVES

To assess the validity of self-rated frailty and to determine whether self-rated frailty relates to mortality.

DESIGN

The Manitoba Follow-up Study was initiated in 1948 as a prospective cohort study of 3,983 men.

SETTING

Community dwelling older adult men.

PARTICIPANTS

Survivors of the original cohort (231 men) were sent a quality of life survey in 2015. A response was received from 186 men, including 146 surveys completed by the participant himself and thus were eligible to include (completion rate of 78.4%).

MEASUREMENTS

The quality of life survey is sent out annually to the study participants to ascertain information about mental, physical, and social functioning. In 2015, the Clinical Frailty Scale was adapted and added to the survey as a simple self-rating of frailty.

RESULTS

The mean age of the 146 respondents in 2015 was 93.7 years (SD 2.7) Self-ratings of "moderate-severe" frailty, received from 132 men, were associated with worse measures of physical health and functional impairment, thus supporting the significance of self-rated frailty. Adjusted for age, the Hazard Ratio for mortality over the next 3 years was 3.3 (95% CI: 1.5, 7.1) for those who rated themselves as "mildly to severely frail" vs. "very fit or well, with no disease".

CONCLUSION

The present study has illustrated that self-rated frailty is associated with other measures of health and that self-rated frailty predicts mortality over a three-year period. These findings support the utilization of older adult's self-ratings of frailty for new avenues of operationalizing frailty.

Interprofessional Teamwork During Family Meetings in the Pediatric Cardiac Intensive Care Unit

CONTEXT

Parents of children in the pediatric cardiac intensive care unit (CICU) report inadequate communication and a lack of empathy during conversations with their clinicians.

OBJECTIVE

To assess quantitatively and qualitatively the contributions made by team members of different professions in communicating with parents during family meetings.

METHODS

Prospective observational study. The study was conducted in the pediatric CICU at the Children's Hospital of Philadelphia. Subjects were members of the interprofessional team attending family meetings for patients admitted to the CICU longer than two weeks. We used quantitative conversation attribution and coding to compare durations of attendee contributions and contribution type by professional role. The SCOPE codebook and other quantitative codes drawn from best practices in family meetings were used to measure communication behaviors. A qualitative analysis of nurses' and social workers' contributions was used to identify themes not otherwise captured.

RESULTS

Across 10 meetings, physicians spoke for an average of 78.1% (SD 10.7%) of each meeting, nonphysicians 9.6% (SD 7.8%), and parents 17.4% (SD 12.2%). Parental understanding was assessed an average of 0.2 (SD 0.4) times per meeting. Parents expressed emotion an average of 4.2 times per meeting (SD 7.1), and the clinical team responded empathetically 2.2 times per meeting (SD 4.3). All clinician empathic responses were a minority of their overall contributions. Conversation was almost exclusively between physicians and families until physicians indicated other team members could contribute.

CONCLUSIONS

Coordination of team members' roles in the meetings may improve parental engagement necessary for decision-making and empathic responses that are often missed.

Optimizing pain treatment interventions (OPTI): A pilot randomized controlled trial of collaborative care to improve chronic pain management and opioid safety-Rationale, methods, and lessons learned

Veterans seeking care in VA medical facilities have high rates of chronic pain, which often co-occur with mental health and substance use disorders, including prescription opioid misuse. The overall goal of the Optimizing Pain Treatment Interventions (OPTI) study was to pilot a 12-week Collaborative Care intervention to improve opioid safety, chronic pain disability, and use of non-pharmacological pain management strategies in veterans in VA primary care. Between November 2014 and January 2017, 100 veteran patients with chronic pain and high-risk prescription opioid use (e.g., high-dose therapy, early refills, etc.) were enrolled and completed an initial one-hour study visit with a primary care provider (PCP) within 4 weeks of enrollment. Study PCPs were guided by a web-based opioid management decision support program and templated notes in the VA electronic medical record. After assessment and education, study PCPs used Shared Decision-Making to formulate a Pain Care Plan aligned with a participant's personal values and goals. After the initial visit, patients randomized to Collaborative Care received one Motivational Interviewing (MI) session with a Care Manager followed by 3 Care Manager-delivered brief telephone MI sessions at 6, 8, and 12 weeks to reinforce Pain Care Plans; patients randomized to an Attention Control condition met with a Care Manager briefly, followed by 3 brief scripted telephone psychoeducation sessions at 6, 8, and 12 weeks. Masked evaluators assessed outcomes at baseline, end of intervention (12 weeks), and after eight weeks of no contact (20 weeks). We present study rationale, detailed methods, preliminary results and lessons learned.

