Serum retinol levels of persons aged 4-74 years from three Hispanic groups

Previous research suggests that Hispanics in this country may have poor vitamin A status. Using serum retinol data from the Hispanic Health and Nutrition Examination Survey, we examined the vitamin A status of Mexican Americans (MA), Cubans, and Puerto Ricans (PR) aged 4-74 y. MA had lower mean serum retinol levels and higher prevalences of serum retinol in the range of 0.70-1.01 mumol/L than did Cubans in several age-sex groups. The prevalence (or percentage) of serum retinol in a range indicating possible risk of functional impairment was not elevated in any of the Hispanic groups except the females aged 18-44 y. However, a high percentage of children and adolescents in the three Hispanic groups had serum retinol values in ranges that might indicate less-than-optimal vitamin A status. Determination of vitamin A status requires a more definitive assessment than by serum vitamin A alone.

An evaluation of a dry-fat product as a source of supplemental energy in pig diets

Three feeding trials (278 pigs) and one balance trial (14 pigs) were conducted to evaluate acceptance and utilization of diets containing a dry-fat product containing 90% fat. The fat was a mixture of equal parts vegetable and animal fats. In Trial 1, 4-wk-old pigs fed diets with 5% dry-fat added had average daily gain (ADG), average daily feed intake (ADFI) and gain/feed (G/F) values equal to pigs fed the diet containing 4.5% liquid fat, the unprocessed equivalent to the dry-fat. Values for G/F with both diets were higher (P less than .05) than for pigs fed the unsupplemented control diet. In Trial 2, dry-fat and roasted soybeans were compared as sources of supplemental fat in diets for finishing pigs. Both were efficiently utilized, with no differences (P greater than .05) among diets. In Trial 3, diets with 0, 5 and 10% levels of added dry-fat were fed to pigs from 34 to 100 kg. Rates of gain were not affected, but ADFI decreased (P less than .05) and G/F increased (P less than .05) with increased fat level. Carcass measurements were not affected by dietary treatment, but iodine number of backfat increased (P less than .05) with dietary fat level. In Trial 4, values for grams of N absorbed and retained and megacalories of energy absorbed and metabolized did not differ (P greater than .05) between diets with 0 and 5% added dry-fat. These results show that the dry-fat product was efficiently utilized by growing and finishing pigs.

Survey of burn education in entry-level physical therapy programs

We investigated the extent of burn education in entry-level physical therapy curricula and also collected information about oncology instruction. A questionnaire was sent to the directors of 96 entry-level physical therapy curricula, and 76 directors responded. Most of the respondents (98.7%) indicated that burn and cancer management warranted lectures. The programs that quantified instruction averaged 4.8 hours of burn-related medical and surgical lectures and 4.2 hours of burn-related physical therapy procedure lectures. The instructional time devoted to oncology was slightly less. Physicians presented the medical and surgical lectures in 36% of the curricula and provided instruction with physical therapists and nurses in 39% of the curricula. Physical therapists alone presented the lectures on physical therapy procedures in 83% of the curricula. Sixty-three percent of the respondents believed that new graduates could effectively treat both patients with burns and those with cancer, but other respondents attached various qualifiers to their responses. Some respondents thought that new graduates could not adequately treat patients with burns (12%) or cancer (8%). Suggestions for future physical therapy burn education are given.

Ethnic and racial differences in serum vitamin A levels of children aged 4-11 years

Interpretation of differences in serum vitamin A levels observed between Hispanic and non-Hispanic children may be complicated by confounding environmental factors. Data from the Mexican-American portion of the Hispanic Health and Nutrition Examination Survey and the second National Health and Nutrition Examination Survey were used to explore these differences in 4-11-y-old Mexican Americans and non-Hispanic blacks and whites before and after accounting for vitamin-mineral supplement use and poverty status. Initial differences in mean serum vitamin A levels and prevalences less than 20 micrograms/dL (0.70 mumol/L) or less than 25 micrograms/dL (0.87 mumol/L) among the three ethnic or racial groups were reduced or eliminated after accounting for the two descriptive variables. These results support the hypothesis that differences in serum vitamin A levels between Mexican-American and non-Hispanic children in the United States are due more to environmental factors than to ethnicity.

