[Improved liposome encapsulated hemoglobin by electret technology and its influence on the blood rheologic behavior in vitro]

To study the influence of different electret properties of Liposome Encapsulated Hemoglobin(LEH) on the blood rheologic behavior in vitro, four kinds of LEH have been prepared. Their electret properties have been determined by using Thermally Stimulated Depolarization Current(TSDC). The results show that 4# LEH, whose Ta is 12 degrees C and Ia is -5.6 x 10(-9) A, has the best electret property, furthermore, the results of the thrombus formation in vitro also show that the addition of 4# LEH induces the lightest thrombus figuration in vitro. It is obvious that the rational improvement of the electret property of LEH can meliorate the surface charge of blood and effectively inhibit the formation of thrombus.

An evaluation of whole blood testing for Helicobacter pylori infection in the Chinese population

BACKGROUND

Near patient tests for Helicobacter pylori were developed to assist in the management of dyspepsia patients in general practice. Most studies were performed in western populations.

AIM

To evaluate the rapid whole blood test (Flexpack HP) for H. pylori in the Chinese population.

METHODS

Consecutive dyspeptic patients referred for upper endoscopy were recruited. During upper endoscopy, biopsies were taken from the antrum and corpus for rapid urease test (CLO test) and histological examination. After endoscopy, the whole blood test (FlexPack HP) was performed according to the manufacturer's instruction. Patients then received a 13C-urea breath test. Results of the whole blood test were compared with the gold standard (CLO test, histology and 13C-urea breath test).

RESULTS

A total of 294 consecutive patients gave a valid Flexpack HP result for interpretation. The mean age of patients was 47.7 (range 15-85) years. Analysis showed a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 58%, 92%, 91%, 63% and 73% respectively.

CONCLUSION

The FlexPack HP whole blood test showed good specificity but lacked sensitivity. It is not sensitive enough to be used in a general practice setting for the test-and-treat approach in the Chinese population.

Use of donepezil in elderly patients with Alzheimer's disease--a Hawaii based study

Donepezil (Aricept) is a reversible acetylcholinesterase inhibitor which is indicated for the treatment of mild to moderate dementia of the Alzheimer's type. We did a retrospective analysis of 41 elderly Alzheimer's subjects of different ethnic groups including a large number of Asian and Hawaiian patients. Donepezil appears to be clinically effective in patients of different ethnicities with mild to moderate Alzheimer's disease, even at advanced age.

Two novel myogenic factors identified and isolated by sequential isoelectric focusing and sodium dodecyl sulfate-polyacrylamide gel electrophoresis

A number of environmental factors were used experimentally to enhance myogenesis during muscle regeneration; however, many hormones and growth factors have been shown to have the ability to increase the rate of satellite cell division, but they only work on satellite cells that are already active in many animal experiments. Recently, the crushed muscle extract (CME) of rats was found to be able to trigger dormant adult rat satellite cells to re-enter the cell mytogenic cycle; however, the identity of the active factors present in rat CME remains unknown. In the present study, the CME was fractionated by the strategy of sequential isoelectric focusing and sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) coupled with functional analysis by myoblast culture. Two satellite cell-specific myogenic factors were identified and purified from CME by this strategy. One of the factors has a molecular mass of around 7 kDa and another about 39 kDa. The factor of 39 kDa could be retained in heparin-Sepharose column and eluted with phosphate-buffered saline (PBS) containing 1 M NaCl, but the 7 kDa factor did not bind to the heparin column. These two purified myogenic factors could synergistically trigger the proliferation and differentiation of dormant satellite cells, whose progenies subsequently fuse in vitro, or fuse to pre-existing partially damaged muscle fibers to form full repair of the damaged muscle fibers or to form new myotubes to replace the completely damaged muscle fibers during the cascade of muscle healing and regeneration in vivo. The identities of these two myogenic factors are under study.