Pediatric continuity care intensivist: A randomized controlled trial

INTRODUCTION

Long-stay critically ill patients in the Pediatric Intensive Care Unit (PICU) may be at risk for inconsistencies in treatment plan, delay in plan progression, and patient/family dissatisfaction with communication. This article describes the development and evaluation of an intervention designed to improve continuity and communication delivered by continuity PICU attendings.

METHODS AND ANALYSIS

A randomized controlled trial of an intervention in one PICU that was randomized at the patient level. Eligible patients and their parents included those admitted to the PICU for longer than one week and were anticipated to remain for an additional 7 days. The intervention, a Continuity Care Intensivist (CCI), included early assignment of a continuity attending (separate from a regularly scheduled service attending), standardization of the continuity role to ensure consistent team and family contact and facilitate timely decision making, and enhancement of CCI communication skills. The outcomes evaluated were 1) patient PICU length of stay, ventilator-dependent days, and hospital acquired infections, 2) parental mood and satisfaction with PICU communication, and 3) intensivist perception of acceptability of intervention. Intention to treat analysis will be completed using multivariable linear regression to determine the impact of the intervention on outcomes. Lessons have been learned about the appropriate enrollment criteria for patients to allow for impact of continuity attending, frequent prognostic uncertainty in determining which patients will become longer stay in the PICU, and the difficulty of achieving timely initial contact of continuity attending with patients given the CCI's other commitments.

Gender and growth variation in palatal bone thickness and density for mini-implant placement

BACKGROUND

The objective was to compare the palatal bone thickness (PBT) and palatal bone density (PBD) in the anterior, middle, and posterior part of the palate in males and females.

METHODS

This retrospective study reviewed cone beam computed tomography scans of 359 patients. The scans were divided into 99 growing males, 105 growing females, 74 non-growing males, and 81 non-growing females. The measurements of PBT and PBD were made in between the canine and first premolar, the first premolar and second premolar, the second premolar and first molar, and the first molar and second molar. The measurements were made in the center of the palate and 4 mm away from the center. ANOVA was used to analyze the PBT and PBD in different areas between four different groups.

RESULTS

The PBT was lower (P <  0.0001) as we moved from the anterior to the posterior palate. The PBT was more (P <  0.001) in the center of the palate than 4 mm away from the center, except in between the canine and first premolar. The growing male and non-growing male had higher (P <  0.0001) PBT than the growing female and non-growing female in between the canine and first premolar and the first premolar and second premolar both in the center and 4 mm away from it. The PBD was higher (P <  0.05) in between the canine and first premolar area at the center of the palate and between the second premolar and first molar 4 mm away from the center in all the experimental groups.

CONCLUSIONS

There exists a definite gender and growth variation in the PBT and PBD in different parts of the palate. Palatal bone thickness between the males and females revealed that the males had significantly higher PBT than the females.

On sinking and swimming: the dialectic of hope, hopelessness, and acceptance in terminal cancer

For terminally ill cancer patients, hope and hopelessness are constructs that significantly impact quality of life. The aim of this study was to examine the relationship between hope and hopelessness in advanced cancer and to identify factors that maintain hope and increase vulnerability to hopelessness. Semistructured interviews were conducted with 22 terminally ill cancer patients. Interview transcripts were analyzed using thematic content analysis to identify patient definitions of these terms and associated cognitions and emotions. Hope and hopelessness were identified as distinct, often co-occurring, and dialectically interacting constructs. The relationship between hope and hopelessness often balanced on acceptance, perceived as diametrically opposed to hopelessness, and conducive to redirecting hope toward new goals. Positive interpersonal relationships enhanced hope, and uncontrolled physical pain increased vulnerability to hopelessness.

