Venous Thromboembolism in Children and Teenagers Admitted for Trauma: A 5-Year Nationwide Perspective

Venous thromboembolism (VTE) in pediatric trauma patients is under-investigated. The purpose of this study was to perform an evaluation of the risk factors for VTE after pediatric trauma, including readmissions across the United States. The Nationwide Readmissions Database for 2016-2020 was queried for all patients under the age of 18 years admitted for trauma. 276 670 patients were identified; 2063 (.8%) were diagnosed with VTE. Among those with VTE, 300 (15%) were identified during a readmission. Higher rates of VTE were seen in ages 15-17 years (n = 1,294, 1.3%, P < .001), penetrating injuries (n = 478, .9%, P < .001), and assault (n = 271, 2.7%, P < .001). The strongest risk factor for VTE was prolonged mechanical ventilation (OR 5.5 [4.9-6.3] P < .001). Our study found that a significant portion of post-traumatic VTE in children and teenagers occur during readmissions. A deeper understanding of the risk factors outlined here can guide enhanced clinical protocols, ensuring early detection and prevention of this complication.

Comparison of outcomes using the rituximab originator MabThera with the biosimilar Truxima in patients with ANCA-associated vasculitis

OBJECTIVES

The use of rituximab (MabThera^®), an anti-CD20 monoclonal antibody, is the most significant development in the management of anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV) since the introduction of cytotoxic therapy in 1950. Truxima^® is the first anti-CD20 biosimilar approved for the same indications, and has been available in the UK since 2017. Significant cost savings have been reported when switching to biosimilars, which could lead to greater patient access to such treatment. Therefore, it is important to know whether patients' clinical and laboratory parameters respond equally well to biosimilars as to reference medicines, tested in clinical trials.

METHOD

We retrospectively reviewed the clinical outcomes and laboratory parameters in 257 consecutive patients treated with anti-CD20 depletion therapy using MabThera or Truxima, for induction and maintenance of remission, in two tertiary renal centres between 2010 and 2019.

RESULTS

We demonstrated no difference between patients treated with MabThera or Truxima in rates of remission, relapse, and hospitalization with infection when used for either induction or maintenance of remission of AAV. In one hospital subgroup analysis, we showed comparable levels of hypogammaglobulinaemia, B-cell depletion, and frequency of infusion reactions, with no significant differences.

CONCLUSION

The efficacy and safety of the rituximab biosimilar Truxima are not inferior to the originator MabThera in patients with AAV. Truxima represents a cheaper and safe therapeutic alternative that could increase patient access to rituximab.

Navigating radial artery loops in neurointerventions

BACKGROUND

Although studies continue to demonstrate lower complications in neurointerventions using transradial access (TRA) compared with transfemoral approaches, anatomic radial variants can be difficult to navigate and remain one of the frequent causes of access site conversion.

OBJECTIVE

To evaluate predictors of TRA failure in neuroendovascular patients with radial loops and suggest a protocol for managing these anomalies.

METHODS

A prospective collection of patients undergoing TRA at participating institutions from July 2018 to September 2020 was reviewed. Patients with a radial loop were identified. Patient demographics and procedural characteristics were evaluated to determine predictors of both TRA failure and successful reduction of the radial loop.

RESULTS

We identified 32 transradial neurointerventions in which patients had radial loops. Twenty-two (68.8%) were identified by diagnostic angiography, and the majority were performed for evaluation or treatment of an aneurysm (56.3%). TRA failure occurred in 13 (40.6%) of the cohort and happened more frequently in patients over 60 years of age (p=0.01) and those with recurrent radial artery diameters ≤2 mm (p=0.02). Of the 19 patients who had successful TRA, 12 (63.2%) procedures were performed through the recurrent radial artery.

CONCLUSION

Although radial loops are associated with high transradial failure rates, our results suggest that the presence of a loop is not an absolute contraindication to TRA. Therefore, we recommend attempting loop navigation using our protocol. Patient age, vascular tortuosity, and recurrent radial artery size should help dictate when to convert to an alternative access site.

Implementation of a radial long sheath protocol for radial artery spasm reduces access site conversions in neurointerventions

BACKGROUND

Many neurointerventionalists have transitioned to transradial access (TRA) as the preferred approach for neurointerventions as studies continue to demonstrate fewer access site complications than transfemoral access. However, radial artery spasm (RAS) remains one of the most commonly cited reasons for access site conversions. We discuss the benefits, techniques, and indications for using the long radial sheath in RAS and present our experience after implementing a protocol for routine use.

METHODS

A retrospective review of all patients undergoing neurointerventions via TRA at our institution from July 2018 to April 2020 was performed. In November 2019, we implemented a long radial sheath protocol to address RAS. Patient demographics, RAS rates, radial artery diameter, and access site conversions were compared before and after the introduction of the protocol.

RESULTS

747 diagnostic cerebral angiograms and neurointerventional procedures in which TRA was attempted as the primary access site were identified; 247 were performed after the introduction of the long radial sheath protocol. No significant differences in age, gender, procedure type, sheath sizes, and radial artery diameter were seen between the two cohorts. Radial anomalies and small radial diameters were more frequently seen in patients with RAS. Patients with clinically significant RAS more often required access site conversion (p<0.0001), and in our multivariable model use of the long sheath was the only covariate protective against radial failure (OR 0.061, 95% CI 0.007 to 0.517; p=0.0103).

