Biochemical responses of broiler chicks to folate deficiency

The effects of folate sufficiency and deficiency in three pathways of folate metabolism were studied in 2-and 3-week-old broiler chicks. Erythrocyte phosphoribosylpyrophosphate concentrations and dihydrofolate reductase (EC 1.5.1.3) activity were significantly elevated in folate deficiency. Percentage incorporation of deoxyuridine into bone marrow DNA was reduced in folate deficiency. There was a trend towards reduced liver dihydrofolate reductase activity in deficient chicks. These studies identify further biochemical criteria that can be used to assess folate status of chicks.

Some complications of the therapy of hemorrhagic disorders

The principal mode for treating disorders of hemostasis is correction of the patient's functional defect by transfusions of appropriate fractions of normal plasma or transfusions of platelets. Two major complications of such therapy are the transmission of infectious diseases, particularly hepatitis and the acquired immune deficiency syndrome (AIDS), and the development of antibodies against clotting factors that are deficient in the patient's plasma. Measures that reduce the occurrence of infection include careful selection of donors, fractionation of plasma with the help of monoclonal antibodies, and treatment of plasma or its fractions with heat or with virus-inactivating organic solvents. No technique of preparing or administering blood or its components can prevent the emergence of antibodies against clotting factors. Desensitization by repeated infusions of antigen, for example, antihemophilic factor, however, appears to result in remission in some patients.

Cellular biology of bone resorption

Past knowledge and the recent developments on the formation, activation and mode of action of osteoclasts, with particular reference to the regulation of each individual step, have been reviewed. The following conclusions of consensus have emerged. 1. The resorption of bone is the result of successive steps that can be regulated individually. 2. Osteoclast progenitors are formed in bone marrow. This is followed by their vascular dissemination and the generation of resting preosteoclasts and osteoclasts in bone. 3. The exact pathways of differentiation of the osteoclast progenators to mature osteoclasts are debatable, but there is clear evidence that stromal cells support osteoclast generation. 4. Osteoclasts are activated following contact with mineralized bone. This appears to be controlled by osteoblasts that expose mineral to osteoclasts and/or release a factor that activates these cells. 5. Activated osteoclasts dissolve the bone mineral and digest the organic matter of bone by the action of agents secreted in the segregated microcompartments underlying their ruffled borders. The mineral is solubilized by protons generated from CO2 by carbonic anhydrase and secreted by an ATP-driven vacuolar H(+)-K(+)-ATPase located at the ruffled border. The organic matrix of the bone is removed by acid proteinases, particularly cysteine-proteinases that are secreted together with other lysosomal enzymes in the acid environment of the resorption zone. 6. Osteoclastic bone resorption is directly regulated by a polypeptide hormone, calcitonin (CT), and locally, by ionized calcium (Ca2+) generated as a result of osteoclastic bone resorption. 7. There is new evidence that osteoclast activity may also be influenced by the endothelial cells via generation of products including PG, NO and endothelin.

Age-related changes in laboratory test results. Clinical implications

Many quantities assayed in clinical laboratories demonstrate age-related changes. Particularly important periods are early life, adolescence, old age, and after the menopause in females. The changes that occur until adulthood are well documented. Fewer data are available on elderly people even though they consume a large component of healthcare resources. In diagnosis, and prior to initiation of drug therapy, when no previous results are available, reference values must be available to aid interpretation. Reference intervals generated from elderly people are sometimes wider than in younger adults. It is suggested that conventional adult reference values should be used in general for the very elderly since, at least in part, the wider intervals are probably due to inclusion of individuals who are unhealthy in the reference sample group. Most quantities have marked individuality, and serial values for an individual span only a part of the reference interval. Individuals can have values which are very unusual for them but still lie within the reference limits; this implies that clinical laboratory tests will be less than ideal in the detection of latent or early disease. The average within-subject variation in healthy elderly people and younger adults is similar. Therefore, the large database on biological variation can be used, with analytical imprecision, to calculate critical differences for serial results in an elderly individual which must be exceeded before significance can be claimed. These critical differences are of value in monitoring the effects of drug therapy.