Age-related changes of aqueous protein profiles in rat fast and slow twitch skeletal muscles

Two-dimensional electrophoresis was used to generate the aqueous protein expression patterns of rat extensor digitorum longus muscle (EDL, fast twitch muscle) and solues muscle (SOL, slow twitch muscle) of different ages. Two specific protein spots, S1 and S3, were identified from EDL muscles at the ages of 12 and 18 months onward respectively. In the EDL muscles of aged rat (24 months) after intensive exercise training, S3 was still detected while S1 disappeared. In addition, diaphragm muscle (DIA, fast twitch muscle), which retains physically active throughout the life span, was used as nondisuse control. The results showed that the expressions of S1 and S3 in 24-month DIA muscle were identical with the trained aged EDL muscle. It is suggested that exercise might delay the onset of S1 expression. However, the expression of S3 over age seemed to be progressive and exercise independent. Another protein spot, S2 was identified to express only in young EDL and SOL muscles, but its expression decreased over age. Furthermore, exercise has no effect on S2 expression since S2 could not be detected in aged DIA as well as trained aged EDL and SOL muscles. These results indicated that aqueous protein expression patterns of skeletal muscle undergo changes during aging. Some of these changes such as S2 and S3 appear progressively, and some such as S1 could be delayed by exercise. S3 was identified as ubiquitin, which might play an important role in protein degradation during skeletal muscle aging process.

Liquid acrylic adhesive agents in interventional neuroradiology

Treating patients with brain arteriovenous malformations by the deposition of liquid embolic agents, particularly cyanoacrylates, requires judgment, technical expertise, and experience. Even though the first deposition of cyanoacrylate in human brain arteries occurred more than 25 years ago, the relative rarity of the disease and the high risk for complications has kept this procedure from being universally applied. Physicians are fortunate that, within the past year, new and better catheters have become available, and with the promise of approved cyanoacrylate devices that are now being evaluated, the future looks bright. This article reviews the history, chemistry, and uses of cyanoacrylate.

Influence of warfarin regimen type on clinical and monitoring outcomes in stable patients in an anticoagulation management services

Options for dosing warfarin include same daily dosing, such as 7 mg/day, and alternate-day dosing, such as 5 mg Monday and Thursday, and 7.5 mg all other days. Some practitioners favor same daily dosing because it is simple, whereas others prefer alternate-day dosing because it requires a single tablet size. Computerized records of patients followed by an anticoagulation management service were reviewed retrospectively to identify those whose anticoagulation was stable with one of these two dosing methods. Clinical and monitoring outcomes were compared between groups. Rates of hemorrhagic and thromboembolic complications were similar in the two groups, as were monitoring outcomes, including clinic visits/year, warfarin dosage adjustments/year, and percentage of international normalized ratios within range. Patients receiving the same daily dose reported lower rates of confusion (0% vs 7%) and dosing errors (3.3% vs 14%) that those receiving alternate-day dosing, and expressed a stronger preference for their regimen (40% vs 1.5%). When selecting a regimen, consideration must be given to patient-specific risk of confusion and dosing errors, associated costs, practicality and precision of dosing adjustments, and patient preference.

Early onset of hypernatraemic dehydration and fever in exclusively breast-fed infants

Five cases of moderately severe hypernatraemic dehydration were identified within a 5-month period between two regional hospitals in Hong Kong. Unlike previous reported cases, these exclusively breast-fed infants presented with the unusual triad of fever, absence of overt signs of dehydration and within the first week of life. Three of the cases also had high serum bilirubin concentrations at presentation. The fever subsided quickly and the serum bilirubin concentration fell rapidly within a few hours of rehydration. All infants made an uneventful recovery without permanent neurological sequelae. Fever, presumably secondary to dehydration, is an useful early warning sign. These cases emphasize the importance of early and regular measurement of bodyweight in exclusively breast-fed infants so that prompt identification of affected cases may prevent potentially detrimental complications.