CONCLUSION

In our experience, we have found that the use of long radial sheaths significantly reduces the need for access site conversions in patients with RAS during cerebral angiography and neurointerventions.

Response-time dynamics: evidence for linear and low-dimensional nonlinear structure in human choice sequences

Response time (RT) is a commonly used measure of cognitive performance, which is usually characterized as stochastic. However, useful information may be hidden in the apparently random fluctuations of RT. Dynamical systems analysis techniques allow an exploration of the alternative hypothesis that RT fluctuations are deterministic, albeit in a complex manner. We applied careful task construction and noise-reduction and surrogate series tests to show that RT series from a forced-pace serial response-time task have low-dimensional chaotic characteristics. In Experiment 1, 80% of subjects' filtered RT series had low dimensionality, sensitive dependence on initial conditions, spectra close to 1/f, and stable attractor geometry across sessions. In Experiment 2, we showed that the size of the inter-stimulus interval (ISI) determined the number of subjects with low-dimensional chaotic series. A small ISI caused 100% of subjects to respond in the chaotic regime, whereas only 25% had a low-dimensional chaotic RT component when the ISI was large. We argue that demanding task requirements cause a reduction in the dimensionality of the dynamics, producing RT fluctuations that may reflect a response strategy for controlling RT.

Recombinant Neisseria meningitidis transferrin binding protein A protects against experimental meningococcal infection

To better characterize the vaccine potential of Neisseria meningitidis transferrin binding proteins (Tbps), we have overexpressed TbpA and TbpB from Neisseria meningitidis isolate K454 in Escherichia coli. The ability to bind human transferrin was retained by both recombinant proteins, enabling purification by affinity chromotography. The recombinant Tbps were evaluated individually and in combination in a mouse intraperitoneal-infection model to determine their ability to protect against meningococcal infection and to induce cross-reactive and bactericidal antibodies. For the first time, TbpA was found to afford protection against meningococcal challenge when administered as the sole immunogen. In contrast to the protection conferred by TbpB, this protection extended to a serogroup C isolate and strain B16B6, a serogroup B isolate with a lower-molecular-weight TbpB than that from strain K454. However, serum from a TbpB-immunized rabbit was found to be significantly more bactericidal than that from a TbpA-immunized animal. Our evidence demonstrates that TbpA used as a vaccine antigen may provide protection against a wider range of meningococcal strains than does TbpB alone. This protection appears not to be due to complement-mediated lysis and indicates that serum bactericidal activity may not always be the most appropriate predictor of efficacy for protein-based meningococcal vaccines.

Presence of antibodies to canine distemper virus, canine parvovirus and canine adenovirus type 1 in free-ranging jackals (Canis adustus and Canis mesomelas) in Zimbabwe

A survey of free-ranging jackals (Canis adustus and Canis mesomelas) in Zimbabwe was conducted to determine the prevalence of serum antibodies to canine distemper virus (CDV), canine parvovirus (CPV) and canine adenovirus type 1 (CAV-1). Sera from 16 Canis adustus and 22 Canis mesomelas were collected from 1990 to 1993 from various regions of Zimbabwe and assayed by means of immunofluorescent techniques. Seroprevalence in C. adustus and C. mesomelas respectively were 50% and 63.6% for CDV, 12.5% and 18.2% for CPV and 37.5 and 9.1 for CAV-1. These results demonstrate that jackals are infected with these viruses and may act as reservoirs of them, although their susceptibility to the viruses is not known.

Is outpatient laparoscopic cholecystectomy safe and cost-effective? A model to study transition of care

BACKGROUND

There is increasing pressure to perform traditional inpatient surgical procedures in an outpatient setting. The aim of the current trial was to determine the safety and cost savings of performing laparoscopic cholecystectomy in an outpatient setting using a "mock" outpatient setting.

METHODS

Patients who were scheduled for laparoscopic cholecystectomy by four attending surgeons and for whom operating time was available in the outpatient center were studied. All patients received a standardized anesthetic, including ondansetron, and were discharged from the outpatient postanesthesia care unit if appropriate. At discharge, all patients were admitted to a clinical research center where they were observed in a "mock home" setting and monitored for complications that would have necessitated readmission. A decision analysis was created assuming all patients underwent outpatient surgery with either direct admission or discharge to home and readmission if complications developed.

RESULTS

Of 99 patients who were enrolled in this study, 96 patients would have met the discharge criteria for home. No major complications were observed in these 96 patients. Eleven patients experienced postoperative nausea and vomiting, 3 of whom required an additional 24 h of hospital observation. In the decision model, the optimal strategy would be to perform the procedure on an outpatient basis and readmit patients only for complications, with an average baseline cost savings of $742/patient.

CONCLUSIONS

The results show that outpatient laparoscopic cholecystectomy is safe and cost-effective in selected patients, and that the mock home setting provides a means of studying the safety of transition of care.

Valsartan, a new angiotensin II antagonist for the treatment of essential hypertension: efficacy and safety compared with placebo and enalapril

OBJECTIVE

To compare the antihypertensive efficacy and systemic tolerability of valsartan, a new angiotensin II receptor antagonist, with placebo and with an angiotensin converting enzyme (ACE) inhibitor, enalapril.