Assessing hopelessness in terminally ill cancer patients: development of the Hopelessness Assessment in Illness Questionnaire

Hopelessness has become an increasingly important construct in palliative care research, yet concerns exist regarding the utility of existing measures when applied to patients with a terminal illness. This article describes a series of studies focused on the exploration, development, and analysis of a measure of hopelessness specifically intended for use with terminally ill cancer patients. The 1st stage of measure development involved interviews with 13 palliative care experts and 30 terminally ill patients. Qualitative analysis of the patient interviews culminated in the development of a set of potential questionnaire items. In the 2nd study phase, we evaluated these preliminary items with a sample of 314 participants, using item response theory and classical test theory to identify optimal items and response format. These analyses generated an 8-item measure that we tested in a final study phase, using a 3rd sample (n = 228) to assess reliability and concurrent validity. These analyses demonstrated strong support for the Hopelessness Assessment in Illness Questionnaire providing greater explanatory power than existing measures of hopelessness and found little evidence that this assessment was confounded by illness-related variables (e.g., prognosis). In summary, these 3 studies suggest that this brief measure of hopelessness is particularly useful for palliative care settings. Further research is needed to assess the applicability of the measure to other populations and contexts.

Three Dimensional Printing: Surface Finish and Microstructure of Rapid Prototyped Components

Three Dimensional Printing is a process for rapid prototyping of functional components. Thin layers of powder are bound in selected areas by ink-jet printing of a liquid binder. Layers are added sequentially until a three dimensional part is completed. The unbound powder is then removed. The raster scan pattern and layering used in forming has an observable effect on the surface finish and microstructure of the part, as does the chemistry of the particular materials system used. Important phenomena include ballistic interaction of the jet with the powder bed and wicking of the binder. Process parameters such as layer height, flow rate, and powder density were studied. Microstructural examination of the printed components is also reported.

New Process and Materials Developments in 3-Dimensional Printing, 3DP™

The Three-Dimensional Printing (3DP™) process has been modified to incorporate colloidal science for the fabrication of fine ceramic parts. Complex shaped alumina and silicon nitride components have been formed directly from 3-dimensional CAD files using submicron powders. Parts were built using a sequential layering process of the ceramic slurry followed by ink jet printing of a binder system. A well dispersed slurry and optimized printing parameters are required to form a uniform powder bed with a high green density. Liquid-powder bed interactions affect the geometry and internal structure of the component. The redispersion of the unprinted powder bed is critical in order to retrieve the printed components. The slurry and powder bed chemistry are the major factors controlling powder bed redispersion. The process is generic and can be readily adapted for new materials systems. Our research is currently focused on the fabrication of dielectric RF filters. Preliminary results have demonstrated the ability to successfully fabricate cylindrical RF resonators.

ON THE RELATION OF THE OPTIC THALAMUS TO RESPIRATION, CIRCULATION, TEMPERATURE, AND THE SPLEEN

From what has already been said, it is apparent that changes in respiration and blood pressure may be produced by stimulation of a very large portion of the optic thalamus; that no one region controls these phenomena; that the spleen shows variations in volume only when marked blood pressure changes occur, and that such a change has been observed on stimulation of many places in the thalamus. Furthermore, the regions in the thalamus from which such effects are obtained are those in which the large afferent paths end; namely, the fillet and superior cerebellar peduncle, and a region directly connected with the vagus nucleus. The portions of the thalamus which proved inert to stimulation were those which in our previous investigation also were inactive; namely, the median nucleus, and the upper anterior end of the lateral-the region through which the fibers of the median nucleus pass. These phenomena are similar in every respect to those observed when an afferent nerve is stimulated. In what has gone before, it has been shown that the respiratory and circulatory changes occurred when one of the sensory paths, or a path running directly to the medullary nuclei governing these functions was stimulated. In explaining these phenomena, therefore, there is no necessity for invoking the existence of special centers.

Entering exile: trauma, mental health, and coping among Tibetan refugees arriving in Dharamsala, India

Each year thousands of Tibetans escape Chinese-controlled Tibet. The authors present findings on the experiences, coping strategies, and psychological distress (depression, anxiety, somatization, and posttraumatic stress disorder) of 769 Tibetan refugees arriving in Dharamsala, India (2003-2004). Distress increased significantly with greater trauma exposure. However, despite a high prevalence of potentially traumatizing events, levels of psychological distress were extremely low. Coping activity (primarily religious) and subjective appraisals of trauma severity appeared to mediate the psychological effects of trauma exposure. The potential impact of other variables, including culturally determined attitudes about trauma and timing of assessment, are discussed.