The neonatal implications of a high placental ratio in small-for-gestational age infants

An increased placental ratio has been associated with small-for-gestational age (SGA) infants. A retrospective study on 252 singleton SGA infants without major anomalies born within a 1-year period was performed to determine the relationship between placental ratio and maternal/infant characteristics, and perinatal complications. The cases were categorized into three groups according to the placental ratio (<1 sd below the mean, within 1 sd of the mean, >1 sd above the mean) based on our previous data. There were more infants with a high ratio (32.9 per cent) than with a low ratio (15.5 per cent). While there was no difference in the maternal characteristics or antenatal complications, there was a significant trend in decreasing birthweight and an increasing placental weight in relation to an increasing placental ratio. The infants with a high ratio had increased incidence of meconium stained liquor, hypocalcaemia, hypomagnesaemia and phototherapy, a trend that was consistent even after exclusion of the preterm infants. Our data indicated that a high placental ratio in SGA infants was due to both increased placental size and decreased birthweight, and this was associated with increased neonatal morbidity.

Drug use behaviors among Asian drug users in San Francisco

Due to a pervasive bias toward Asian Americans, such as tendency to view Asian Americans as model minorities, drug use behaviors among them are often ignored by health professionals, researchers, and community members, including Asian community members. This study identified patterns of drug use behaviors in relation to cultural factors among Asian drug users in San Francisco, CA. A sample of 92 Asian drug users (35 Chinese, 31 Filipino, 26 Vietnamese) who were not currently enrolled in drug treatment programs were recruited through targeted sampling methods and interviewed using a questionnaire with open-ended questions. The study evaluated responses of the participants and used content analyses. This study clearly revealed that the patterns of drug use among Asian drug users are unique to their ethnicity, gender, immigrant status, and age groups. Also, Asian drug users share cultural constructs related to drug use such as fear of addiction and injecting drugs, and stigma attached to drug users in the community. Therefore, drug abuse prevention programs should address both common factors among Asian drug users, as well as unique factors in specific target groups (e.g., ethnic groups, Asian immigrants, Asian women, refugees, and adolescents).

Classical galactosaemia in Chinese: A case report and review of disease incidence

We report a case of galactose-1-phosphate uridyl transferase (GALT) deficiency in a full-term Chinese neonate, who presented with atypical biochemical features of hyperammonaemia in addition to the classical presenting features of jaundice and lethargy after feeding. Red cell GALT activity was virtually absent in the patient while 50% of normal activity was found in parents and a sibling. Mutation screening excluded both Q188R and N314D as the causative mutation in GALT gene, which suggested a possible genetic segregation among ethnic groups. Data from a Taiwan screening program suggested that the incidence of the disease was approximately 1 in 400 000 in the Chinese population which was a sixth of that in Caucasian populations.

Congenital nephrotic syndrome responsive to captopril and indometacin

Two children with congenital nephrotic syndrome are described (one with Finnish-type nephrosis, the other with diffuse mesangial sclerosis). Both children have had a prolonged and sustained clinical response with good physical health and normal growth patterns using captopril and indometacin as their sole treatment. No adverse effects have been noted. We recommend a trial of indometacin and captopril treatment in cases of congenital nephrotic syndrome.

Classical galactosaemia in Chinese: A case report and review of disease incidence

We report a case of galactose-1-phosphate uridyl transferase (GALT) deficiency in a full-term Chinese neonate, who presented with atypical biochemical features of hyperammonaemia in addition to the classical presenting features of jaundice and lethargy after feeding. Red cell GALT activity was virtually absent in the patient while 50% of normal activity was found in parents and a sibling. Mutation screening excluded both Q188R and N314D as the causative mutation in GALT gene, which suggested a possible genetic segregation among ethnic groups. Data from a Taiwan screening program suggested that the incidence of the disease was approximately 1 in 400 000 in the Chinese population which was a sixth of that in Caucasian populations.