DESIGN

A total of 348 adult outpatients with mild-to-moderate uncomplicated essential hypertension participated in this double-blind, parallel, study. Patients were allocated randomly in a ratio of 2:2:1 to receive 80 mg valsartan once a day, 20 mg enalapril once a day, or placebo for 8 weeks in general practice. Patients were assessed at 4 and 8 weeks of therapy.

MAIN OUTCOME MEASURES

The primary efficacy variable was the change from baseline in mean sitting diastolic blood pressure (SDBP) after 8 weeks of therapy. Secondary variables included the change in sitting systolic blood pressure (SSBP) and response rates at 8 weeks.

RESULTS

Valsartan and enalapril produced statistically significant reductions in diastolic and systolic blood pressures compared with placebo. Similar falls were found in both of the active treatment groups with mean changes in SDBP at 8 weeks of -9.5 mmHg for valsartan and -9.4 mmHg for enalapril (-4.5 mmHg for placebo). No significant differences between valsartan and enalapril were found for reductions in SDBP or SSBP. Response rates at 8 weeks were significantly greater for valsartan (54%) and enalapril (58%) than for placebo (20%), with no significant difference between the two active treatments. Both valsartan and enalapril demonstrated a consistent antihypertensive effect over time, with 90% of patients with a response at 4 weeks responding at 8 weeks. Both of the treatments were tolerated well. Although the incidence of coughing was generally low in the study, more cases were reported with enalapril (three) than with valsartan (one) or placebo (none).

CONCLUSIONS

The data show 80 mg valsartan once a day to be as effective as 20 mg enalapril once a day in the treatment of mild-to-moderate hypertension. Valsartan is tolerated well and does not appear to be associated with any increase in the incidence of coughing.

Increased unsaturated fatty acid production associated with a suppressor of the fabA6(Ts) mutation in Escherichia coli

Plasmids that corrected the temperature-sensitive unsaturated fatty acid auxotrophy of strain M6 [fabA6 (Ts)] were isolated from an Escherichia coli genomic library. Subcloning and physical mapping localized the new gene (called sfa for suppressor of fabA) at 1,070 kb on the E. coli chromosome. DNA sequencing revealed the presence of a 227-bp open reading frame which directed the synthesis of a peptide of approximately 8 kDa, which correlated with the correction of the fabA6(Ts) phenotype. However, the sfa gene was an allele-specific suppressor since plasmids harboring the sfa gene corrected the growth phenotype of fabA6(Ts) mutants but did not correct the growth of fabA2(Ts) or fabB15(Ts) unsaturated fatty acid auxotrophs. Overexpression of the sfa gene in fabA6(Ts) mutants restored unsaturated fatty acid content at 42 degrees C, and overexpression in wild-type cells resulted in a substantial increase in the unsaturated fatty acid content of the membrane. Thus, the suppression of the fabA6(Ts) mutation by sfa was attributed to its ability to increase the biosynthesis of unsaturated fatty acids.

Vincristine with high-dose etoposide in advanced breast cancer: a phase II trial of the Piedmont Oncology Association

Vincristine (VCR) and etoposide (VP-16) have been shown to be synergistic in a murine model, and this combination was studied in a phase II trial. Eligibility required measurable disease, a performance status of 0-2, a life expectancy of > or = 2 months, an interval of at least 3 weeks since the receipt of previous radiation therapy or chemotherapy and recovery from related toxicity, no prior treatment with VCR or VP-16, and no more than two prior chemotherapy regimens (only one for treatment of metastatic disease). Treatment consisted of 0.5 mg i.v. (bolus) VCR followed by 200 mg/m2 VP-16 given over 2 h. Both drugs were given daily for 3 consecutive days every 3 weeks (total dose: VCR, 1.5 mg; VP-16, 600 mg/m2). A total of 18 patients with metastatic breast cancer were accured; 14 had adjuvant chemotherapy and 8 had chemotherapy for advanced disease. As judged by International Union Against Cancer (UICC) criteria, one complete response (CR) and three partial responses (PR) were obtained, for a CR + PR rate of 22% (95% confidence interval, 6%-48%). All responders had soft-tissue involvement only. Six patients had stable disease and 8 showed progression. The median time to treatment failure was 3.5 months, and the median survival from study entry was 8.3 months. The major toxicity was myelosuppression, with 9 patients (50%) experiencing a total WBC of < 1,000/mm3. Grade 2-3 neurologic toxicity was noted in 6 patients (33%) and grade 3 nausea and vomiting was noted in 5 (28%). The combination of VCR and VP-16 is active in advanced breast cancer but is not convincingly superior to either of these agents used alone.

Objective assessment for exercise treatment on the B-200 isostation as part of work tolerance rehabilitation. A random prospective blind evaluation with comparison control population

The purpose of this study was to assess repeated exercise on the B-200 Isostation as part of rehabilitation work tolerance for nonsurgical patients with lumbar spine disorders. For a consecutive 7-month period, treatment subjects were randomly assigned according to birth date for participation in two groups: a standard work tolerance program only or standard work tolerance program plus inclusion of exercise on the B-200 Isostation. Each patient had similar referral diagnosis requiring conservative treatment. Treatment groups were compared with a control population of volunteers who had neither back pain nor known underlying spinal pathology. All study patients had objective measurement of range of motion, isometric strength, and velocity of motion, on the B-200 Isostation before treatment and at follow-up 3 weeks after treatment. The data showed no significant difference of percent improvement when comparing patients in either of the randomized assigned treatment groups. There was a higher percentage of improvement for each treatment group as compared with the control individuals, however. Based on our study using the B-200 Isostation, there is little objective justification for including exercise on the B-200 dynametric Isostation as part of the rehabilitation routine for improvement of functional physical capacity.