Traumatic experiences and psychological distress in an urban refugee population seeking treatment services

While a growing literature has addressed the psychological consequences of torture and refugee trauma, most studies have focused on homogeneous samples drawn from a single region. Thus, relatively little research has attempted to identify demographic or experiential factors that might help explain different levels of distress in these individuals. We measured depression, anxiety, and posttraumatic stress disorder (PTSD) symptoms in a convenience sample of refugees and survivors of torture seeking treatment in a torture treatment program (N = 325). We found 81.1% of patients had clinically significant anxiety, 84.5% had clinically significant depressive symptoms, and 45.7% had significant PTSD symptoms. Regression analyses revealed that anxiety and depressive symptom were significant higher among women (beta = .08, p = 0.02 and beta = .22, p = 0.0001 for anxiety and depression respectively) and those who reported death threats as part of their traumatic experiences (beta = .10, p = 0.033 and beta = .12, p = 0.036 respectively). Symptoms of PTSD were also predicted by death threats (beta = .22, p = 0.03), but were also influenced by the experience of rape (beta = .33, p < 0.001), family torture experiences (beta = .23, p = 0.022), religion (beta = .21, p = 0.03), and age (beta = -.18, p = 0.004). The clinical implications of these results are discussed.

Mental health of detained asylum seekers

Asylum seekers arriving in the USA are likely to be held in detention for months or years pending adjudication of their asylum claims. We interviewed 70 asylum seekers detained in New York, New Jersey, and Pennsylvania. We used self-report questionnaires to assess symptoms of anxiety, depression, and post-traumatic stress disorder. At baseline, 54 (77%) participants had clinically significant symptoms of anxiety, 60 (86%) of depression, and 35 (50%) of post-traumatic stress disorder; all symptoms were significantly correlated with length of detention (p=0.004, 0.017, and 0.019, respectively). At follow-up, participants who had been released had marked reductions in all psychological symptoms, but those still detained were more distressed than at baseline. Our findings suggest detention of asylum seekers exacerbates psychological symptoms.

The Impact of Detention on the Health of Asylum Seekers

Asylum seekers arriving in the United States are often imprisoned for months or years while their asylum claims are processed. Recently, Physicians for Human Rights and the Bellevue/New York University Program for Survivors of Torture released the findings of the first systematic study examining the health of detained asylum seekers. The study found that the mental health of asylum seekers interviewed was extremely poor, including high levels of symptoms for anxiety, depression, and posttraumatic stress disorder, which worsened the longer individuals were in detention. The study also raises concerns about the manner in which asylum seekers are treated upon arrival in the United States and then while in detention. These findings support assertions that detention has a harmful effect on the health and well-being of asylum seekers. Policies regarding the long-term detention of asylum seekers should be reconsidered.

Safety and immunogenicity of TETRActHIB (a vaccine combining DTP vaccine and Haemophilus influenzae type B conjugate vaccine) administered to infants at 6, 10 and 14 weeks of age

The safety and immunogenicity of TETRActHIB (a vaccine combining diphtheria and tetanus toxoids-pertussis vaccine (DTP) with Haemophilus influenzae type b (Hib) conjugate vaccine (polyribosyl ribitol phosphate conjugated to tetanus protein) (PRP-T)) was assessed in 131 Cape Town infants immunized at 6, 10 and 14 weeks of age. Serological responses to all component antigens were measured before the first dose and at 18 weeks of age. In addition, anti-PRP antibodies were measured at 9 and 18 months of age to determine long-term immunogenicity. The vaccine was well tolerated by infants and no significant side-effects were reported. Responses to Hib at 18 weeks of age were good in that most infants achieved a level of anti-PRP antibodies > or = 0.15 microgram/ml, indicative of short-term protection, and 70% achieved a level > or = 1 microgram/ml, indicative of long-term protection. The proportions of children with protective levels > or = 0.15 microgram/ml and > or = 1 microgram/ml were similar at 9 and 18 months of age, i.e. approximately 75% and 45%, respectively. Responses to tetanus and diphtheria toxoids were excellent and all infants achieved protective serological levels. Responses to pertussis were moderate in that approximately 65% achieved 'protective' serum levels of pertussis agglutinins, i.e. titres > or = 320. In conclusion, this study has shown that the DTP/PRP-T vaccine is safe, immunogenic and well tolerated in infants immunised at 6, 10 and 14 weeks of age. TETRActHIB is therefore suitable for inclusion in the World Health Organisation Expanded Programme on Immunisation (WHO EPI) schedule.