Fat mass in infants and toddlers: comparability of total body water, total body potassium, total body electrical conductivity, and dual-energy X-ray absorptiometry

BACKGROUND

Accurate assessment of body composition in infants and children is fundamental to understanding normal growth and development. Validation of methods applicable to pediatric populations is needed. In the absence of a gold standard, this study was conducted to compare methods using total body water, total body potassium, total body electrical conductivity, and dual-energy x-ray absorptiometry measurements for the estimation of body fat mass in infants and toddlers.

METHODS

Repeated body composition measurements were performed on 76 healthy term infants at 0.5, 3, 6, 9, 12, 18, and 24 months of age. Total body water was determined by deuterium dilution and converted to fat-free mass. Total body electrical conductivity was used to measure fat mass. Total body potassium was estimated by whole-body counting and converted to fat-free mass. Dual-energy x-ray absorptiometry was used to estimate fat mass at 0.5, 12, and 24 months only. Data were analyzed by repeated measures analysis of variance, followed by Bonferroni multiple comparisons at 5%.

RESULTS

Significant differences among methods were encountered at each age (p = 0.001-0.05). The rank order of the methods and the magnitude of the method differences were a function of age, not of gender or infant feeding mode. Wide limits of agreement imply that the methods are not interchangeable for group or individual measurements.

CONCLUSIONS

Methods using total body water, total body potassium, total body electrical conductivity, and dual-energy x-ray absorptiometry to estimate body fat mass in infants and toddlers are not interchangeable and require further development and validation.

Severe congenital absence of skin in a preterm infant

A severe case of aplasia cutis congenita in a preterm infant is described. Although major problems with thermoregulation and fluid balance were anticipated, these parameters were relatively easy to control once the patient was stabilized. Meticulous skin care and rapid formation of a membranous-like fibrous tissue layer covering the denuded areas probably played an important role in minimizing excessive fluid and heat loss. The prognosis in aplasia cutis congenita is determined by the underlying associated anomalies, the severity of skin lesions and, in our case, the maturity of the infant who died from complications of prematurity.

Randomised controlled study of early use of inhaled corticosteroid in preterm infants with respiratory distress syndrome

AIM

To investigate the therapeutic efficacy of inhaled fluticasone propionate, started on day 1 of age, on ventilated preterm infants with respiratory distress syndrome.

METHODS

Starting within 24 hours of age, ventilated preterm infants (gestation < 32 weeks, birthweight < 1.5 kg) with respiratory distress syndrome were given a 14 day course (two puffs, 12 hourly) of either fluticasone propionate (250 microg/puff) (group 1, n=27) or placebo (group 2, n=26) with a metered dose inhaler-spacer device. Response to treatment was assessed by the rate of successful extubation by days 7 and 14 of age, changes in respiratory system mechanics, death, occurrence of chronic lung disease, and other neonatal complications.

RESULTS

More infants in the treatment group were successfully extubated by 14 days of age than those in the placebo group (17/27 vs 8/26; p = 0.038). The treated infants also showed a more significant improvement in respiratory system compliance during the first 14 days of life. The two groups, however, did not differ significantly in their need for systemic steroids after day 14 of age, death, or the occurrence of chronic lung disease. The treatment was not associated with any increase in neonatal complications, including those attributable to steroid induced side effects.

CONCLUSION

These results provide preliminary evidence that early treatment with inhaled corticosteroids may be beneficial to ventilated preterm infants with respiratory distress. Further study of its use in a large scale randomised trial is warranted.

Age-related impaired proliferation of peripheral blood mononuclear cells is associated with an increase in both IL-10 and IL-12

Reflective of age-associated decline in immune function among elderly individuals is a decrease in in vitro T cell proliferative ability. Impaired T cell proliferation in the elderly may result from disruption of the well-balanced network of regulatory cytokines produced during an immune response. The purpose of this study was to identify age-related changes in the production of interleukin (IL)-10 and IL-12, and to determine whether in vitro T cell proliferation can be enhanced in the elderly by modulation of these two key cytokines. The superantigen Staphyloccocus entertoxin B (SEB) was used to stimulate proliferation and IL-10 and IL-12 production in peripheral blood mononuclear cells (PBMC) in vitro. Proliferation was determined by standard tritiated thymidine uptake. Cytokine levels in culture supernatants were measured by ELISA. We observed impaired SEB-induced proliferation of PBMC in the elderly that is comparable to that seen with the polyclonal mitogen Con A. This age-related decline in proliferation was associated with increased production of both IL-10 and IL-12. Modulation of PBMC proliferative response with either recombinant IL-12 or IL-10-neutralizing antibodies can boost proliferation of elderly PBMC to the levels seen in unmodulated young controls.