Assessment of masticatory efficiency: new methods appropriate for clinical research in dental practice

A new chewing test has been assessed in which the test food was contained in a chewable rubber bag. Six subjects chewed ten single 'unbagged' almonds and ten single 'bagged' almonds. The bagged experiments gave generally similar results to unbagged ones in terms of the particle size distribution; they also proved more acceptable to the subjects and eliminated the serious, undefinable loss of chewed particles that occurs intraorally in conventional (unbagged) tests. In this study an optical scanning method was used which provided a simple, fast measurement of individual particles.

Identification of polypeptide markers of barley yellow dwarf virus resistance and susceptibility genes in non-infected barley (Hordeum vulgare) plants

Barley yellow dwarf (BYDV) is a group a closely related viruses which cause economic losses in a wide range of graminaceous species throughout the world. Barley plants can be protected from the effects of BYDV by the 'Yd2' resistance gene. Plants which contain the 'Yd2' gene also contain a constitutively expressed polypeptide which was not found in any plants without 'Yd2'. Conversely, BYDV susceptible plants contain another constitutively expressed polypeptide which was not found in any of the BYDV-resistant lines examined. These two polypeptides appear to have the same molecular weight (as assessed by SDS-PAGE) and only slightly different iso-electric points. They also appear to contain an extensive range of similar antigenic determinants. Both polypeptides were found in F1 hybrids made from resistant and susceptible plants. We suggest that these two polypeptides are the products of two allelic genes. Analysis of near-isogenic lines showed that the locus which controls the 'Yd2' resistance gene and the locus controlling the synthesis of the two polypeptides may be within ± 9 cM of each other. We have developed a Western blot technique which allows assessment of barley lines, 4-days after seed imbibition, for the presence of the 'Yd2' gene.

Relationship of removable partial denture use to root caries in an older population

The pattern and severity of root caries in a selected older population, living in the community and attending a general dental practice in Bexhill, East Sussex, England, is reported. A total of 146 patients were examined to determine the relationship among removable partial dentures, their design, and root caries. Of those patients, 57% wore removable dentures and had a higher prevalence of exposed root surfaces and root caries, particularly on abutment teeth. In addition, root caries lesions on abutment surfaces were found to be larger and more active than those on nonabutment surfaces.

Melanoma metastatic to the gastrointestinal tract

Melanoma is increasing in incidence. An often-unsuspected complication is metastasis to the gastrointestinal tract, which leads to bowel obstruction or intussusception. The most common symptoms in patients with gastrointestinal metastasis are vomiting, abdominal pain and abdominal distention. Metastatic disease should be suspected in any patient with gastrointestinal symptoms and a history of cutaneous melanoma.

The predictive value of progesterone receptor levels in endometrial cancer

Recent reports have suggested that the presence of progesterone receptor correlates with other well known predictors of a favorable outcome for endometrial cancer patients. To test this hypothesis, we reviewed the records of 154 patients who had undergone a hysterectomy for adenocarcinoma of the endometrium, and pelvic irradiation if poor prognostic factors were present. The 3 year disease-free survival for all clinical Stage I patients was 80%. Patients with progesterone receptor levels greater than or equal to 100 had a 3 year disease-free survival of 93% compared with only a 36% 3 year disease-free survival for patients with progesterone receptor less than 100 (p less than .0001, log rank test). To determine whether elevated progesterone receptor was an independent prognostic factor for disease-free survival in endometrial cancer, or just correlated with the other well-known predictors, bivariate and multivariate analyses were conducted. Our results indicate the progesterone receptor levels are the single most important prognostic indicator of 3 year disease-free survival in clinical Stage I endometrial cancer, with only cervical involvement and peritoneal cytology being significant prognostic variables after adjusting for progesterone receptor levels.

EXPLORATION IN THE COOPER BASIN

The Cooper Basin is located in the northeastern corner of South Australia and in the southwestern part of Queensland. The basin constitutes an intracratonic depocentre of Permo- Triassic age. The Cooper Basin succession unconformably overlies Proterozoic basement as well as sediments and metasediments of the Cambro- Ordovician age. An unconformity separates in turn the Cooper succession from the overlying Jurassic- Cretaceous Eromanga Basin sediments.The Permo- Triassic succession comprises several cycles of fluvial sandstones, fluvio- deltaic coal measures and lacustrine shales. The coal measures contain abundant humic kerogen, comprising mainly inertinite and vitrinite with a small contribution of exinite. All hydrocarbon accumulations within the Cooper Basin are believed to have originated from these terrestrial source rocks.Exploration of the basin commenced in 1959 and, after several dry holes, the first commercial discovery of gas was made at Gidgealpa in 1963. To date, some 97 gas fields and 10 oil fields, containing recoverable reserves of 5 trillion cubic feet of gas and 300 million barrels recoverable natural gas liquids and oil, have been discovered in the Cooper Basin. Production is obtained from all sand- bearing units within the Cooper stratigraphic succession.The emphasis of exploration in the Cooper Basin is largely directed towards the assessment of four- way dip closures and three- way dip closures with fault control, but several stratigraphic prospects have been drilled. Furthermore, in the development phase of some gas fields a stratigraphic component of the hydrocarbon trapping mechanism has been recognised.Improvements in seismic acquisition and processing, combined with innovative thinking by the explorers, have facilitated the development of untested structural/stratigraphic plays with large reserves potential. Exploration for the four- and three- way dip closure plays in the Cooper Basin is now at a mature stage. However, reserves objectives are expected to continue to be met, with the expectation of a continuing high success rate.Selected new plays are expected to be tested within a continuing active exploration program as exploration for oil and gas in the Cooper Basin refines the search for the subtle trap.