Magnesium metabolism in the rumens of lactating dairy cows fed on spring grass

Six rumen cannulated lactating Jersey cows were used to study the effects of an abrupt change from a dry diet to young spring grass on mineral metabolism in the rumen, on plasma Mg2+ levels and on water intake. There was an increase in the intake of dietary Mg2+ and concentration of ultrafilterable Mg2+ in rumen fluid when the grass was fed associated with a fall in plasma Mg2+ concentration and percentage urinary Mg2+ excretion. The pH of rumen fluid fell when the cows were fed grass and there was a close inverse relationship with the concentration of ultrafilterable Mg2+ and Ca2+. Changes occurred in the mineral composition of rumen fluid that interact to affect the absorption of Mg2+. The concentrations of NH3, ultrafilterable K+ and ultrafilterable Ca2+ increased and the concentration of ultrafilterable Na+ decreased. These changes were associated with an increase in the potential difference between rumen fluid and blood (positive). Water consumption fell abruptly when the grass was fed and some cows drank no water on several days. However, total water intake was almost doubled resulting in an increased rumen volume.

Biochemical studies on McLeod phenotype red cells and isolation of Kx antigen

Red cells of the McLeod blood group phenotype have weak Kell antigens, lack Kx antigen and have acanthocytic morphology. We have immunoprecipitated Kell antigens from McLeod red cells and show that they are markers on the same 93 kDa membrane protein that carries Kell antigens on normal red cells. However, as determined by Western immunoblotting, McLeod red cells have a marked deficiency of this protein. We have also studied the near-neighbour relationship of McLeod and common Kell red-cell membrane proteins by cross-linking intrinsic sulphydryl groups by oxidation, catalysed with orthophenanthroline and copper, or by cross-linking amino groups with dimethyl-3,3'-dithiobispropionimidate. Results were analysed by diagonal mapping in two-dimensional gels. No abnormalities of membrane protein inter-relationship were detected in McLeod red cells. We have isolated Kx antigen from K0 red cells by immunoprecipitation with human alloimmune anti-Kx serum, isolation of immune complexes from detergent-solubilized cell membranes with protein A-Sepharose and analysis of the eluted immune complex by SDS-PAGE under reducing conditions. Kx antigen is a marker on a red-cell membrane protein of approximately 37 kDa. Ko (Knull) red cells have about twice the amount of Kx antigen as do red cells of common Kell type. McLeod red cells have no detectable Kx antigen by serological tests or by immunoprecipitation.

Microbiological assay of blood serum for the vitamin B12 status of dairy cows

Four vitamin B12 assays were compared using blood sera from Friesian cows on winter diets or grazing. In herd 1, ten animals were blood-sampled three times at monthly intervals and the vitamin B12 concentration of the sera determined by the Poteriochromonas malhamensis and Lactobacillus delbrueckii assays. At all three sampling dates the results produced by the P. malhamensis assay were significantly greater than those produced by the L. delbrueckii assay. Cows in herd 2 were divided into two groups, each of 30 animals. One group was given a soluble glass bolus releasing cobalt and the other was unsupplemented. Milk yields were recorded throughout the experimental period and herbage samples were taken at intervals for cobalt determinations. Blood samples were taken at intervals from January to September 1983 and the vitamin B12 concentration of the sera determined by four different assay methods: the P. malhamensis and L. delbrueckii microbiological assays and the Becton Dickinson and RIA Products 'No-boil' radioassays. The last of these failed to detect vitamin B12 in any sample. There was a significant difference between the results obtained by the three other assays, with the Becton Dickinson radioassay consistently producing the lowest result and the P. malhamensis assay the highest result of the three. There was no significant effect of cobalt supplementation on milk yield.