A catalytic mechanism for caspase-1 and for bimodal inhibition of caspase-1 by activated aspartic ketones

We have evaluated 619 aspartic ketones with 9 different types of prime-side groups (acyloxymethyl, aryloxymethyl, arylthiomethyl, alkylthiomethyl, acylamino-oxymethyl, sulfonylaminomethyl, alpha-ketoamide, alpha-(1-phenyl-3-trifluoromethyl-pyrazol-5-yl)oxymethyl (PTP), and aliphatic ketones) as inhibitors of caspase-1. The inhibitory behaviors could be classified as reversible, inactivating, or bimodal (i.e. reversible inhibition followed by slow inactivation) based on the kinetically observed formation of reversible thiohemiketal complexes and conversion to an irreversible thioether adduct, and the mechanism of any given ketone was only poorly predictable on the basis of leaving group structure and chemistry. Among 201 bimodal inhibitors, the rate of conversion of the reversible thiohemiketal complex to the inactive thioether (k(i)) was strictly first-order, consistent with direct conversion of the thiohemiketal to the thioether with no intermediate collapse to free ketone and thiolate. We have examined 22 crystallographic structures of caspase-1 complexed as a thiohemiketal with the inhibitors from 8 different ketone classes, and found the Cys285S-C-C(alpha)-leaving group dihedral angle to be near either to 60 degrees or to 180 degrees. Only the 180 degrees conformation was permissive for SN2 displacement of the leaving group and, furthermore, positioned His237Ndelta to stabilize developing charge on the leaving group. Among these structures and 19 additional complexes, all showed a strong interaction between His237Ndelta and the ketone or thiohemiketal oxygen. We therefore propose a proteolytic mechanism for caspase-1 involving polarization of the scissile carbonyl by the His237 imidazolium group. During thiohemiketal/thioether conversion (but probably not during peptide hydrolysis), the leaving group is stabilized by the His237 imidazolium.

Antigen presenting cell function is enhanced in healthy elderly

Aging is associated with a progressive decline in T cell-mediated immune responses. Little is known about the effect of aging on antigen presenting cells (APC). We have recently reported an age-related decline in proliferative response of peripheral blood mononuclear cells from elderly volunteers to Staphylococcus enterotoxin B (SEB). Since SEB-induced stimulation of T cells is not restricted by major histocompatibility complex, experiments were conducted in which T cells and APC from young and healthy elderly subjects were combined. We initially demonstrated the decreased SEB-induced proliferative capacity of elderly T cell elderly APC co-cultures when compared with young T cell young APC co-cultures. Combination of purified T cells from elderly donors with APC from young donors maintained a reduced T cell proliferative response. Age-related decline in T cell function was also established by the reduced proliferative capacity of elderly T cells co-cultured with a reference monocyte cell line. Surprisingly, co-culture of APC from healthy elderly donors with purified T cells from young donors enhanced T cell proliferation. APC from elderly donors also marginally enhanced the proliferative response of an SEB-specific T cell line.

Long-term renal sodium handling in patients with cirrhosis treated with transjugular intrahepatic portosystemic shunts for refractory ascites

PURPOSE

The long-term effects of transjugular intrahepatic portosystemic shunts on renal sodium excretion are not known. We sought to determine these long-term effects, as well as to measure the effects of a sodium load in patients who are free of ascites.

