Cross-reactivity of human leucocyte differentiation antigen monoclonal antibodies on porcine cells

Thirty-six subpanels of monoclonal antibodies (mAbs) supplied to the Fifth International Workshop on Human Leucocyte Differentiation Antigens were assayed on porcine peripheral blood leucocytes for cross-reactivity. Sixty-two of the 752 mAbs-stained porcine cells. These mAbs identified 30 different CD groups and will be valuable reagents in the field of porcine immunology.

Purification and characterization of bovine dendritic cells from peripheral blood

Optimal activation of T lymphocytes depends on TCR interaction with peptide/MHC complexes in conjunction with costimulatory signals, which are delivered by specialized cells called antigen-presenting-cells (APC). The population of APC is heterogeneous and includes dendritic cells, B cells and macrophages. The family of dendritic cells (DC) is widely distributed in tissues and plays a major role in the induction of primary T-dependent immune responses. The aim of this paper was to isolate and characterize dendritic cells from cattle. Two methods are described that have been used to isolate dendritic cells from bovine peripheral blood. One method involves sequential depletion of other cells, adherence and isolation of low buoyant density cells on Metrizamide column. The second involves enrichment of cells displaying receptors for plasma fibronectin, followed by adherence and separation on Metrizamide. Both preparations were characterized morphologically by flow cytometry and functionally. Both procedures produced enriched populations that did not express molecules typical of T cells (CD3, CD4, CD8, WC1), B cells (sIg, CD21) and monocytes (CD14, Fc gamma 2R). Procedure 2 yielded cells with a typical veiled DC morphology that were highly effective at stimulating allogeneic T cells. Procedure 1 yielded cells that did not have the veiled morphology and were less effective in the MLR which may represent a more immature stage.

The elaboration likelihood model and communication about food risks

Factors such as hazard type and source credibility have been identified as important in the establishment of effective strategies for risk communication. The elaboration likelihood model was adapted to investigate the potential impact of hazard type, information source, and persuasive content of information on individual engagement in elaborative, or thoughtful, cognitions about risk messages. One hundred sixty respondents were allocated to one of eight experimental groups, and the effects of source credibility, persuasive content of information and hazard type were systematically varied. The impact of the different factors on beliefs about the information and elaborative processing examined. Low credibility was particularly important in reducing risk perceptions, although persuasive content and hazard type were also influential in determining whether elaborative processing occurred.

Renal structural-functional relationships in early diabetes mellitus

To define the earliest renal morphological changes in patients with type I diabetes, we studied renal function and morphometric analysis of renal biopsies in 59 patients with diabetes for 5-12 years and normal blood pressure, normal creatinine clearance (CCr), and negative dipstick urinary protein. Arteriolar hyalinization and intimal fibrous thickening were noted in 43%. Glomerular basement membrane thickness and fractional mesangial volume were increased in 51% and 56%, respectively. The pre-pubertal and post-pubertal years of diabetes were associated with similar degrees of renal structural changes, but during the pre-pubertal years normal urinary albumin excretion (UAE) was seen. Principal factor analysis of morphometric structural parameters yielded four clusters of variables: "glomerular size" correlated with patient age, CCr, and UAE; "peripheral capillary decrease" correlated with glycosylated hemoglobin, diastolic blood pressure, glomerular filtration rate, and UAE; "mesangial increase" correlated with UAE; and "interstitial scarring" correlated with diastolic blood pressure. This study provides unique documentation of renal structural abnormalities which precede clinically evident renal functional abnormalities and documents that these early structural abnormalities are present in the pre-pubertal years of diabetes as well as postpuberty, and are associated with each other in constellations that correspond to postulated mechanisms in diabetic nephropathy.

Educational programme for staff implementing a new renal replacement therapy

Haemofiltration is increasingly being considered as an alternative choice of treatment to conventional Haemodialysis for patients with Acute and Chronic Renal Failure. A leading company in renal replacement therapy offered the renal unit the challenge of being one of the first units in the United Kingdom to trial a new on-line Haemofiltration machine.

Economic and ethical considerations in managed care

The growth of managed care has had a significant impact on the way hospitals provide medical services, the relationships between hospitals and physicians, and the relationships between providers and patients. This impact arises primarily from the economic constraints that managed care places on the provider. As hospital employees or contractors, and as consumers of health care services, clinical engineering personnel need to understand the effects of managed care on the hospital and the physician. Beyond general information, this knowledge can play a useful role in understanding the impact of managed care on the acquisition and use of medical technology, and the increasing role that clinical engineering can play in guiding investment in, use and maintenance of hospital medical equipment. Ironically, this potential for increased value occurs at a time when clinical engineering services and departments themselves are under increased scrutiny for their more measurable costs and value.