Comparison of dietary intakes and iron status of vitamin-mineral supplement users and nonusers, aged 1-19 years

Despite widespread use of supplements, few studies have been conducted to determine if supplement users have better nutritional status. Using data from the second National Health and Nutrition Examination Survey (NHANES II), mean values of five iron status indicators (hemoglobin, mean corpuscular volume, transferrin saturation, erythrocyte protoporphyrin, and serum ferritin) and dietary intakes of several nutrients and food groups were compared between regular supplement users and nonusers aged 1-19 y. Users consumed more vitamin C and fruits and vegetables than nonusers in several age-sex groups. No significant differences in mean Fe status indicator values were observed except for hemoglobin for the 3-4-y olds and serum ferritin for the 5-10-y olds. In both cases, users had higher values than nonusers. In general, Fe status was not associated with supplement use but the reason cannot be identified from this survey.

The effect of various dose regimens of famotidine on basal nocturnal and meal-stimulated gastric secretion

The antisecretory profile of the H2-receptor antagonist famotidine was studied with various oral doses and regimens in 10 healthy volunteers with high basal acid output (greater than or equal to 5 mEq/hr). Doses included 10, 20, and 40 mg at 9 PM and 9 AM and also 40 mg at 9 PM only. In the 22 hours after the PM doses, overnight (midnight to 7 AM) basal acid secretion was evaluated. Daytime meal-stimulated secretion was assessed at 7 AM, 12 noon, and 5 PM. Doses of 10, 20, and 40 mg inhibited fasting nocturnal basal secretion by 69%, 86%, and 83% to 94%, respectively (P less than 0.01). Meal-stimulated secretion at 7 AM (10 hours after administration) was inhibited by 28% and 39% (P less than 0.01) by only the 40 mg doses. The response to the 12 noon meal was inhibited by the 9 AM doses of 10, 20, and 40 mg by 45%, 75%, and 85%, respectively (P less than 0.01). The effect of a 40 mg dose given at 9 PM only had dissipated by breakfast (7 AM). The response to the 5 PM meal was suppressed by the 20 and 40 mg doses given at 9 AM by 22% and 35%, respectively (P less than 0.05). Suppression was present in only eight of the subjects after the 20 mg dose but in all 10 after the 40 mg dose. The effect on basal gastric aspirate pH values paralleled those seen on acid output. An association was found between mean plasma concentrations of famotidine and mean inhibition of meal-stimulated acid secretion. However, individual values may not be predictive.

The first example of autoanti-Kx

An IgG autoantibody with Kx specificity was found in the blood of a 61-year-old white man. The antibody did not cause hemolysis of his own or transfused Kx-positive red cells. The patient is of common Kell blood type and does not exhibit any clinical or hematologic features of McLeod syndrome.

The relationship between the binding site of [3H]-d-cis-diltiazem and that of other non-dihydropyridine calcium entry blockers in cardiac sarcolemma

[3H]-d-cis-Diltiazem binds to canine cardiac sarcolemma in a specific, saturable, and reversible manner with a KD = 58.0 +/- 9.5 nM and a receptor site density (maximum binding) of 2.19 +/- 0.24 pmol/mg of protein. Bepridil and verapamil, Ca2+ channel inhibitors, can completely inhibit this binding at nM concentrations. This inhibition was determined from saturation binding data to be due to a change in affinity of the radioligand, suggesting a competitive interaction between the three drugs. However, in dissociation experiments, both bepridil and verapamil increased the dissociation rate of the radioligand. This effect is uncharacteristic of competitive inhibitors and suggests that bepridil and verapamil regulate [3H]-d-cis-diltiazem binding in a negative allosteric fashion through their own distinct binding sites.

Acquired loss of red cell Kell antigens

A 19-year-old patient with a long history of idiopathic thrombocytopenic purpura developed a potent antibody against a high-incidence antigen in the Kell blood group system. The direct antiglobulin test on his red cells was negative. His cells exhibited profound depression of Kell blood group antigens, but antigens of other blood groups were normal. Transfusion of incompatible blood was well tolerated and differential agglutination tests, using selected Rh antisera, showed in vivo survival of the transfused red cells for more than 8 weeks. However, the transfused red cells also showed acquired loss of Kell antigens. Five months after the initial findings, Kell-related antibody disappeared and Kell antigens reappeared on his red cells. The patient's serum stored from the initial investigation now reacted with his freshly collected red cells. These data suggest that an environmental agent in the patient's plasma was responsible for the temporary loss of Kell antigens from red cells in his circulation.