SUBJECTS AND METHODS

Ten patients with cirrhosis who had been successfully treated with transjugular intrahepatic portosystemic stent shunt for refractory ascites were studied before the shunt and again at 6 and 14 months after the shunt while on a 22 mmol sodium/day diet. At 14 months they were also studied on a 200 mmol sodium/day diet for 7 days without diuretics. Renal sodium handling, central blood volume, neurohumoral factors, and hepatic function were measured.

RESULTS

Sodium balance was negative at 6 months (urinary sodium excretion [mean +/- SD] 51 +/- 11 mmol/day versus 7 +/- 2 mmol/day pre-shunt; P < 0.05), was maintained at 14 months (22 +/- 4 mmol/day; P < 0.05 versus pre-shunt), and was associated with normalization of renin activity and aldosterone levels, but not norepinephrine levels, as well as significantly improved renal hemodynamic measurements. Sodium loading with 200 mmol/day resulted in weight gain associated with increased central blood volume and appropriate renal sodium handling in most but not all patients (urinary sodium excretion 188 +/- 14 mmol/day), despite persistent nonsuppressibility of sympathetic hyperactivity.

CONCLUSIONS

In cirrhotic patients with refractory ascites treated with a transjugular intrahepatic portosystemic stent shunt, long-term renal sodium handling is improved. Adequate intravascular filling in ascites-free cirrhotic patients with normal portal pressure permits an improved but not normalized renal response to a sodium load, possibly due to persistently elevated sympathetic activity. Therefore, these patients should increase their sodium intake cautiously.

Cognitive task analyses for decision centred design and training

This paper presents three case studies of Cognitive Task Analysis (CTA) for defining systems design and training requirements. The approach taken involves a modification of the critical decision method of Klein et al. The authors utilized the revised CDM to obtain information from expert white-water rafting guides, general aviation pilots, and emergency ambulance dispatchers. The information obtained was used to develop multi-media tools for training rafting guides and general aviation pilots, and to redesign the VDU display requirements for the ambulance dispatchers. The examples demonstrate the utility of an approach to CTA that is closely based on relevant theory, and provides guidance to practitioners wishing to apply CTA techniques.

Risk factors for Enterobacter septicemia in a neonatal unit: case-control study

Thirty cases of Enterobacter aerogenes or Enterobacter cloacae septicemia diagnosed over a 32-month period in a tertiary care neonatal unit were enrolled in a case-control study. Each case patient was matched with two controls (patients occupying the cots nearest the case patient when the latter developed septicemia). Of the 32 perinatal characteristics evaluated, 11 were identified by univariate analysis to be significantly associated with the infection. These included parents being residents of the Vietnamese refugee camps, respiratory distress syndrome, necrotizing enterocolitis, umbilical arterial catheterization, umbilical venous catheterization, bladder catheterization, mechanical ventilation, antibiotic treatment, peripheral venous catheterization, nasogastric intubation, and parenteral nutrition. Multivariate analysis, however, showed that preceding bladder catheterization and ongoing parenteral nutrition were the only independent risk factors for enterobacter septicemia. Strict aseptic technique in the preparation of parenteral nutrition fluid and avoidance of bladder catheterization are measures that may reduce the risk of enterobacter sepsis for newborns.

Is homozygous alpha-thalassaemia a lethal condition in the 1990s?

Two cases of homozygous alpha-thalassaemia who received active treatment in accordance with parental wishes are reported. One infant survived and the other, although successfully weaned off mechanical respiratory support, unexpectedly developed portal vein thrombosis and died. Homozygous alpha-thalassaemia, a condition previously considered to be universally fatal, and an indication for therapeutic abortion, is now potentially curable with advances in diagnostic technology and treatment. However, active management of these cases raises serious ethical questions and has major financial implications on the health-care system. Invasive prenatal and intensive postnatal interventions should remain experimental and cannot be recommended as routine clinical practice until the questions of long-term neurodevelopmental outcome, and the morbidity and mortality associated with bone-marrow transplantation have been fully addressed. As a result of advances in information technology, more and more parents of affected foetuses are likely to request active treatment.