Peritoneal fluid cytology in endometrial cancer: its significance and the role of chromic phosphate (32P) therapy

Between 1978 and 1986, 243 patients (all stages) had peritoneal fluid cytology performed while undergoing total abdominal hysterectomy for endometrial carcinoma; 39 (16%) were found to be positive. At 3 years (median follow-up of 30 months) the disease-free survival (DFS) for the 165 negative cytology clinical Stage I patients was 91% compared to only 56% for the 25 positive cytology patients (p less than .001). Of the 25 Stage I positive cytology patients, 14 with greater than one-third myometrial invasion had a DFS of 30% at 3 years as compared to 87% for negative cytology patients with comparable depth of invasion (p less than .001). There was no difference in DFS between the negative and positive cytology Stage I patients who had one-third or less myometrial invasion. Stage I patients with histologic Grade 2 and 3 had a lower 3 year DFS when cytology positive, 49% and 22%, versus 92% and 79% when cytology negative (p less than .001 and p = .03 respectively). In clinical Stage II patients the 3-year DFS was 21% for those with a positive cytology and 59% with a negative cytology. Fourteen of the 25 clinical Stage I positive cytology patients received 15 mCi of intraperitoneal 32P. At 3 years they had a 68% DFS as compared to 27% for those not receiving 32P (p = 0.01). All 11 patients with superficial myometrial invasion (9 received 32P) remained disease-free. The 4 Stage I patients with deep invasion who received 32P therapy had an improvement in abdominal/pelvic control and DFS when compared to 9 similar patients who did not receive 32P (p = .02). For histologic Grade 2 and 3 patients, there was a 64% 3-year DFS in the 32P treated group and 16% for those not receiving 32P (p = 0.02). Although 32P therapy improved DFS in Stage I positive cytology patients its use along with pelvic radiation therapy can lead to complications. Of 9 Stage I patients receiving 32P as well as pelvic irradiation, 4 experienced serious bowel complications requiring surgery. None of the 5 patients receiving 32P only had a complication.

Changes in proteinase/proteinase inhibitor levels in rat skeletal muscle tissue during diabetes and fasting

The skeletal muscle content of three rat proteinase inhibitors, a 1-proteinase inhibitor, contrapsin and a 1-cysteine proteinase inhibitor was measured by immunochemical techniques following streptozotocin-induced diabetes. When compared with normal rats, a 1-cysteine proteinase inhibitor and a 1-proteinase inhibitor levels remained essentially unchanged, whereas the content of rat contrapsin was reduced by nearly 80% after the onset of diabetes. Similarly, fasting of rats for three days resulted in a lowering of the levels of contrapsin in skeletal muscles. Under these conditions, levels of chymotrypsin-like activity (chymase) were increased by 150%, whereas the content of the trypsin-like, neutral proteinase was unchanged. Kinetic studies in vitro with Tosyl-Gly-Pro-Arg-4-nitroanilide as substrate showed no inhibition of the trypsin-like proteinase by a 1-proteinase inhibitor, while contrapsin inhibited the enzyme with a Ki value of 40nM. The changing pattern of these proteinases and their potential inhibitors (chymase/a 1-proteinase inhibitor and trypsin-like proteinase/contrapsin) may be a factor contributing to muscle wasting as observed in diabetes and fasting.

Deficiency of protein 4.2 in erythrocytes from a patient with a Coombs negative hemolytic anemia. Evidence for a role of protein 4.2 in stabilizing ankyrin on the membrane

A patient with a mild hemolytic anemia and osmotically fragile, spherocytic erythrocytes was studied. Analysis of the erythrocyte membrane proteins by SDS-PAGE revealed a deficiency of protein 4.2 (less than 0.10% of normal). The protein 4.2-deficient erythrocytes contained normal amounts of all other membrane proteins, although the amount of band 3 was slightly reduced and the amount of band 6 (G3PD) was slightly elevated. The spectrin content of these cells was normal, as measured by both SDS-PAGE and radioimmunoassay. Erythrocytes from the patient's biologic parents were hematologically normal and contained normal amounts of protein 4.2. Immunological analysis using affinity purified antibodies revealed that the patient's protein 4.2 was composed of equal amounts of a 74-kD and 72-kD protein doublet, whereas the normal protein was composed primarily of a 72-kD monomer. Proteolytic digestion studies using trypsin, alpha-chymotrypsin and papain demonstrated that the patient's protein 4.2 was similar but not identical to the normal protein. Binding studies showed that the protein 4.2-deficient membranes bound purified protein 4.2 to the same extent as normal membranes, suggesting that the membrane binding site(s) for the protein were normal. Depleting the protein 4.2-deficient membranes of spectrin and actin resulted in a loss of nearly two-thirds of the membrane ankyrin, whereas similar depletion of normal membranes resulted in no loss of ankyrin. Repletion of the protein 4.2-deficient membranes with purified protein 4.2 before spectrin-actin extraction partially prevented the loss of ankyrin. These results suggest that protein 4.2 may function to stabilize ankyrin on the erythrocyte membrane.