Epidemiology of bulimia and bulimic behaviors

A number of studies in recent years have attempted to establish prevalence rates for bulimia as defined by the DSM-III criteria and for bulimic behaviors such as binge eating, purging, and restrictive dieting. The literature has reported widely differing estimates of these behaviors. A critique of these studies suggests that a variety of methodological issues probably accounts for the lack of consistency across reports. A review of the literature indicates that some behaviors which could be considered bulimic are extremely widespread. Some recent work highlights the importance of using both behavioral and attitudinal variables in an assessment of clinically significant bulimia associated with life impairment, which is much less prevalent.

Acquired loss of red-cell Wj antigen in a patient with Hodgkin's disease

A patient with Hodgkin's disease became temporarily Wj-negative with alloanti-Wj in his serum. Four human autoantibodies, and 1 of 2 murine monoclonal antibodies, with serological characteristics of anti-Wj were nonreactive with his red cells, confirming that they have anti-Wj specificity. Six siblings of the patient are all Wj-positive. The patient was also temporarily Anton-negative, and cross-testing between Wj and Anton red cells and antisera showed mutual compatibility, indicating that the antigens are the same. The patient and 3 of his 6 siblings are also of the rare Lu: - 13 phenotype, providing the first evidence that this is an inherited characteristic.

Arthroscopic meniscal repair evaluated with repeat arthroscopy

Arthroscopic meniscal repair is a technically feasible approach to the treatment of meniscal tears in young active individuals. To evaluate this premise, we repaired 29 minisci in 27 patients and then arthroscoped their knees 3 months later. Repairs were limited to displaceable longitudinal tears. In 16 patients ligaments were intact. Eleven patients were anterior cruciate ligament deficient, six of whom underwent concomitant ACL reconstructions. In two patients, bicompartmental tears were encountered. Under arthroscopic control, using curved cannulae, horizontal mattress sutures of absorbable monofilament were placed across the tear, out through the capsule, and tied over the fascia, deep to the skin. No arthrotomies were performed, and all portions of the menisci could be reached with this method. Twenty-four of 29 repairs healed completely; 5 healed partially (30 to 50% healing). Four of the five failed repairs occurred in unstable anterior cruciate ligament deficient knees.

Effects of dimaprit on growth and differentiation of human promyelocytic cell line, HL-60

The human promyelocytic cell line HL-60, differentiates in response to a variety of agents including dibutyryl cAMP and agents which increase intracellular cAMP concentrations (phosphodiesterase inhibitors, PGE2, and cholera toxin). HL-60 is also known to be rich in H2 -histamine sensitive adenylate cyclase activity. The present study was therefore designed to test the effects of H2-stimulation on growth and differentiation of HL-60 using the potent H2 agonist dimaprit. Dimaprit markedly increased cAMP production in a dose-dependent manner reaching maximal levels after 30-60 minutes. Intracellular cAMP levels decreased thereafter and by 24 hours were approximately 2-3 fold increased above control. Intracellular cAMP levels were not altered by dimaprit (10(-7)M to 10(-4)M) at 4 days in culture compared to either untreated HL-60 cells or dimethylsulfoxide (DMSO) (1.3%) treated cells. While exponential growth was unaltered by dimaprit (10(-7)M to 10(-4)M) as compared to control, dimaprit induced i) morphologic maturation to the myelocyte and metamyelocyte form with no differentiation seen beyond the metamyelocyte even after 6 days in culture, ii) increased NBT reductase activity and iii) dose-dependent increase in lysozyme activity which could be completely blocked by cimetidine, a specific H2 antagonist. Dimaprit-induced differentiation of HL-60 cells was associated with an initial but transient increase in intracellular cAMP production. Maturation beyond the metamyelocyte stage was not observed. Acquisition of NBT reductase and lysozyme activity correlated with morphologic maturation.