Enhanced therapeutic effect of amsalog (CI-921) in combination with cisplatin in vitro and in vivo

CI-921, the 5-methyl-4-carboxamide analog of amsacrine, in combination with cisplatin produced a 6-fold better cell kill in vitro than expected based on additive effects. The combination of CI-921 and cisplatin was subsequently evaluated in three in vivo model systems: intraperitoneally (TP) and intravenously (IV) implanted P388 leukemia, and advanced stage subcutaneously (SC) implanted LC-12 squamous cell carcinoma. All drug treatments were administered IP on an intermittent treatment schedule which was optimal for both agents. Combination therapy was superior to therapy with the best single agent alone, CI-921, in all three model systems. Against IP implanted P388 leukemia, combination therapy produced greater than 8 logs of net tumor cell kill with 60-day survivors (cures). This level of activity was 50-fold greater (1.7 log) than that obtained with CI-921 alone. An IV implant of P388 leukemia was used in a confirmatory study to provide a more rigorous evaluation against disseminated disease. Combination therapy against IV implanted P388 leukemia produced greater than 7.7 logs of net tumor cell kill, which was 630-fold greater (2.8 logs) than that obtained with CI-921 therapy alone. Against advanced stage LC-12 (200-1000 mg tumors at initial treatment), combination therapy improved tumor cell kill by 0.6 log (4-fold) over that obtained with CI-921 therapy alone and also produced greater numbers of 120-day survivors than did single agent therapy with CI-921. The combination of carboplatin and CI-921 was also evaluated against IV implanted P388 leukemia to determine if the enhanced therapeutic effect of CI-921 and cisplatin could be extended to include CI-921 and carboplatin. Combination therapy with CI-921 and carboplatin increased net log tumor cell kill by 0.8 and 1.5 log in two separate tests (6- and 32-fold, respectively) over that obtained with CI-921 therapy alone. The data indicate that combination therapy with CI-921 and platinum containing anticancer agents may have clinical application.

In situ distribution of integrin alpha 2 beta 1 and alpha-actinin in melanocytic proliferations

Integrin alpha 2 beta 1 is a transmembrane protein receptor for collagen and laminin previously reported as a melanoma tumor progression antigen. alpha-Actinin is an actin-binding protein reported to interact with the cytoplasmic domain of the beta 1-integrin chain of alpha 2 beta 1. In vitro, both alpha 2 beta 1 and alpha-actinin play a role in melanoma cell motility. In turn, increased melanoma cell line motility (measured as mean migration rates), correlates with metastasis. To determine the in situ distribution of these proteins, we used monoclonal antibodies directed against the alpha 2-integrin subunit of alpha 2 beta 1 and alpha-actinin on frozen sections of 33 melanocytic proliferations, which included dermal nevi, primary melanomas, and metastatic melanomas. We found that the superficial portion of all of the melanocytic proliferations tested stained for alpha-actinin. In benign nevi and superficial spreading melanoma, there was a notable loss of staining for alpha-actinin in the cells in the deep reticular dermis. In contrast, alpha-actinin was present on almost all of the tumor cells in the nodular melanomas and the melanoma metastases. Tumors stained either uniformly positive or uniformly negative for alpha 2 beta 1; the expression of this protein correlated with the later stages of melanoma progression. Our findings suggest that alpha-actinin protein levels initially decrease and then increase during melanocytic tumor progression, whereas the alpha 2 subunit protein appears in the later stages of melanoma progression. The variable distribution of these proteins is evidence for the differential adhesive and motile properties of subpopulations of cells in melanocytic proliferations.

Volatilization of chemicals from drinking water to indoor air: role of the kitchen sink

Contaminated tap water is one source of potentially hazardous air pollutants in residential indoor air. Contaminants have been observed to volatilize from household tap water sources, including showers, wash basins, bath-tubs, washing machines, dishwashers, and toilets. A background search of these sources led to the conclusion that more attention should be given to wash basins and tubs, the numerous operating conditions of which yield a significant range of chemical stripping efficiencies. In response, nine laboratory experiments were completed to determine chemical stripping efficiencies and mass transfer coefficients for a kitchen wash basin. Chemical stripping efficiencies ranged from 1.1% to 4.9% for acetone, 13% to 26% for toluene, and 18% to 48% for cyclohexane. The product of overall mass transfer coefficient and interfacial area (KLA) ranged from 0.06 L/min to 0.24 L/min for acetone, 0.7 L/min to 1.9 L/min for toluene, and 0.9 L/min to 3.5 L/min for cyclohexane. Results clearly indicate that chemical properties (e.g., Henry's law coefficient) and system operating conditions (e.g., liquid flow rate and nozzle type) have a significant effect on contaminant stripping efficiency. Furthermore, significant gasphase resistance can occur, even for relatively volatile contaminants, during some operating conditions. The latter observation has important implications with respect to conventional protocols used to extrapolate radon data to other volatile contaminants in drinking water.