Diagnosis and management of salivary dysfunction

Salivary gland dysfunction may occur as a result of common medications, cancer therapy, or Sjögren's syndrome. Affected patients may develop significant oral, dental, and upper gastrointestinal sequelae. This article reviews the basic elements in diagnosis of salivary dysfunction, including initial evaluation and specialized diagnostic procedures. Patient management depends primarily on the severity of salivary dysfunction. More severe permanent forms of dysfunction, such as radiation-induced and Sjögren's syndrome, require long-term care, with preventive measures to maintain the dentition and therapeutic attempts to increase oral fluids.

Sialochemistry: a diagnostic tool?

Saliva has proven to be a discriminating element in forensic arenas, an effective indicator of acute diseases of salivary glands, and a promising probe for drug monitoring. With the advent of sensitive immunochemical assays, the compositional profile of human salivary secretions has been expanded considerably. Thus, the establishment of a range of "normal values" for a variety of "intrinsic" and "extrinsic" salivary components represented the initial step to use saliva as a diagnostic tool of oral health status. Unfortunately, numerous cross-sectional studies have shown a wide individual variation in the salivary composition of healthy populations, thus precluding its use as a diagnostic chair-side test for the screening of the most common chronic oral diseases (e.g. caries and periodontal disease). A possible explanation may arise from the wide functional versatility of salivary molecules. For instance, it has been recognized recently that in addition to its digestive properties, salivary amylase may modulate bacterial colonization, whereas histatins are not only antifungal but also bactericidal. Thus, low levels of already known antimicrobial salivary molecules (e.g., secretory IgA, lactoferrin, and lysozyme) could be compensated with higher concentrations of other molecules with antimicrobial activity, such as amylase and histatins. Consequently, for caries and periodontal diseases, longitudinal sialochemical studies may yield more insight than cross-sectional studies.

Environmental exposure to Aspergillus fumigatus allergen (Asp f I)

Asp f I is a major allergen produced by the mycelia of Aspergillus fumigatus. It is not present in spores and can be used as a specific marker for the detection of germination of this fungus. We investigated the domestic and outdoor concentration of Asp f I in Poole, U.K. and Charlottesville, VA, U.S.A. Asp f I was undetectable in 95% (281/296) of house dust extracts and present at low levels (< 0.17 micrograms/g of sieved dust, mean 0.038 micrograms/g) in the remainder. In contrast, Asp fI could be detected in 65% (15/23) of cultures of house dust, suggesting the presence of viable, but ungerminated, A. fumigatus in the majority of homes. Asp f I was detectable in 80% (28/35) of extracts of leaves and compost, but present in these outdoor samples at low levels (< 0.11 micrograms/g, mean 0.27 micrograms/g). Air sampling for Asp f I was undertaken before and after vigorous disturbances at indoor (n = 5) and outdoor (n = 6) sites. Airborne Asp f I was not detected in domestic samples or in undisturbed outdoor samples. Following disturbance it could be measured in outdoor samples (range 7.6-29 ng/m3). The results suggest that while exposure to A. fumigatus is common, exposure to Asp f I and germinating A. fumigatus is uncommon. It is probable that those individuals who develop antibody responses to Asp f I have been exposed to A. fumigatus which has germinated in their respiratory tract.