Human erythrocyte protein 4.1 is a phosphatidylserine binding protein

The aminophospholipids phosphatidylethanolamine (PE) and phosphatidylserine (PS) are the major phospholipids contained in the cytoplasmic leaflet of the human erythrocyte (RBC) plasma membrane and are largely confined to that leaflet over the entire RBC lifespan. In particular, PS, which comprises approximately 13% of total RBC membrane phospholipids, is normally restricted entirely to the cytoplasmic leaflet. However, molecular mechanisms that regulate this asymmetric distribution of phospholipids are largely unknown. We examined elliptocytic RBCs that completely lacked protein 4.1 (HE [4.1 degrees]), but contained normal amounts of all other peripheral membrane proteins, and found approximately 10% of total membrane PS was accessible in the exoplasmic leaflet of these membranes. Inside out vesicles (IOVs) derived from HE [4.1 degrees] RBCs bound fewer PS liposomes than did IOVs derived from normal RBCs. Normal IOVs that were depleted of proteins 2.1 (ankyrin), 4.1, and 4.2 bound fewer PS liposomes similar to HE [4.1 degrees] IOVs, and repletion with protein 4.1 restored PS liposome binding to control levels. Addition of purified protein 4.1 to PS liposomes resulted in saturable binding with the extent of binding being proportional to the liposome PS content. Our data suggests that human RBC protein 4.1 is a PS binding protein and may be involved in the molecular mechanisms that stabilize PS in the cytoplasmic leaflet of the human RBC plasma membrane.

Maternal serum alpha fetoprotein concentrations in mid trimester in hepatitis B surface antigen positive and negative subjects

Maternal serum alpha fetoprotein (AFP) was measured as part of a routine antenatal screening programme in 48 patients positive for hepatitis B surface antigen (HBsAg). After exclusion of two cases with obvious obstetric abnormalities there was no difference in AFP concentrations between subjects who were positive or negative for HBsAg.

Acquired immune deficiency syndrome without the recognized risk factors

We report two cases of acquired immune deficiency syndrome (AIDS), apparently without the usual exposure factors, in whom a temporal association was detected after detailed epidemiological investigation. The index case, a 45 year old housewife, had provided terminal home-nursing care for a 33 year old African man, who died from an undiagnosed encephalitis. At that time she had fissures of the skin of both her hands. Review of post-mortem pathology specimens of the African man allowed a retrospective diagnosis of AIDS with cerebral toxoplasmosis to be made. The type of home-nursing care given by the index case was quite different from that normally provided by health care workers with the training and facilities to prevent the spread of infection.

Human milk and preterm formula compared for effects on growth and metabolism

Metabolic tolerance to a 'premature formula' feed was studied in a group of small immature infants, mean (SD) gestation 27.8 (1.4) weeks. Ten infants weighing 880-1295 g at the time of the study were fed on SMA low birthweight formula for a mean (SD) of 23.5 (5.5) days and were compared with 10 who were fed on expressed breast milk for 25.8 (6.1) days. The infants were well matched for weight, gestation, and postnatal age at the time of the study and were receiving full enteral feeds. They were investigated by balance techniques and plasma sampling on at least two occasions. Ten larger infants weighing 1330-1740 g and being fed on the same formula feed were also studied as an additional control group. Formula fed infants retained more nitrogen and gained weight faster. Plasma phosphorus concentrations were higher in the group fed on the formula feed, and alkaline phosphatase activity was lower. There were no significant differences in plasma concentrations of urea, electrolytes, or albumin or in acid base status. Taurine and arginine concentrations were higher in the group being breast fed, but there were no other significant differences in plasma amino acids, and no toxic concentrations occurred after either feed. The results of this study show that this formula (and presumably other feeds of similar composition) seem to be metabolically safe for the smallest infants.

Slow moving proteinase. Isolation, characterization, and immunohistochemical localization in gastric mucosa

Human gastric mucosa contains three immunochemically distinguishable aspartic proteinases, pepsinogen I (pepsinogen A), pepsinogen II (pepsinogen C, progastricsin), and a nonpepsinogen proteinase also termed slow moving proteinase (SMP). The properties of SMP, and in particular its relationship to another aspartic proteinase, cathepsin D, were examined in this study. Slow moving proteinase and cathepsin D were isolated, respectively, from gastric mucosa and human spleen. Antiserum specific to each proteinase was prepared in rabbits. Rabbit anti-SMP did not recognize cathepsin D, and conversely, anticathepsin D did not react with SMP. Immunohistochemical studies localized SMP to surface epithelial cells in both the fundic and pyloric gland areas of the stomach. In contrast, cathepsin D was found mainly in mononuclear cells in the lamina propria and in parietal cells. Slow moving proteinase exhibited considerably lower Km values for its interaction with two chromogenic substrates than did cathepsin D. An even greater distinction between the two enzymes was found with the protein inhibitor from Ascaris lumbricoides; the activity of SMP was inhibited very strongly, whereas that of cathepsin D was not affected. By sodium dodecyl sulfate-polyacrylamide gel electrophoresis under denaturing conditions, SMP consisted of two subunits with apparent molecular weights of 42,500 and 41,000. The last two properties characterize a less-well-known aspartic proteinase, cathepsin E. We conclude that SMP is not cathepsin D, but that it may be cathepsin E.