Bulimia: multivariate predictors of life impairment

The current study investigated the ability to predict life impairment in a group of women who reported frequent binge eating episodes. Results indicated that a combination of feeling out of control when binge eating, frequent binge episodes, frequent use of laxatives for weight control, plus early age at onset, guilt feelings after binging, and a history of low weight best predicted life impairment. Implications of these findings are discussed with respect to refining DSM-III criteria for bulimia.

Sulindac and ibuprofen inhibit furosemide-stimulated renin release but not natriuresis in men on a normal sodium diet

We compared the effect of two commonly prescribed nonsteroidal anti-inflammatory drugs, ibuprofen and sulindac, and placebo on intravenous furosemide-induced natriuresis and renin stimulation in 11 healthy male volunteers, consuming a 100 mEq sodium, 80 mEq potassium diet. Chronic (6-day) therapy with each agent was followed by a 1-week washout period. There were no significant treatment-related differences in either urine volume or sodium excretion for any of the designated collection periods or for the cumulative value for the 4 h after furosemide administration. Similarly, differences among groups were not observed for creatinine clearance, urinary potassium and urinary chloride excretion. Mean basal plasma renin activity levels prior to furosemide administration on day 6 were significantly lower in the presence of ibuprofen (1.5 +/- 2.0 ng/ml/h;p less than 0.01) and sulindac (2,3 +/- 0.9 ng/ml/h; p less than 0.05), compared with placebo (3.3 +/- 1.1 ng/ml/h); the difference between the two NSAIDs was also significant (p less than 0.05). Mean plasma renin activity levels in the 4 h after furosemide increased significantly at all time points in comparison to basal values, but were significantly less for ibuprofen and sulindac groups in the first hour. Our data suggest that the natriuresis following intravenous furosemide in men consuming a normal sodium intake is not prostaglandin-dependent. Furthermore, the observation that sulindac suppressed basal and stimulated plasma renin activity levels, albeit to a lesser extent than ibuprofen, questions the claim that sulindac "spares' the kidney and compels further evaluation of this issue.

Treatment of bulimia with brief psychoeducational group therapy

Two groups of 10 normal-weight bulimic women received short-term, structured group treatment beginning 3 weeks apart in a multiple baseline design. The multifaceted treatment approach incorporated education, self-monitoring, goal setting, assertion training, relaxation, and cognitive restructuring. Results showed an overall reduction of 70% in binge/purge episodes. There were significant improvements in psychological functioning, including self-esteem, depression, assertiveness, and pathological attitudes about eating.

Histamine H2 receptor desensitization in HL-60 human promyelocytic leukemia cells

Recent studies have suggested that cyclic AMP (cAMP) may be involved in regulation of cell growth and differentiation of cancer cells. Incubating HL-60 cells in the presence of the specific H2 agonist dimaprit resulted in 30-fold increases in cAMP levels (EC50 = 5.7 X 10(-6) M) and morphological changes suggestive of cell maturation along the granulocyte pathway. However, cells cultured with 10(-5) M dimaprit showed more than an 80% decrease in their cAMP response to subsequent addition of H2 agonists, whereas the cAMP response to prostaglandin E2 was unaltered. Desensitization was time-dependent (halftime approximately 2.5 hr with 10(-5) M dimaprit), dose-dependent (dimaprit EC50 = 1.4 X 10(-6) M) and completely prevented by 10(-3) M cimetidine. Desensitization of HL-60 cells for 4 hr with 10(-5) M dimaprit followed by the addition of 10(-3) M cimetidine resulted in total recovery of the cAMP response in less than 24 hr. The pharmacologically inactive analog N-methyldimaprit (SK&F 92054) did not increase cAMP production or cause desensitization to H2 stimulation. Desensitization was observed in the presence or absence of a phosphodiesterase inhibitor, indicating that induction of cAMP-phosphodiesterase was not involved in this process. No difference in the number of [3H]tiotidine binding sites was observed between control and dimaprit-desensitized HL-60 cells. Based on these results, we suggest that H2 receptor agonists caused an agonist-dependent desensitization, presumably due to an uncoupling of receptors from adenylate cyclase.(ABSTRACT TRUNCATED AT 250 WORDS)

