Automated anti-Mullerian hormone measurement: data review to provide insights and interpretation

RESULTS

AMH results were pooled and a table with 2.5 and 97.5 percentiles for each age group constructed. Based on Youden index, the optimal cut off for low responders (0-3 eggs), was 5.5 pmol/l (87% sensitivity, 55% specificity) and for high responders (>15 eggs) 15.6 pmol/l (78% sensitivity, 57% specificity). AMH correlated with number of eggs collected (r = 0.48) and clinical pregnancies (r = 0.14), (p < .0001).

CONCLUSIONS

The table of AMH levels measured using the Access 2 fully automated immunoassay system according to age may be used as a reference and cutoff levels for high and poor responders are clearly defined to help tailor controlled ovarian stimulation, maximizing efficiency and ensuring patient safety. The use of a random access automated immunoassay system means that blood sampled on arrival can produce an AMH result in 40 mins by the time the subject enters the doctor's clinic together with other relevant endocrine markers.

In Situ Raman Spectroscopic Studies of Liquid Carbon Tetrachloride (CCl4) Under Static and Laser-Driven Shock Compression

High pressure (up to ∼2.2 GPa) Raman scattering studies were performed in carbon tetrachloride (CCl₄) under static and dynamic compressions using diamond anvil cell (DAC) and laser-driven shock methods, respectively, and their results are compared. The laser-driven shock experiments were conducted in a glass-confined target geometry. The symmetric stretching mode ν₁, symmetric bending mode ν₂, and asymmetric bending mode ν₄ blueshifts with pressure. Mode Gruneisen parameters were obtained for the above Raman modes. Time-resolved Raman spectroscopic (TRRS) studies were performed under laser-driven shock compression at different delay times. Shock velocity deduced from the intensity ratios of Raman signal scattered from unshocked and shocked regions of symmetric stretching mode is in agreement with the one obtained from one-dimensional hydrodynamic simulations.

Outcomes After Percutaneous Coronary Intervention in Women: Are There Differences When Compared with Men?

Despite advances in the diagnosis and treatment of coronary artery disease, there remains evidence of a disparity in the outcomes for women when compared with men. This article provides a review of the evidence for this discrepancy and discusses some of the potential contributing factors.

Time-Resolved Vibrational Spectroscopy of Polytetrafluoroethylene Under Laser-Shock Compression

Shock-wave-induced high pressure and nanosecond time-resolved Raman spectroscopic experiments were performed to examine the dynamic response of polytetrafluoroethylene (PTFE) in confinement geometry targets. Time-resolved Raman spectroscopy was used to observe the pressure-induced molecular and chemical changes on nanosecond time scale. Raman spectra were measured as a function of shock pressure in the 1.2-2.4 GPa range. Furthermore, the symmetric stretching mode at 729 cm^-1 of CF₂ was compared to corresponding static high-pressure measurements carried out in a diamond anvil cell, to see if any general trend can be established. The symmetric stretching mode of CF₂ at 729 cm^-1 is the most intense Raman transition in PTFE and is very sensitive to change in pressure. Therefore, it can also be utilized as a pressure gauge for large amplitude shock wave compression experiments. A maximum blueshift of 12 cm^-1 for the 729 cm^-1 vibrational mode has been observed for the present experimental pressure range. A comparative study on the similarities and differences from the earlier work has been done in detail. One-dimensional radiation hydrodynamic simulations were performed to validate our shock compression results and are in very good agreement.

Arrhythmogenic right ventricular cardiomyopathy (ARVC): case report and review of literature

Arrhythmogenic right ventricular dysplasia (ARVD) is an inherited condition characterised by fibrofatty replacement of the right ventricle. It causes sudden death in 30% of young adults and in 5% of those less than 65 years of age. As the presentation is non-specific, ARVD can be a diagnostic challenge leading to delayed treatment. We report a case along with the review of literature, of a 63-year-old man who presented (atypical) with a history of palpitations, dizziness and raised cardiac enzymes associated with ECG changes in the inferior and anterior leads. Further investigation helped in confirming this rare and potentially fatal cardiac condition.

Utility of bronchoalveolar lavage in the diagnosis of pulmonary infection in children with haematological malignancies

BACKGROUND

Fibre-optic bronchoscopy with bronchoalveolar lavage (BAL) is a safe procedure and is associated with low morbidity and mortality in immunocompromised children. Although many studies have highlighted the advantages of positive BAL results in the diagnosis of pulmonary infections, there have been few reports examining the impact of a negative BAL result on clinical management in immunocompromised children on empiric broad-spectrum antimicrobial therapy.

AIM

The aim of this study was to evaluate BAL in the diagnosis of pulmonary infections in children with haematological malignancies who develop pneumonia unresponsive to empiric antimicrobial therapy, and also to determine whether a negative BAL result contributed to the clinical management of these patients.

MATERIALS AND METHODS

A retrospective review of 44 BAL procedures performed in 33 children with haematological malignancy diagnosed and treated at Our Lady's Children Hospital, Crumlin, Dublin 12, Ireland, over a 10-year period was carried out.