Effects of pyridinyl imidazole compounds on murine TNF-alpha production

The effects of SK&F 86002 and other pyridinyl imidazole compounds on murine cytokine production were investigated. In vitro, SK&F 86002 inhibited LPS stimulated TNF-alpha production by the RAW 264.7 cell line and by oil elicited peritoneal macrophages with an IC50 of 5 microM. In general, the activity was reflective of previous results obtained with human monocytes as SK&F 86002 and its analogs demonstrated identical rank order potency for TNF-alpha inhibition in both species. These compounds also inhibited TNF-alpha in vivo in a murine model of endotoxin shock. Following oral administration, SK&F 86002 and its analogs reduced serum TNF-alpha levels by > 80% and afforded 100% protection from lethality. In contrast, tenidap, a novel anti-inflammatory drug, had minimal to no effect on murine TNF-alpha production in the same assays. These data further extend the pharmacological profile of the pyridinyl imidazoles by demonstrating that these compounds potently inhibit murine TNF-alpha production both in vitro and in vivo.

Systemic viral infections and their retinal and choroidal manifestations

Viruses are one of the most common causes of infections involving the posterior segment of the eye. Such infections can occur either on a congenital or an acquired basis, and may affect primarily the retina or the choroid. Congenital cytomegalovirus (CMV) and rubella infections may result in retinitis. CMV retinitis is also the most common cause of acquired viral retinitis, primarily because of the acquired immunodeficiency syndrome (AIDS). Other types of viral retinitis, such as those caused by herpes simplex or herpes zoster, can occur in immunocompromised or immunocompetent individuals. Retinitis or choroiditis caused by viruses such as measles, influenza, Epstein-Barr virus, and Rift Valley fever virus, typically occurs subsequent to an acute viral systemic illness. The systemic and ocular manifestations, as well as the histopathology, laboratory tests, differential diagnoses, and treatment regimens for each of the individual viruses are discussed in detail.

Septic shock in critically ill patients: aetiology, management and outcome

Over a period of 28 months, 45 episodes of septic shock from 83 episodes of bacteraemia were studied prospectively to evaluate their clinical profile, management and outcome. Thirty-six patients were studied, the overall incidence of septic shock being 54.2%. Gram-negative organisms accounted for 23 (51.1%) of such episodes, Gram-positive 17 (37.8%), and three episodes were polymicrobial (6.7%). The organisms isolated most frequently were Staphylococcus epidermidis (17.8%), Pseudomonas aeruginosa (13.3%), Escherichia coli and Klebsiella sp. (each 11.1%). Coagulation abnormalities were detected in 32 episodes (78%) and disseminated intravascular coagulation (DIC) occurred in 11 of these with high mortality. The most common underlying conditions were respiratory, hepatic and renal failures. The majority of these patients received crystalloids, colloids, vasopressor drugs and blood. Swan-Ganz catheters (SGC) were inserted on eight occasions, the majority of times indicating a hyperdynamic circulatory response. The overall mortality was 40%, despite aggressive management and intensive care. The most important factor in reducing mortality is early detection of bacteraemia and prompt management of these patients.

IgG subclass deficiency in amyotrophic lateral sclerosis

In order to get to clues about T-cell independent versus T-cell dependent immune mechanism in ALS, we measured IgG subclasses in 25 ALS-patients: 16 patients had deficiency of T-cell dependent expressed IgG1 or IgG3 or both with essentially normal levels of T-cell independent expressed IgG2 and IgG4. Ten of these patients had no prior treatment and five of these 10 had normal total IgG. Six patients had some immunosuppressive treatment before measurements of subclasses were done and all of them had deficiency of total IgG. Eight of 14 patients who underwent a d-xylose breath test, had evidence of small bowel overgrowth, which was confirmed by cultures of duodenal aspirate. IgG1 and IgG3 are T-cell dependent antibodies against protein antigens with close linkage on chromosome 14. The findings suggest a defect in the IgG subclass expression in ALS.