Strategic feeding of high yielding dairy cows

Computerised management schemes are widely used in British dairy herds yet the standardised lactation curves might not be the most appropriate in particular herds. The shape of these curves is more a reflection of feeding than lactational physiology. Experimental evidence supports the approach of prediction of yield potential for each cow in early lactation, the mean rate of fall for the herd and appropriately tailored feeding. Daily pattern of supplementary feeding interacts with body energy balance and might have implications in the incidence of metabolic diseases and infertility. Compositional quality and total yields of milk constituents are influenced by the level of nutrition used at the onset of each lactation.

Indacrinone: natriuretic and uricosuric effects of various ratios of its enantiomers in healthy men

Indacrinone is an investigational loop-acting diuretic. To evaluate the natriuretic and uricosuric effects of varying ratios of its enantiomers, 10 healthy men, on a controlled Na+ (100 mEq) and K+ (80 mEq) diet, participated in a double-blind, randomized, balanced incomplete block, multiple-dose (one week) study of a fixed daily dose (10 mg) of (-) enantiomer combined with increasing doses (40, 90 and 140 mg) of (+) enantiomer versus 50 mg hydrochlorothiazide and placebo. On day 1, mean 24-h urinary Na+ increased (p less than 0.01) comparably (approximately 285 mEq) after each enantiomer combination and hydrochlorothiazide; however, the enantiomer combinations had marked uricosuric and hypouricemic effects that were enhanced with increased (+) enantiomer doses. By day 7, while enantiomer combinations and hydrochlorothiazide demonstrated comparable natriuretic activity, mean serum uric acid levels (mg/dl), in comparison to placebo, were increased (p less than 0.05) with hydrochlorothiazide but progressively decreased with increases in (+) enantiomer. Thus varying the ratio [(+, uricosuric): (-, natriuretic)] of the enantiomers of indacrinone caused natriuresis similar to hydrochlorothiazide, but had an opposite effect on serum uric acid.

Physical therapists as scar modifiers

Hypertrophic scars, a common sequelae to burn injuries, represent an overgrowth of dermal components like collagen. To the burn-injured patient, the red, raised, rigid scars represent impaired function and distorted appearance. Physical therapists modify scars by treating with pressure and stretching to minimize the devastating effects. Healing time, location of the injury, condition of the unhealed and healed areas, and treatment cost influence physical therapy. This article describes scarring and provides practical guidelines for pressure materials and stretching techniques. With an appropriate program, caring for a patient with burns becomes extremely beneficial and rewarding.

Operative management of thyroid disease. Technical considerations in a residency training program

Experience with 294 thyroid operations at Medical Center Hospital as performed by resident housestaff in general surgery has been reported. Operative results were consistent with the morbidity and mortality figures from large reviews. The importance of an active role for surgical housestaff in the operative management of thyroid disease is emphasized. With close supervision and attention to intraoperative identification of the recurrent laryngeal nerves and parathyroid glands, satisfactory results can be achieved.