What determines trust in information about food-related risks? Underlying psychological constructs

Trust in risk information about food related-hazards may be an important determinant of public reactions to risk information. One of the central questions addressed by the risk communication literature is why some individuals and organizations are trusted as sources of risk information and others are not. Industry and government often lack public trust, whereas other sources (for example, consumer organizations, the quality media, medical doctors) are highly trusted. Problematically, previous surveys and questionnaire studies have utilized questions generated by the investigators themselves to assess public perceptions of trust in different sources. Furthermore, no account of the hazard domain was made. In the first study reported here, semistructured interviewing was used to elicit underpinning constructs determining trust and distrust in different sources providing food-related risk information (n = 35). In the second study, the repertory grid method was used to elicit the terminology that respondents use to distinguish between different potential food-related information sources (n = 35), the data being submitted to generalised Procrustes analysis. The results of the two studies were combined and validated in survey research (n = 888) where factor analysis indicated that knowledge in itself does not lead to trust, but that trusted sources are seen to be characterised by multiple positive attributes. Contrary to previous research, complete freedom does not lead to trust-rather sources which possess moderate accountability are seen to be the most trusted.

Randomized, placebo-controlled, double blinded trial of dexamethasone in African children with sepsis

OBJECTIVE

To determine the effect of moderate dose dexamethasone administered before antibiotics on the outcome of African children with sepsis.

METHODS

The design was a randomized, double blinded, placebo-controlled trial of dexamethasone (0.2 mg/kg) vs. placebo given intravenously before antibiotic therapy. Patients were recruited from the patient populations at two missionary hospitals. Primary outcome variables were determined before analysis of data.

RESULTS

Seventy-two children with sepsis were enrolled in the study. Treatment with dexamethasone was not associated with improved outcome for any of six outcome variables: survival to discharge (83%, dexamethasone group; 89%, placebo group); hemodynamic stability at 48 h (33%, dexamethasone group; 49%, placebo group); median length of hospital stay (11 days, dexamethasone group; 11 days, placebo group); normal at discharge (90%, dexamethasone group; 75%, placebo group); normal at follow-up (90%, dexamethasone group; 72%, placebo group); and afebrile at 48 to 72 h (61%, dexamethasone group; 44%, placebo group).

CONCLUSIONS

These data indicate that a moderate dose of dexamethasone given before antibiotic therapy did not improve outcome in the pediatric patients with sepsis whom we studied.

Diagnosis and management of asthma: occupational health nurses' awareness and use of national consensus practice guidelines

A regional sample of members of the American Association of Occupational Health Nurses (AAOHN) from Maryland, Delaware, Virginia, and the District of Columbia was surveyed prior to the publication of the Expert Panel Report on Guidelines for the Diagnosis and Management of Asthma (time 1). The guidelines were disseminated directly to AAOHN members through an article in AAOHN Journal and an annual convention plenary session presentation at which copies of the Report were distributed. They were disseminated indirectly through medical journals and government documents. A follow up survey of AAOHN members' familiarity with and use of the Expert Panel Report was conducted 1 year later (time 2). Of the total eligible sample of 570 persons, 325 (57.0%) responded at time 1. Of these, 232 (71.4%) responded at time 2. One year after publication, 31 (13.4%) of the nurses participating in the time 2 survey were aware of the Report, 16 (6.9%) reported having an available copy of the Report, 31 (13.4%) were familiar with the recommendations in the Report, 17 (7.3%) referred to the guidelines and 34 (14.7%) based care on the guidelines. Multiple direct dissemination strategies of consensus guidelines to improve practice will be necessary if nurses' awareness and use are to be enhanced.

Fast-track care after cardiac surgery

This article explains the rationale for fast-track management of low-risk cardiac surgical patients and describes the selection process and care received by these patients at the Royal Brompton Hospital. A review of the fast-track audit is presented and discussed.

Long-term efficacy of continuing hepatitis B vaccination in infancy in two Gambian villages

In 1984, all non-immune children under the age of 5 years in the Gambian villages of Keneba and Manduar were vaccinated against hepatitis B virus (HBV). All children born in these villages since 1984 have been vaccinated in infancy. Despite a rapid fall in antibody concentrations, vaccine efficacy against HBV infection and chronic carriage of HBsAg has increased with time. Overall, vaccine efficacies in 1993 against HBV infection and chronic HBsAg carriage were 94.7% (95% Cl 93.0-96.0) and 95.3% (91.0-97.5), respectively. Breakthrough infections in vaccinated children largely originate from chronic HBsAg carriers. Thus, we tested 261 chronic carriers for HBV DNA and e antigen. The prevalence of these markers of infectivity, and the amount of HBV DNA, decreased greatly with age. Detailed studies of breakthrough infections over two 4-year periods revealed that in the second period there were fewer than half the expected numbers of infections. Our findings suggest that in Keneba and Manduar long-term vaccination is progressively decreasing HBV transmission by chronic carriers, since their infectivity diminishes with time.