RESULTS

We identified a pathogen causing pneumonia in 24 of 44 BAL procedures (54.5 %). The BAL procedure resulted in modification of antimicrobial treatment after 20 of 24 procedures with positive results (83.3 %) in 16 of 20 patients (80 %). Management was changed after 8 of 20 procedures with negative results (40 %) in 8 of 18 patients (44.4 %). The procedure was well tolerated in all patients.

CONCLUSIONS

Our study supports the use of bronchoscopy with BAL as a diagnostic intervention in this patient population. We consider BAL a safe procedure from which both positive and negative results contribute to the patient's clinical management.

Lesson of the month (2). An unique presentation of infective endocarditis

This lesson reports the case of endophthalmitis, a rare presentation of infective endocarditis (IE), two months following cardiac surgery. Although inflammatory markers were increased, blood cultures were negative. Transoesophageal echocardiography demonstrated an aortic root abscess. Culture of tissue obtained at surgery revealed the infective organism to be Aspergillus fumigatus, a rare cause of IE in the immunocompetent patient.

Idiopathic infantile arterial calcification with thrombotic microangiopathy--a unique case

Idiopathic Infantile Arterial Calcification (IIAC) is a rare syndrome of unknown cause characterized by disruption and calcification of the internal elastic laminae of fetal arteries with calcium deposits leading to fibrosis and occlusion of the arteries. The diagnosis is often made at post-mortem examination. However, in a few cases it has been detected prenatally as in this case. Fewer than 10 cases of antenatal detection of this condition have been reported in the literature. In our case, thrombotic microangiopathy was an added feature, which has not been reported thus far in the literature to the best of our knowledge.

A novel strategy for managing clopidogrel-induced adverse skin reactions

AIMS

We conducted a prospective observational study using a course of steroids and antihistamines to treat a cohort of patients who developed skin reactions to clopidogrel, to assess whether dual antiplatelet therapy could be continued in an outpatient setting.

METHODS AND RESULTS

This study included 2,701 patients who underwent percutaneous coronary intervention (PCI) at our centre over a 23 month period. Patients with skin reactions to clopidogrel were identified and then commenced on five days oral prednisolone (30 mg/od) and chlorpheniramine (4 mg/tds) for seven days. A subsequent telephone survey was performed to evaluate a number of variables. The probability of the adverse reaction being secondary to clopidogrel was assessed using the Naranjo adverse drug reaction probability scale. Twenty (0.7%) patients were identified who developed adverse skin reactions to clopidogrel. There was complete resolution seen in the majority (89%) of patients within an average of 3.2 days following treatment. One patient had partial resolution, and one had no response to treatment, but both were able to continue clopidogrel.

CONCLUSIONS

We propose a novel, safe and effective way of managing clopidogrel-induced skin reactions using a short course of prednisolone and chlorpheniramine, without stopping or substituting clopidogrel.

The response of IFNAR2 to high-dose IFNα2b during a neoadjuvant clinical trial

3027

Background: The appropriate subgroup of melanoma patients to select for high-dose IFNa2b (HDI) adjuvant therapy has been undefined since approval of this modality in 1996. A biomarker appropriate for clinical practice and relevant to the biological effects of this agent would be of great importance. IFNAR2 is required for type I IFN-dependent signaling. Therefore, the response of IFNAR2 during HDI was evaluated during a prospective neoadjuvant clinical trial of HDI. Methods: Following diagnostic biopsy and before definitive surgery, HDI was administered as a neoadjuvant therapy for patients with stage IIIB melanoma, in the context of an IRB-approved protocol UPCI 00- 008, separately reported. Immunohistochemical analysis of IFNAR2 was performed on fixed paired biopsies of 8 patients. Paired-sample permutation tests and two-sample permutation tests were used to evaluate the findings of this study. Mean values of the percentage of IFNAR2 positive cells are presented with standard errors (SE). Results: HDI down-regulates IFNAR2 in both responders and non- responders, from 86.875 ± 5.82 (pre-treatment) to 34.375 ± 9.919 (post-treatment), p = 0.0145. However, the decrease in IFNAR2 differs between responders (25.0 ± 12.583) and non-responders (69.0 ± 3.588), p = 0.021. Conclusions: HDI down-regulates IFNAR2 expression, and may provide a biomarker relevant to HDI benefit, given differences between patients with and without response to neoadjuvant therapy. A larger clinical trial is needed to evaluate these pilot data.

No significant financial relationships to disclose.