Design and fabrication of cast orthopedic implants with freeform surface textures from 3-D printed ceramic shell

Three-dimensional printing is a solid freeform fabrication process, which creates parts directly from a computer model. The parts are built by repetitively spreading a layer of powder and selectively joining the powder in the layer by ink-jet printing of a binder material. 3D printing was applied to the fabrication of sub-millimeter surface textures with overhang and undercut geometries for use in orthopedic prostheses as bony ingrowth structures. 3D printing is used to fabricate ceramic molds of alumina powder and silica binder, and these molds are used to cast the bony ingrowth surfaces of Co-Cr (ASTM F75) alloy. Minimum positive feature sizes of the ceramic mold and, therefore, minimum negative feature sizes of castings were determined to be approximately 200 x 200 x 175 microm and were limited by the strength of ceramic needed to withstand handling. Minimum negative feature sizes in the ceramic mold and, therefore, minimum positive features in the casting were found to be approximately 350 x 350 x 175 microm and were determined by limitations on removal of powder from the ceramic and the pressure required to fill these small features with molten metal during casting. Textures were designed with 5 layers of distinct geometric definition, allowing for the design of overhung geometry with overall porosity ranging from 30-70%. Features as small as 350 x 350 x 200 microm were included in these designs and successfully cast.

[Investigational and methodological difficulties in the demonstration of cryoglobulins]

Cryoglobulins and cryofibrinogens are special forms of cryopathies. With regard to the clinical findings, determination and analysis of cryoproteins can support the diagnostics. Because cryoproteins occur in patients and healthy persons, occasionally it may be difficult to estimate the clinical significance. We determined and analyzed cryproteins in 47 patients with the following diagnoses: urticaria (8), morbus Raynaud (10), acrocyanosis (7), vasculitis (3), collagenosis (6), lupus erythematosus (2), suspect of cryoproteinemia (9) and of cryofibrinogenemia (2). There were cryoproteins in 42 patients of the following characteristics: immunoglobulins A, G, M (14), fibrinogen (2), immunoglobulins A, G, M together with fibrinogen (26) with a considerable predominance of IgM. There was no correlation between the diagnoses and the cryoprotein types, and therefore it is reasonable to determine cryoproteins in close cooperation with the clinics. Contamination of the cryoprecipitates with hemoglobin from red blood cells can simulate alpha 2-macroglobulin and cause misinterpretations.

Serum complement determinations in patients with quiescent systemic lupus erythematosus

OBJECTIVE

To determine whether complement component analyses during a period of inactive disease can define clinically important subgroups and predict morbidity in patients with systemic lupus erythematosus (SLE).

METHODS

We identified 277 patients with SLE whose disease became clinically inactive at some point after diagnosis. Serum samples were obtained at that time and tested for total complement activity (CH100) and antigenic levels of C1q, C1r, C1s, C3 and C4. Results of complement determinations were correlated with demographic characteristics and clinical findings in the followup period (mean observation period 4.25 years).

RESULTS

We identified 25 (9%) patients with multiple complement determinations below the normal range. 24 other patients (8.5%) had a very low level of a single complement component. The group with multiple complement determinations below the normal range was much more likely than the normocomplementemic SLE controls to progress to renal insufficiency. In other respects, complement component determinations were neither reflective nor predictive of clinical course.

CONCLUSION

In this group of patients with inactive SLE, complement component analyses did not generally correlate with longterm outcome; however, multiple low complement component determinations during disease quiescence was associated with increased risk of renal insufficiency.

Screening for diabetic retinopathy in South Africa with 60 degrees retinal colour photography

OBJECTIVES

Comparison of 60 degrees mydriatic retinal photography, in screening for diabetic retinopathy, with diabetes clinic doctors, formal ophthalmological assessment, and with one or two 45 degrees fields.

