Pretransplant HLA antibodies are associated with reduced graft survival after clinical islet transplantation

Despite significant improvements in islet transplantation, long-term graft function is still not optimal. It is likely that both immune and nonimmune factors are involved in the deterioration of islet function over time. Historically, the pretransplant T-cell crossmatch and antibody screening were done by anti-human globulin--complement-dependent cytotoxicity (AHG-CDC). Class II antibodies were not evaluated. In 2003, we introduced solid-phase antibody screening using flow-based beads and flow crossmatching. We were interested to know whether pretransplant human leukocyte antigen (HLA) antibodies or a positive flow crossmatch impacted islet function post-transplant. A total of 152 islet transplants was performed in 81 patients. Islet function was determined by a positive C-peptide. Results were analyzed by procedure. Class I and class II panel reactive antibody (PRA) > 15% and donor-specific antibodies (DSA) were associated with a reduced C-peptide survival (p<0.0001 and p<0.0001, respectively). A positive T- and or B-cell crossmatch alone was not. Pretransplant HLA antibodies detectable by flow beads are associated with reduced graft survival. This suggests that the sirolimus and low-dose tacrolimus-based immunosuppression may not control the alloimmune response in this presensitized population and individuals with a PRA > 15% may require more aggressive inductive and maintenance immunosuppression, or represent a group that may not benefit from islet transplantation.

Enhancing the success of human islet isolation through optimization and characterization of pancreas dissociation enzyme

A major obstacle to successful human islet isolation has been the variability of the enzymatic digestion phase. The aim of this study was to define optimal enzyme activity ranges normalized by the pancreas weight and to identify valid parameters for the optimal selection of successful lots of collagenase enzyme blends. Our results from 251 islet isolations showed that optimization of thermolysin dosage based on Caseinase unit/g pancreas contributed considerably to islet isolation outcome but that collagenase dosage measured by the manufacturer (Wünsch unit/g pancreas) was not a major determinant of islet isolation outcome. We also found that lot-to-lot inconsistency of enzyme performance was not explained by the activity values provided by the manufacturer, but rather by an in-house assay of class I collagenase (CI) and class II collagenase (CII); using a lot with a lower CII/CI resulted in a higher success rate. The odds of successful isolation was 8.67 times higher when a vial with CII/CI ratio <0.204 was used than when a vial with CII/CI >or=0.204 was used, suggesting that CII/CI ratio may be a strong predictor to distinguish potential lot success. This study provides a framework for improved enzymatic digestion in human islet isolation.

Aposthia: a birth defect or normal quantitative recessive human genetic trait?

Aposthia (natural circumcision) is the condition of being born without a prepuce. Usually sporadic cases are reported in the medical literature. In this paper for the first time we present the genetic profile of 3 families with aposthia trait and discuss the possible genetics.

Unilateral Hydrocephalus Due to Foramen of Monro Stenosis

Unilateral lateral ventricular dilatation due to foramen of Monro stenosis or constriction can present with headache. Fundoscopy can be normal. This condition is congenital, radiological appraisal can disclose the diagnosis, and treatment depends upon the symptomatology. The condition can be treated well with insertion of a ventriculoperitoneal shunt.

On the effect of a radiation field in modifying the intermolecular interaction between two chiral molecules

The change in the mutual energy of interaction between a pair of chiral molecules coupled via the exchange of a single virtual photon and in the presence of an electromagnetic field is calculated using nonrelativistic quantum electrodynamics. The particular viewpoint adopted is one that has an intuitive physical appeal and resembles a classical treatment. It involves the coupling of electric and magnetic dipole moments induced at each center by the incident radiation field to the resonant dipole-dipole interaction tensor. The energy shift is evaluated for fixed as well as random orientations of the molecular pair with respect to the direction of propagation of the field. A complete polarization analysis is carried out for the former situation by examining the effect of incident radiation that is linearly or circularly polarized and traveling in a direction that is parallel or perpendicular to the intermolecular distance vector. After tumble averaging, all polarization dependence of the energy shift vanishes. In both cases the interaction energy is directly proportional to the irradiance of the applied field, and is discriminatory, changing sign when one optically active species is replaced by its enantiomer. The asymptotic behavior of the energy shift at the limits of large and small separations is also studied.

Does the circadian pattern for acute cardiac events presentation vary with fasting?

BACKGROUND

Over one billion Muslims fast worldwide during the month of Ramadan. The impact of fasting on circadian presentation with acute cardiac events is unknown.

AIM

To determine if fasting has any effect on the circadian presentation of acute cardiac events.

SETTING AND DESIGN

A prospective study in a general hospital.