Refinement of purothionins reveals solute particles important for lattice formation and toxicity. Part 2: structure of beta-purothionin at 1.7 A resolution

The crystal structure of beta-purothionin (beta-PT) has been determined at 1.7 A resolution. beta-PT and previously solved alpha(l)-PT belong to a family of membrane-active plant toxins homologous to crambin. (beta-PT crystallizes in the same space group as alpha(l)-PT (1422) but with the c axis 3 A longer than (alpha(l)-PT. The unit-cell dimensions of beta-PT crystals are a = b = 53.94 and c = 72.75 A. Two data sets were collected on a multiwire area detector, each with R(sym) around 6.0%, and were merged to get a single data set at 1.7 A, (R(merge) = 9.6%). The X-ray structure of alpha(l)-PT was used to build a starting model for beta-PT. The beta-PT model was refined using the program PROLSQ from 10 to 1.7 A resolution to an R-factor of 19.8% with very good geometry. The final structure contains 439 atoms including 337 protein atoms, 77 waters, two acetates, two glycerols and one phosphate. The high-resolution structure of the beta-PT agreed well with that of the lower resolution alpha(l)-PT structure only after the latter was extensively rerefined. Both refinements revealed phosphate and glycerol molecules which are important in lattice formation. The binding of phosphate and glycerol molecules to purothionins (PT) was confirmed by NMR and was implicated in the biological activity of toxins. Modeling of phospholipid binding to PT based on glycerol and phosphate-binding site could shed light on the lytic toxicity of this protein-toxin family. Although the structures of (alpha(l)-PT and beta-PT preserve the overall fold of crambin, they exhibit key differences that are directly relevant to the toxicity of thionins.

Proposal for molecular mechanism of thionins deduced from physico-chemical studies of plant toxins

We propose a molecular model for phospholipid membrane lysis by the ubiquitous plant toxins called thionins. Membrane lysis constitutes the first major effect exerted by these toxins that initiates a cascade of cytoplasmic events leading to cell death. X-ray crystallography, solution nuclear magnetic resonance (NMR) studies, small angle X-ray scattering and fluorescence spectroscopy provide evidence for the mechanism of membrane lysis. In the crystal structures of two thionins in the family, alpha(1)- and beta-purothionins (MW: approximately 4.8 kDa), a phosphate ion and a glycerol molecule are modeled bound to the protein. (31)P NMR experiments on the desalted toxins confirm phosphate-ion binding in solution. Evidence also comes from phospholipid partition experiments with radiolabeled toxins and with fluorescent phospholipids. This data permit a model of the phospholipid-protein complex to be built. Further, NMR experiments, one-dimensional (1D)- and two-dimensional (2D)-total correlation spectroscopy (TOCSY), carried out on the model compounds glycerol-3-phosphate (G3P) and short chain phospholipids, supported the predicted mode of phospholipid binding. The toxins' high positive charge, which renders them extremely soluble (>300 mg/mL), and the phospholipid-binding specificity suggest the toxin-membrane interaction is mediated by binding to patches of negatively charged phospholipids [phosphatidic acid (PA) or phosphatidyl serine (PS)] and their subsequent withdrawal. The formation of proteolipid complexes causes solubilization of the membrane and its lysis. The model suggests that the oligomerization may play a role in toxin's activation process and provides insight into the structural principles of protein-membrane interactions.

Antiplatelet agents in atherothrombotic diseases

Atherothrombotic disease places a huge financial and social burden on the nation, and antiplatelet therapy is important in preventing this. Aspirin is most widely used but newer compounds are valuable, especially on top of standard therapy in patients with unstable angina or non-ST segment elevation myocardial infarction. This article reviews the changing use of antiplatelets.

Prevalence of markers of transfusion transmissible diseases in voluntary and replacement blood donors

BACKGROUND

Transfusion of safe blood requires a safe donor. The voluntary donor movement encompasses the concept of a donor who is free from transfusion transmissible infections. It is now mandatory to screen blood for hepatitis B surface antigen, antibodies to HIV-1 and HIV-2, antibodies to hepatitis C virus, syphilis and malarial parasites.

METHODS

Between 1996 and 2002, 235 461 donors were screened for markers of hepatitis B virus, and HIV-1 and HIV-2 using commercially available ELISA kits, VDRL test for syphilis and Geimsa stain for the malarial parasite, respectively. A total of 56 476 donors were screened for hepatitis C virus antibodies from June 2001 to December 2002, using third-generation ELISA kits.

RESULTS

The proportion of voluntary donors increased from 47% to 56% during the study period. The prevalence of HIV showed a steady increase from 0.16% in 1996 to 0.3% in 2002. The prevalence of hepatitis B surface antigen decreased from 1.55% to 0.99%. VDRL reactivity did not show any trend and ranged between 0.11% and 0.66%. Hepatitis C virus antibodies showed a prevalence of 0.4%. The prevalence of all markers was significantly less in voluntary donors. Among the voluntary donors, transfusion transmissible disease markers were significantly less in student donors as compared to other donors.

CONCLUSION

A change-over to a voluntary donor service would considerably reduce the number of infectious donors and, among voluntary donors, student donors are the safest.

Antiplatelet drugs in cardiovascular diseases

Platelets play a key role in the pathogenesis of atherothrombotic conditions, e.g. acute coronary syndromes, cerebrovascular and peripheral vascular events. Antiplatelet agents interfere with platelet activation and aggregation and, as such, would be expected to modify the natural history of cardiovascular disease. In this review we explore the evidence to support the use of such drugs, singly or in combination, in a variety of situations characterised by thrombosis and summarise some of the concerns inherent in their use.