Laboratory and bedside evaluation of portable glucose meters

A two-phase, laboratory and bedside, evaluation of blood glucose meters was conducted in this study. Four meters, the AccuData Easy (Boehringer-Mannheim, Indianapolis, IN), HemoCue Glucose (HemoCue, Mission Viejo, CA), LifeScan One Touch II (LifeScan, Milpitas, CA), and Miles Encore QA (Miles, Elkhart, IN) systems, were compared to the Nova Stat Profile 5 (Nova, Waltham, MA) as the laboratory reference. Precision, linearity, correlation to the laboratory method, interference from hematocrit, data management, and operator preference were examined. None of the meters were found to satisfy all of the study's evaluation criteria. Therefore, institutions must weigh which criteria are most important to their individual settings. Although the HemoCue Glucose was found to be technically superior, this meter had no data management capabilities. The Encore QA had greater variance and low bias, whereas the AccuData Easy had bias affected by hematocrit and glucose concentration, and the One Touch II had a negative hematocrit bias and limited linear range when compared to the Nova. Only meters meeting both minimal analytical performance and computerization requirements, the One Touch II and AccuData Easy, were selected for further evaluation. At the bedside, the One Touch II demonstrated performance consistent with the lab evaluation, whereas the AccuData Easy showed greater imprecision in the low glucose range and a correlation that varied with sample type: capillary, venous, or arterial blood. This evaluation indicates that the clinician must interpret near-patient glucose results with respect to meter limitations. FDA approval and marketing statistics, alone, are insufficient to judge the performance of the meters in routine institutional use. Independent method validation, under actual operating conditions, is a better means of predicting future performance of the meters.

Effect of level of lung injury on HR, MAP and SaO2 changes during suctioning

25 patients with documented lung injury were suctioned using a manual resuscitation bag (MRB) and a standardised procedure. Level of lung injury was not significantly correlated with changes from baseline in heart rate (HR) oxygen saturation (SaO2) or mean arterial pressure (MAP). However, HR and MAP increased significantly returning to baseline at 5 min. Patients' SaO2 did not change significantly during the procedure or up to 15 min afterwards. No changes in cardiac rhythm were found during the event or for 15 min afterwards. Standards for hyperoxygenation and hyperinflation could not be achieved using the MRB even with a standardised procedure.

In vivo experimental analysis of silicone implants on bone and soft tissue

We report experimentally produced silicone microparticles (synovitis) in 47 white rabbits and discuss the implications for clinical practice. Silastic HP100 (Dow Corning Wright, Arlington, TN) finger hinges (size 5) were inserted in 20 rabbit's knees. The upper tibia was replaced with Swanson design great toe implants in another 15 rabbits; articular cartilage was removed and endosteal drilling was performed in 6 animals as a "sham" arthroplasty. Small silicone blocks were inserted in the proximal tibial endosteal canal of 6 others. Animals were followed by monthly x-ray films and killed at 2, 4, 6, 12, and 16 months. Implant wear, bone surfaces, and soft tissue were examined under the operating microscope and by light microscopy; implant surfaces were examined with scanning electron microscopy. X-ray changes included reactive endosteal bone formation around implant stems as early as 1 month postoperatively; at 2-3 months the new bone line was clearest but it became progressively homogeneous and less evident. Extensive cortical erosion around the stems was observed in one third of the animals. Neither ossification nor lysis was observed around the silicone block. Proliferative synovitis was found at post-mortem examination beginning after 4 months; femoral condylar erosions were observed in most animals after 12 months. Wherever there was bone destruction, silicone particles were confirmed by x-ray spectrography.

In vivo experimental analysis of silicone implants used with titanium grommets

This study evaluated the titanium grommets recommended to reduce breakage by protecting hinge implants from bone edges. Silastic HP-100 (Dow Corning Wright, Arlington, TN) flexible finger implants (size 5) were used to replace one knee of 10 rabbits, and implants plus titanium grommets were used in another 10. X-ray films were taken monthly; deaths from each group were 1 animal at 2 and 4 months, 2 animals at 6, and 3 each at 12 and 16 months. X-ray films revealed that 4 of 10 implants from each group had fractured. Silicone fractures occurred identically at the proximal stem-hinge junction in both groups, destruction was always most pronounced at the dorsal surface of the proximal stems. The time from surgery to x-ray film evidence of implant fracture without grommets was an average of 9 months and with grommets 13 months. Although grommets delayed x-ray film evidence of fracture onset, after 14 months all implants in both groups of animals fractured. These findings do not support the hypothesis that grommets prevent silicone hinge implant wear or fracture in this experimental model.