Effects of sulindac and indomethacin on renal prostaglandin synthesis

We compared the effects of sulindac and indomethacin, the effects of two nonsteroidal anti-inflammatory drugs, on renal prostaglandin synthesis and renal function. Sulindac, 200 mg twice daily, indomethacin, 25 mg four times a day, or placebo were taken by 15 normal female subjects (five in each of three treatment groups). Indomethacin decreased renal excretion of prostaglandins PGE2, PGF2 alpha, and 6-keto-PGF1 alpha, but sulindac and placebo had no effect on renal prostaglandin excretion. Concomitant with the reduction of renal prostaglandin synthesis in the indomethacin group, sodium and chloride excretion decreased; sulindac and placebo had no discernible effects on urine electrolytes. Extrarenal cyclooxygenase activity, as assessed by platelet thromboxane beta 2 release, was inhibited by both sulindac and indomethacin. Plasma renin activity and plasma aldosterone levels fell in all groups as a result of positive sodium balance, but the decrements of aldosterone were greater after indomethacin and sulindac. None of the treatments altered glomerular filtration rate or renal plasma flow in these normal women. We conclude that in normal women renal prostaglandin synthesis and prostaglandin-dependent tubular functions such as Na and Cl reabsorption are relatively unaffected by doses of sulindac (200 mg twice daily) that inhibit nonrenal cyclooxygenase. This may reflect the capacity of oxidative enzymes in the kidney to convert the active sulfide metabolite of sulindac to the inactive prodrug sulindac sulfoxide.

Isolation of Kell-active protein from the red cell membrane

Kell blood-group-active protein has been isolated by labeling red cell surface proteins with 125I, sensitizing intact cells with anti-K1, anti-K2, anti-K7, or anti-K22, solubilizing the cell membranes, isolating immune complexes, and separating their components by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). Each antibody separated a protein of approximately 93,000 daltons. Periodic-acid Schiff (PAS) staining of Kell protein showed that it was glycosylated. When separated under non-reducing conditions, Kell protein had different SDS-PAGE characteristics with protein bands of approximately 85,000 daltons and 115,000 daltons. This suggests that in the red cell membrane Kell protein is complexed with other proteins. Quantitative experiments made with anti-K7, anti-K22, and a mixture of anti-K7 and anti-K22 indicate that both antigen specificities are present in the same molecule. These biochemical data support serological studies which indicate that K22 is part of the Kell system.

Grasp and pinch strength in children 5 to 12 years old

The objective of this study was to establish normative data concerning grasp and pinch strength for use by clinicians who are treating children with hand problems. A population of 474 children ages 5 to 12 were tested using the Jamar dynamometer and the Preston pinch guage. Means and standard deviations of all measurements for all subjects were determined. Results of the study indicate that there is a steady increase in both grasp and pinch strength that coincides with the increase in chronological age and development; males are consistently stronger than females across the age range in all tests, although the differences are not striking. Hand dominance was judged not to be an important factor in predicting strength in this population.

Posterior compartment fractures of the ankle. A commonly missed athletic injury

This paper brings to the reader's attention an injury and symptom complex resulting from an ankle sprain during athletic competition. Twenty patients were reviewed and followed over a 3 1/2 year period of time. Three patients presented acutely and 17 patients presented after an extended period of time with residual ankle morbidity. Common to this group of patients was a history of having sustained an ankle sprain, most commonly secondary to a forced plantar flexion type injury. Subsequent disability was generally posterior and postero-lateral ankle pain associated with running and/or jumping. Clinical examination invariably demonstrated posterior ankle pain, particularly with forced plantar flexion of the foot. All patients demonstrated bony changes in the area of the posterior talus and/or tibia by x-ray, and all patients had a positive technetium bone scan of the posterior ankle area. If the injury is diagnosed acutely, cast immobilization is the treatment of choice. If diagnosed late, it is suggested that for those patients who fail conservative treatment, surgical removal of the fragment is best. The majority of patients in this study required surgical extirpation of the posterior talus bony fragment in order to relieve symptoms and return to full sports competition.

Autoimmunity and the Kell blood groups: auto-anti-Kpb in a Kp(a+b-) patient

An example of auto-anti-Kpb in a Kp(a+b-) patient is described. The antibody present in the patient's serum and in eluates from her red cells was IgG. It did not bind complement, and did not cause in vivo hemolysis. 9 months after recognition of the autoimmune state the direct antiglobulin test had become negative and anti-Kpb was no longer detectable. It is postulated that autoimmunity involving the Kell blood group may be precipitated by antigens or enzymes of microbial origin.