Physicochemical stability and inactivation of human and simian rotaviruses

The effects of various physical and chemical treatments on the stability of a human serotype 1 rotavirus and simian agent 11 (SA11) were compared by using a fluorescence focus assay. The infectivity of both strains was retained after storage at room temperature for 14 days, 4 degree C for 22 days, and -20 degree C for 32 days; lyophilization; and treatment at pH 3 to 11. Both viruses were inactivated at pH 12, as was the human virus at pH 2, although this pH resulted in only partial inactivation of SA11. The human virus also appeared to be more sensitive than SA11 to the action of ether and chloroform. The infectivity of both viruses was lost after UV irradiation for 15 min and after treatment with 8% formaldehyde for 5 min, 70% (vol/vol) ethanol for 30 min, and 2% lysol, 2% phenol, and 1% H2O2 for 1 h each.

Immunochemical characterisation of the myofibrillar proteinase from cultured rat myocytes as chymase

The proteinase extracted from the myofibrillar fraction of (a) primary rat myocytes and (b) the L-8 myogenic cell line, both maintained in culture, was identified by immunochemical analysis as chymase, the chymotrypsin-like serine proteinase of rat mast cells. Chymase would therefore appear to be an intrinsic protein in the rat myocyte also.

Biological characterization of six Australian isolates of potato virus Y and their serological detection by ELISA

Six potato virus Y isolates from Victoria and Queensland were characterized on the basis of host plant reactions. Four isolates from potato produced symptoms in indicator plants and potato cultivars consistent with those caused by the PVYO group. Two isolates from tobacco produced necrotic symptoms on some tobacco cultivars characteristic of the PVYN group, but did not systemically infect potato cultivars and therefore could not be considered to belong to any of the previously described PVY strain groups. Despite the wide variation in their biological characteristics, an antiserum produced to one of the potato isolates was able to detect all six of the isolates when used in ELISA

Alkaline proteinase localization in myoblasts

Recent interest in elucidating the role of non-lysosomal proteases in intracellular protein catabolism in muscle has led to various investigations with three alkaline proteases: a trypsin-like, a chymotrypsin-like, and a high molecular weight cysteine proteinase. Although in vitro biochemical assays have revealed the catabolic potential of at least two of these proteases, confirmation of their presence in muscle cells has been difficult. In this study immunohistochemical techniques were employed to localize each of these proteases in rat myoblasts. Antisera against the trypsin-like and chymotrypsin-like proteinase (both serine proteinases) showed strong localization in the cytoplasm immediately around the nucleus. Both also stained chromatin material in the nucleus of these cells. Fluorescent localization of the high molecular weight cysteine proteinase (Proteinase I) also appeared to be cell-associated in the myoblasts. The use of myoblasts in cell culture sections of whole muscle was advantageous, since localization of the proteases could be assessed in the absence of other cell types.

Antigenic analysis of rotavirus isolates using monoclonal antibodies specific for human serotypes 1, 2, 3 and 4, and SA11

Five neutralizing monoclonal antibodies produced against human rotavirus (HRV) serotypes 1, 2, 3 and 4 and the simian rotavirus (SA11) were used to study 59 rotavirus isolates of human, simian and feline origin previously serotyped using polyclonal antisera. In neutralization tests, 19 of 26 HRV serotype 1 isolates, both strains of HRV serotype 2, 14 of 24 HRV serotype 3 isolates and all of seven serotype 4 isolates were neutralized by the homologous serotype-specific monoclonal antibodies. Use of the panel of monoclonal antibodies revealed antigenic differences between strains within serotypes 1 and 3 and, in the case of the serotype 3 strains, each variant had a unique RNA electropherotype. An enzyme immunoassay (EIA) which utilized the monoclonal antibodies essentially confirmed the neutralization results. Preliminary results show that direct serotyping in faecal extracts by EIA using these monoclonal antibodies is specific but lacks sensitivity.

Immunogold electron-microscopic localisation of calpain I in skeletal muscle of rats

By using a double-affinity-purified first antibody and colloidal gold-conjugated second antibody, it is shown that calpain I (a cysteine proteinase activated by micromolar concentrations of Ca2+) has a predominant intracellular location in the I-band region of the extensor digitorum longus (EDL) muscle of the rat, but is not exclusively associated with the Z-line.

Evaluation of carrier detection of Duchenne muscular dystrophy using carbonic anhydrase III and creatine kinase

Carbonic anhydrase III (CAIII) and creatine kinase (CK) were measured in plasma samples from a series of females at-risk as carriers of Duchenne muscular dystrophy and compared with control groups. Both plasma CAIII and CK levels were raised in a proportion of carriers. Although measurement of CAIII and CK was no more successful in identifying carriers than CK alone, CAIII could fulfill a useful confirmatory role, particularly for cases with a marginally elevated CK or where the sample is poorly preserved. The difference between the CK and CAIII results could indicate biochemical heterogeneity in the expression of Duchenne muscular dystrophy.