DESIGN

Consecutive subjects screened by clinicians and photography, and selected eyes evaluated by an ophthalmologist. Randomized photographs assessed through one or two 45 degrees fields (by masking the slides), and at 60 degrees.

SETTING

The first 663 patients attending for routine clinic visits and screened for retinopathy.

MAIN OUTCOME MEASURES

The relative diagnostic sensitivity of screening methods, the utility of screening one eye only, and the costs of photographic screening.

RESULTS

Compared to an ophthalmologist's assessment, retinal photography had a sensitivity of 93% and a specificity of 89% for any retinopathy, and 100 and 75%, respectively, for severe retinopathy. Photography detected 28% more retinopathy (16% severe) than the clinicians. Compared to a 60 degrees field, one 45 degrees field missed 31%, and 2 x 45 degrees fields 11% of retinopathy. Of 57 patients with retinopathy meeting referral criteria, 31 pairs of eyes had substantially discordant scores. The cost of diagnosis in a patient requiring referral to ophthalmologist was about US $37.00.

CONCLUSIONS

60 degrees retinal photography compares well with an ophthalmologists screening, and is better than clinical and one to two 45 degrees field assessments. Both retinae should be screened. This method is cost-effective in our hands.

Three Dimensional Printing: Rapid Tooling and Prototypes Directly from a CAD Model

Three Dimensional Printing is a process for the manufacture of tooling and functional prototype parts directly from computer models. Three Dimensional Printing functions by the deposition of powdered material in layers and the selective binding of the powder by “ink-jet” printing of a binder material. Following the sequential application of layers, the unbound power is removed, resulting in a complex three-dimensional part. The process may be applied to the production of metal, ceramic, and metal-ceramic composite parts. An experiment employing continuous-jet ink-jet printing technology has produced a three-dimensional ceramic part constructed of 50 layers, each 0.005 in. thick. The powder is alumina and the binder is colloidal silica. The minimum feature size is 0.017 in., and features intended to be 0.5000 in. apart average 0.4997 in. apart in the green state and 0.5012 in. apart in the cured state, with standard deviations of 0.0005 in. and 0.0018 in., respectively. Future research will be directed toward the direct fabrication of cores and shells for metal casting, and toward the fabrication of porous ceramic preforms for metal-ceramic composite parts.

Perturbation of regulated secretion in the pancreatic acinar cell line, AR42J

The regulated secretory pathway comprises accelerated discharge of proteins in response to hormonal stimuli, their presence in secretory granules (SG), and a long intracellular residence time. Dexamethasone induction of AR42J results in an increase in granule content and responsiveness to cholecystokinin (CCK). We studied the effects of conditions implicated in sorting of secretory proteins into the regulated pathway using [35S]methionine pulse-chase protocols that examine transport of secretory proteins from the rough endoplasmic reticulum (RER)----SG and specifically from the Golgi complex (GC)----SG. The latter uses a chase at 20 degrees C to allow accumulation of labeled proteins in the trans-Golgi, followed by a shift to 37 degrees C that initiates their transport to SG under test conditions. Quantitation of CCK-8-stimulated discharge of prestored amylase and of newly synthesized labeled proteins that have entered SG during the chase enables us to examine the effect of perturbants over selected parts of the pathway. The effects of acidic intracellular compartments, the cytoskeleton, protein synthesis, ATP, and temperature on pre- and post-Golgi entry of proteins into the regulated pathway were studied. NH4Cl, monensin, Na azide, incubation at 20 degrees C, and pertussis toxin retarded RER----SG transport without affecting amylase discharge. Only incubation with 20 mM NH4Cl or 1 microM monensin inhibited transfer of newly synthesized proteins from the late GC----SG. RER----Golgi or intra-Golgi transport thus appears to require ATP and possibly guanosine 5'-triphosphate (GTP)-binding proteins. Acidic compartments appear to be essential for sorting of secretory proteins from the GC----SG.