Prevalences of anemia and iron deficiency anemia in Black and White women in the United States estimated by two methods

Prevalences of anemia were estimated by two methods for 742 Black and 3,074 White nonpregnant women of childbearing age drawn from a large probability sample of the United States civilian noninstitutionalized population (NHANES I). One method defines the prevalence of anemia as the proportion of women with hemoglobin levels below a 12 g/dl "cut-off". The second method defines the prevalence of anemia as the proportion of women whose hemoglobin values are shifted downwards relative to a distribution of hemoglobin values of non-anemic women. Estimates produced by both methods suggest a higher prevalence of anemia in Black than in White women. Estimates produced by the "cut-off" method, however, are higher than those from the "distribution" method for both racial groups, probably because the "cut-off" method results in large overestimates in populations where anemia prevalence is low. The "distribution" method is further used to estimate the contribution of iron deficiency to anemia. Essentially all anemia in White women and a high proportion of anemia in Black women is associated with iron deficiency in the US civilian noninstitutionalized population. Iron supplementation trials are needed in order to define the magnitude of the problem accurately and plan appropriate public health programs.

An individual with McLeod syndrome and the Kell blood group antigen K(K1)

McLeod syndrome is an X-linked condition in which individuals of McLeod blood group phenotype have weak Kell antigens, acanthocytic red cells, and a muscular disorder. We now report a family in which two brothers have McLeod syndrome. One is K:-1, while the other is the first known K:1 person with McLeod syndrome. The K1 gene in the latter is expressed weakly and was inherited from the father, in whom it is expressed normally. The brothers have the same clinical and laboratory manifestations of McLeod syndrome but have different Kell genes. Therefore, the Kell gene is unlikely to have any positive input into development of McLeod syndrome; its role is one of passive involvement in which its expression is modified.

A micro-analysis of "senility": the responses of the family and the health professionals

In research on 167 post-hospitalized older people, thirty individuals were described by their families as being senile. In comparisons of the behaviorally impaired with those who have only a physical condition, it was found that the behaviorally impaired were significantly more likely to be placed in a nursing home than were those with serious physical impairment. In this sub-group, the family also was much more likely to seek-out health professionals for advice in the disposition of the patient, although mental health professionals were rarely consulted. Through a case study analysis, we analyze the interactions between the patients, their families and the health professions as a three-stage process where the patient's behaviors become increasingly specified and elaborated. As a result behaviors formerly tolerated become a formal problem where the solution is likely to be institutionalization.

Depressed blood group antigens on red cells from a Mexican donor

Red cells from a Mexican blood donor had depressed H, IF, ID, i, Sda, Sdx, D, LW, Dib, Vel and JMH antigens. A wide range of other blood group antigens had normal activity. The unusual red cell phenotype may be caused by a membrane anomaly that alters orientation of certain cell surface components. The specificities of the depressed red cell antigens in this phenomenon differ from those affected in Melanesians with ovalocytosis or in individuals with the In(Lu) inhibitor gene.

Inactivation of Kell blood group antigens by 2-aminoethylisothiouronium bromide

Human red cells incubated with a solution containing 6% 2-aminoethylisothiouronium bromide (AET) lose activity of antigens that are part of, or related to, the Kell blood group system. However, Kx antigen is not inactivated. Studies on a wide range of other blood-group antigens show no other evidence of changes and AET appears to react specifically with red-cell membrane structures that have Kell activity. The AET procedure produces an artificial K0 red cell that can be used in blood group serology, and allows easy recognition of antibodies that are associated with the Kell system. AET has been used by other workers to produce a red cell that has many serological and biochemical characteristics of a PNH cell. Our studies on red cells from PNH patients have not shown any changes in Kell blood-group antigens.

Characterization of an anti-Dia antibody causing hemolytic disease in a newborn infant

A case of hemolytic disease in a newborn infant caused by anti-Dia is described. The parents are Japanese. The antibody was an IgG of subclasses IgG1 and IgG3, did not bind complement, and gave a 27 percent phagocytosis rate when used to sensitize red blood cells for a macrophage binding assay. The antibody was not detected during antenatal serologic testing. This case suggests the need for reagent red blood cell panels selected to match antibody specificities likely to be encountered in a particular population.