Fetal plasma carbonic anhydrase III in prenatal diagnosis of Duchenne muscular dystrophy

Carbonic anhydrase III (CAIII), a skeletal-muscle-specific enzyme which is elevated in the plasma of Duchenne muscular dystrophy (DMD) patients, was measured by radioimmunoassay in fetal plasma in order to evaluate its application to prenatal diagnosis of DMD. Using fetoscopy, pure fetal blood samples were taken at 17-24 weeks gestation from 25 fetuses at risk for DMD and from 78 control fetuses. Care was taken in the handling and storage of all samples. Normal sons were born in eight cases at risk for DMD. The CAIII levels in the infants were not significantly different from those of the control infants. Pregnancies were terminated in the remaining 17 at-risk cases. The CAIII levels in the fetuses were significantly different (p = 0.0034) from those of the control fetuses, although the distributions overlapped. Based on prior maternal risk, seven affected fetuses were expected in the terminated group; five had CAIII levels at or above the 95th centile of the control range. It is suggested that measurement of CAIII achieves partial discrimination between affected fetuses and their normal at-risk brethren.

Mechanism of inhibition of sickling by dimethyl adipimidate. Effects of intertetramer cross-linking

Dimethyl adipimidate (DMA), an effective antisickling agent in vitro, reacts with free amino groups producing chemically modified and cross-linked molecules. In this report, we have investigated the effect of cross-linked hemoglobin tetramers on sickle hemoglobin polymerization. Since the extent of cross-linking is pH-dependent, we first compared the solubilities of deoxygenated hemolysates prepared from sickle cells previously treated with dimethyl adipimidate at either pH 7.4 or 8.4. The solubility of the hemolysate increased from 18.6 +/- 0.8 g/dl in the untreated sample to 20.9 +/- 1.5 g/dl (pH 7.4) and to 25.4 +/- 3.0 g/dl (pH 8.4) after dimethyl adipimidate treatment. Removal of cross-linked hemoglobin tetramers from hemolysate obtained from dimethyl adipimidate-treated cells abolished part of this effect; at pH 7.4, the solubility decreased from 20.9 +/- 1.5 to 19.4 +/- 0.2 and at pH 8.4 from 25.4 +/- 3.0 to 21.0 +/- 1.5. However, the ratio of [14C]DMA-labelled hemoglobin in the sol phase to that in the gel phase in the unfractionated hemolysate was 1.17 at pH 7.4 and 1.25 at pH 8.4, suggesting that part of the cross-linked hemoglobin tetramers was incorporated into the gel. In order to further investigate the effect of cross-linked hemoglobin tetramers on sickle hemoglobin polymerization, we separated cross-linked hemoglobin tetramers on a gel-filtration column, prepared mixtures of untreated sickle hemoglobin and cross-linked hemoglobin tetramers and studied the polymerization of these mixtures. The Csat of the untreated hemolysate increased progressively from 18.6 +/- 0.8 to 22.5 +/- 0.8 g/dl with 33% cross-linked hemoglobin tetramers. The hemoglobin concentration in the gel decreased from 43 +/- 1.0 to 33.8 +/- 1.0 g/dl with 33% cross-linked hemoglobin tetramers, while the pellet volume fraction, phi p, increased with and almost approached 1 at 50% cross-linked hemoglobin tetramers. In addition, the sol phase contained a higher molecular weight distribution of cross-linked hemoglobin tetramers than the gel phase. These observations suggest that a loose polymer was formed in the gel phase with a hemoglobin concentration much lower than that of the control. Thus, polymerization of sickle hemoglobin is inhibited by: (1) exclusion of higher molecular weight cross-linked hemoglobin tetramers from the gel, and (2) loose incorporation of cross-linked hemoglobin tetramers into the gel, perhaps preventing lateral packing and formation of tightly ordered fibers.

The mechanism of inhibition of ureogenesis by acidosis

In perfused rat liver a decrease of cytosol pH, determined with pH-sensitive microelectrodes, from 7.2 to 6.85 is associated with a 50% fall in ureogenesis from ammonium chloride. In isolated rat hepatocytes the fall in ureogenesis due to acidosis is associated with decrease in the mitochondrial and cytosolic concentration of citrulline. Limitation of carbamoyl phosphate synthesis and thus citrulline supply could be responsible for the inhibition of ureogenesis observed.

Hormonal control of carbonic anhydrase III

Using radioimmunoassay, the concentration of carbonic anhydrase III (CA III) in the livers of adult male rats was found to be approximately 30 times greater than that observed in mature females. Castration of male rats led to a marked reduction in liver CA III concentrations that could be partially restored to control levels by testosterone replacement. Administration of testosterone to ovariectomized female rats induced about a 5-fold increase in liver CA III concentration. Immunoprecipitational analysis of the products of liver mRNA translation in vitro with antiserum specific for CA III showed that hormonal control of the levels of CA III in rat liver is mediated by changes in the amount of translatable CA III mRNA. Marked changes in liver CA III concentrations were also observed in developing and aging male rats. Different control mechanisms appear to operate in mouse and man.