MATERIALS AND METHODS

Patients with acute coronary events were divided into two groups based on the history of fasting. Information about age, gender, cardiovascular risk factor profiles and outcome was collected. The relationship of time of presentation of initial symptoms with fasting was evaluated using Student's t-test, Mann-Whitney U-test and chi2 analysis.

RESULTS

Of the 1019 patients hospitalized during the study period, 162 were fasting. Although, fasting patients were more likely to present to the emergency department in the time periods 5-6 AM (10.5% vs 6.3%) and 11 PM (11.1% vs 7.1%) and were less likely to present in the time periods 1-2 PM (3.7% vs 7.2%) and 5-6 PM (3.7% vs 7.0%); these differences were not statistically significant. Fasting patients were less likely to have their symptoms start between 5 and 8 AM (11.1% vs 19.4%) and more likely to have symptoms between 5 and 6 PM (11.1% vs 6.0%) and 3 and 4 AM (11.1% vs 6.9%). These differences for time of initial symptoms were statistically significant (P=0.002).

CONCLUSION

Exogenous factors associated with fasting, namely, the changes in food intake and/or sleep timings, affect the circadian rhythm and influence the timing of presentation of acute coronary events.

Ximelagatran, the Oral Anticoagulant of the Future An Evidence Based Review

This article presents the available data on Ximelagatran, a novel oral direct thrombin inhibitor and explores its therapeutic potential Recent large clinical trials have evaluated the efficacy and safety of this anticoagulant compared to the standard anticoagulation therapy with warfarin and heparins in several thrombotic disorders. These trials provide strong evidence for the efficacy and safety of ximelagatran in the following clinical indications; the prevention of venous thromboembolism after knee or hip replacement, the treatment of deep venous thrombosis, and prevention of stroke in patients with atrial fibrillation. Further evaluation of this promising oral anticoagulant is warranted in other thrombotic cardiovascular disorders requiring chronic oral anticoagulation therapy such as in patients with prosthetic heart valves, intracardiac thrombi, dilated cardiomyopathy, after myocardial infarction and post percutaneous coronary interventions.

An Ab Initio and Density Functional Theory Study of Keto−Enol Equilibria of Hydroxycyclopropenone in Gas and Aqueous Solution Phase

Keto-enol tautomerism in hydroxycyclopropenone (2-hydroxy-2-cyclopropen-1-one) has been studied using ab initio methods, the B3LYP functional of density functional theory, as well as complete basis set (CBS-QB3 and CBS-APNO) and G3 methods. Absolute and relative energies were calculated with each of the methods, whereas computations of geometries and harmonic frequencies for hydroxycyclopropenone and 1,2-cyclopropanedione were computed in the gas phase but were limited to HF, MP2 and CCSD levels of theory, and the B3LYP functional, in combination with the 6-31++G** basis set. Using the MP2/6-31++G** gas phase optimized structure, each species was then optimized fully in aqueous solution by employing the polarizable continuum model (PCM) self-consistent reaction field approach, in which HF, MP2 and B3LYP levels of theory were utilized, with the same 6-31++G** basis set. In both gas and aqueous solution phases, the keto form is higher in energy for all of the model chemistries considered. The presence of the solvent, however, is found to have very little effect on the bond lengths, angles and harmonic frequencies. From the B3LYP/6-31++G** Gibbs free energy, the keto-enol tautomeric equilibrium constant for 2-hydroxy-2-cyclopropen-1-one <==> 1,2-cyclopropanedione is computed to be K(T)(gas) = 2.35 x 10(-6), K(T)(aq) = 5.61 x 10(-14). It is concluded that the enol form is overwhelmingly predominant in both environments, with the effect of the solvent shifting the direction of equilibrium even more strongly in the favor of hydroxycyclopropenone. The almost exclusive nature of this species is attributed to stabilization resulting from aromaticity. Confirmation is provided by comparison of the simulated vibrational spectra of hydroxycyclopropenone with the measured infrared spectrum in an argon matrix.