[Electrolyte disorders, EEG changes and epileptic seizures in alcohol withdrawal delirium]

For 180 patients suffering alcohol-withdrawal induced delirium, electrolytic concentration in the serum of Na, K, Ca, and Mg was determined in the early withdrawal phase, and the electroencephalograms of 95 delirium patients evaluated in respect of local and diffuse changes and epileptic activity, and compared in delirium patients with and without initial seizures. Delirium patients who had initial seizures suffered significantly longer-lasting periods of delirium and significantly more frequent electrolytic changes in the form of hypomagnesemia and hypopotassemia (hypokalemia). There was no significant difference in the EEG changes. A temporary metabolic disorder in the initial phase of the two-phase withdrawal process should be assumed to be the cause of seizures during alcohol withdrawal, and the pathogenetic significance of hypomagnesemia and hypopotassemia should be taken into consideration.

The use of interferon functional assays in the laboratory monitoring of patients with hepatocellular carcinoma receiving interferon

Patients with hepatocellular carcinoma receiving recombinant leukocyte alpha interferon therapy were monitored using a series of assays to evaluate various components of the interferon system. Pretherapy serum interferon concentrations were not elevated significantly in these patients, although elevated levels were recorded after initiation of therapy. Both before and after interferon treatment, the peripheral blood leukocytes of the patients were shown to be capable of producing both gamma and alpha interferon when appropriately stimulated in vitro. The patients' peripheral blood leukocytes also responded to interferon therapy, with 85% resisting viral replication after treatment was initiated. However, interferon did not appear to be of therapeutic value in these patients.

Protein markers of nutrition status as related to sex and age

We assessed age- and sex-related variation in those proteins commonly measured to evaluate protein catabolic losses in patients in acute care. We determined concentrations of iron and iron-binding capacity, transferrin, albumin, prealbumin, and retinol-binding protein in sera from 158 healthy blood donors and 48 hospitalized patients, then grouped the data according to age (by decade) and sex. There was no significant variation in either category. For the total nondiseased population the concentrations of three proteins (means SD, and range) were: transferrin, 2760, 510, 1740-3780 mg/L (population CV 18.5%); prealbumin, 296, 49, 200-390 mg/L (CV 16.6%); retinol-binding protein, 60, 127, 35-85 mg/L (CV 21.2%). Prealbumin and retinol-binding protein concentrations were highly correlated (r = 0.803). Because prealbumin can be easily monitored and its assay is subject to few interferences, we conclude that determination of prealbumin is suitable for assessing the existence and severity of nutritional metabolic deficits.

Protein markers of nutrition status as related to sex and age

We assessed age- and sex-related variation in those proteins commonly measured to evaluate protein catabolic losses in patients in acute care. We determined concentrations of iron and iron-binding capacity, transferrin, albumin, prealbumin, and retinol-binding protein in sera from 158 healthy blood donors and 48 hospitalized patients, then grouped the data according to age (by decade) and sex. There was no significant variation in either category. For the total nondiseased population the concentrations of three proteins (means SD, and range) were: transferrin, 2760, 510, 1740-3780 mg/L (population CV 18.5%); prealbumin, 296, 49, 200-390 mg/L (CV 16.6%); retinol-binding protein, 60, 127, 35-85 mg/L (CV 21.2%). Prealbumin and retinol-binding protein concentrations were highly correlated (r = 0.803). Because prealbumin can be easily monitored and its assay is subject to few interferences, we conclude that determination of prealbumin is suitable for assessing the existence and severity of nutritional metabolic deficits.

Recombinant leukocyte interferon treatment of chronic hepatitis B

We have investigated the efficacy of a relatively prolonged course of recombinant leukocyte interferon treatment in 14 chronic HBsAg-, HBeAg-, hepatitis B virus DNA- and DNA polymerase-positive carriers. alpha-Interferon was administered for 9 weeks. Six of 14 treated carriers have a sustained loss of HBeAg, hepatitis B virus DNA and DNA polymerase. Four subsequently lost HBsAg (28.5%). Elevated pretreatment SGPT concentrations, histologic chronic active hepatitis, an exacerbation of chronic hepatitis with an increase in SGPT concentrations in the last weeks of treatment and possibly recent onset of the carrier state was associated with complete inhibition of viral replication. None of 11 matched, untreated HBsAg-, HBeAg-, hepatitis B virus DNA- and DNA polymerase-positive carriers monitored during the same period lost HBsAg. The effect of recombinant leukocyte interferon may require an appropriate host-immune response. The efficacy of recombinant leukocyte interferon therapy is restricted, but it may be of benefit in a proportion of carriers, if these carriers can be precisely identified.