A general formula for the rate of resonant transfer of energy between two electric multipole moments of arbitrary order using molecular quantum electrodynamics

A general expression is derived for the matrix element for the resonant transfer of energy between an initially excited donor species and an acceptor moiety in the ground state, with each entity possessing an electric multipole moment of arbitrary order. In the quantum electrodynamical framework employed, the coupling between the pair is mediated by the exchange of a single virtual photon. The probability amplitude found from second-order perturbation theory is a product of the electric moments located at each center and the resonant multipole-multipole interaction tensor. Using the Fermi golden rule, a general formula for the rate of energy transfer is obtained. As an illustration of the efficacy of the theory developed, rates of excitation energy exchange are calculated for systems interacting through dipole-quadrupole, dipole-octupole, quadrupole-quadrupole, and the familiar dipole-dipole coupling. For each of the cases examined, the near- and far-zone limits of the migration rate are calculated from the result valid for all donor-acceptor separations beyond wave function overlap. Expression of the octupole contribution to the transfer rate in terms of its irreducible components of weights 1 and 3 leads to new features. The octupole weight-1 term is found to contribute only when the interaction is retarded, while the dipole-octupole weight-1 contribution appears as a higher-order correction term to the dipole-dipole rate. Order of magnitude estimates are given for the contributions of dipole-quadrupole and dipole-octupole terms relative to the leading dipole-dipole rate for near-, intermediate-, and far-zone separations to further understand the role played by higher multipole moments in the transfer of excitation and the mechanism dominating the process.

Resonant transfer of excitation between two molecules using Maxwell fields

The matrix element for the resonant transfer of excitation between two molecules possessing electric and magnetic multipole moments of arbitrary order is calculated using quantum electrodynamical response theory. A prerequisite of the method is the functional form for the lth order linear electric and magnetic multipole dependent electric displacement and magnetic field operators in the neighborhood of a molecule, whose derivation is also given. The initially unexcited species is viewed as a test body accepting energy resonantly via coupling to the Maxwell fields of the excited multipole source molecule. The generalized electric-electric multipole contribution to the matrix element is shown to agree with an earlier calculation using time-dependent perturbation theory. As an application involving both electric and magnetic terms, the rate of excitation transfer between two chiral molecules is computed and found to depend on the handedness of each species.

Features distinguishing amoebic from pyogenic liver abscess: a review of 577 adult cases

Distinguishing amoebic from pyogenic liver abscesses is crucial because their treatments and prognoses differ. We retrospectively reviewed the medical records of 577 adults with liver abscess in order to identify clinical, laboratory, and radiographic factors useful in differentiating these microbial aetiologies. Presumptive diagnoses of amoebic (n = 471; 82%) vs. pyogenic (n = 106; 18%) abscess were based upon amoebic serology, microbiological culture results, and response to therapy. Patients with amoebic abscess were more likely to be young males with a tender, solitary, right lobe abscess (P = 0.012). Univariate analysis found patients with pyogenic abscess more likely to be over 50 years old, with a history of diabetes and jaundice, with pulmonary findings, multiple abscesses, amoebic serology titres <1:256 IU, and lower levels of serum albumin (P < 0.04). Multivariate logistic regression analysis confirmed that age >50 years, pulmonary findings on examination, multiple abscesses, and amebic serology titres <1:256 IU were predictive of pyogenic infection. Several clinical and laboratory parameters can aid in the differentiation of amebic and pyogenic liver abscess. In our setting, amebic abscess is more prevalent and, in most circumstances, can be identified and managed without percutaneous aspiration.

Quantum dynamics calculations using symmetrized, orthogonal Weyl-Heisenberg wavelets with a phase space truncation scheme. III. Representations and calculations

In a previous paper [J. Theo. Comput. Chem. 2, 65 (2003)], one of the authors (B.P.) presented a method for solving the multidimensional Schrodinger equation, using modified Wilson-Daubechies wavelets, and a simple phase space truncation scheme. Unprecedented numerical efficiency was achieved, enabling a ten-dimensional calculation of nearly 600 eigenvalues to be performed using direct matrix diagonalization techniques. In a second paper [J. Chem. Phys. 121, 1690 (2004)], and in this paper, we extend and elaborate upon the previous work in several important ways. The second paper focuses on construction and optimization of the wavelength functions, from theoretical and numerical viewpoints, and also examines their localization. This paper deals with their use in representations and eigenproblem calculations, which are extended to 15-dimensional systems. Even higher dimensionalities are possible using more sophisticated linear algebra techniques. This approach is ideally suited to rovibrational spectroscopy applications, but can be used in any context where differential equations are involved.

Quantum dynamics calculations using symmetrized, orthogonal Weyl-Heisenberg wavelets with a phase space truncation scheme. II. Construction and optimization

In this paper, we extend and elaborate upon a wavelet method first presented in a previous publication [B. Poirier, J. Theo. Comput. Chem. 2, 65 (2003)]. In particular, we focus on construction and optimization of the wavelet functions, from theoretical and numerical viewpoints, and also examine their localization properties. The wavelets used are modified Wilson-Daubechies wavelets, which in conjunction with a simple phase space truncation scheme, enable one to solve the multidimensional Schrodinger equation. This approach is ideally suited to rovibrational spectroscopy applications, but can be used in any context where differential equations are involved.