Disorders of blood viscosity

In clinical situations associated with disturbed blood flow, the primary focus is usually on improving cardiovascular performance. However, during recent decades, both basic science and clinical literature reports have presented evidence that the flow properties of blood must also be considered in these situations. Thus, the relatively new fields of haemorheology and clinical haemorheology have evolved; the former deals with the flow and deformation behaviour of blood, plasma and the formed elements of blood, whereas the latter relates to alterations of their behaviour in various pathophysiologic states. This review therefore summarizes some of the salient aspects of clinical haemorheology and of the determinants of blood flow properties (flow rate, haematocrit, plasma viscosity, red cell aggregation, red cell deformability). In addition, it briefly describes several clinical disorders associated with abnormal blood, plasma or cell rheology ('hyperviscosity syndromes' occurring in polycythaemia, leukaemia, sickle cell disease, paraproteinaemias).

Recombinant Aspergillus fumigatus allergen I/a (rAsp f I/a) in the diagnosis of Aspergillus related diseases

A. fumigatus allergen I/a (rAsp f I/a) was produced in Escherichia coli, affinity purified by Ni(2+)-chelate chromatography and refolded. rAsp f I/a binds IgE of A. fumigatus-allergic individuals as shown by ELISA, dot blots and Western blots. In addition, rAsp I/a elicited positive immediate type I skin reactions in individuals allergic to A. fumigatus but not in control individuals. Hence, rAsp f I/a can be used as a standardized antigen/allergen for an improved serological and clinical diagnosis of A. fumigatus-associated diseases.

Subclinical and reversible hepatic effects of occupational exposure to trichloroethylene

To detect early hepatic effects of chronic exposure to low-level trichloroethylene (TCE), serum total cholesterol (T-C), high-density-lipoprotein cholesterol (HDL-C) and activities of three serum enzymes [aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyl transpeptidase (GGT)] were determined in 148 workers (a cross-sectional study) and in 13 workers (a 2-year follow-up study) occupationally exposed to TCE in air. In the cross-sectional study, three exposure groups were defined by urinary total trichloro-compounds (U-TTC) levels of the workers [low-exposure group (n = 49): U-TTC < 10 mg/g creatinine; moderate-exposure group (n = 56): U-TTC 10- < 100; high-exposure group (n = 43): U-TTC > or = 100]. With increasing exposure levels, T-C (P = 0.143 by ANOVA) and HDL-C (P = 0.080 by ANOVA) slightly increased. The exposure, however, had no effect on the activities of the three serum enzymes. In the follow-up study, the fluctuations in U-TTC were well reflected in subclinical changes in HDL-C, AST, and GGT, but not in T-C or ALT. These results suggest that exposure to low-level TCE influences hepatic functions, affecting cholesterol metabolism rather than causing hepatic cell damage, and that these influences are subclinical and reversible. The increases in HDL-C caused by exposure to low-level TCE may be an example of "chemical hormesis" in humans.

Iron: metabolism, toxicity and therapy

This paper is an overview on iron metabolism, iron toxicity and therapeutics against this toxicity. The attention has been focused on: i) the solubilization of iron by living organisms; ii) the iron metabolism in human; iii) the toxicity of iron (Fe-catalyzed reduction of oxygen, Fenton reaction, decomposition of lipid peroxides); iv) the natural protective mechanisms; v) the relations between iron, free radicals and human diseases; and vi) the iron overload and its treatment.

Sampling conditions for biological fluids for trace elements monitoring in hospital patients: a critical approach

Lack of coherence in the results of trace element (TE) analyses produced by various laboratories has been such as to necessitate much needed technical improvements and more detailed control over sample preparations. For too long, except for a few praiseworthy researchers, the importance of sampling conditions has been underestimated as a source of erroneous TE results. Many of the precautionary procedures for previously studied TE collection materials have proven to be so cumbersome that they cannot be applied in a hospital setting. This report deals with sampling material and conditions from a workday standpoint; a rigorous description of the contaminating roles of ambient air and routine handling of specimens places emphasis on the practical. While some metals, including cobalt, copper, iron, and selenium, present no significant risk of contamination, others, such as aluminum, cadmium, chromium, manganese, and nickel, pose quite a significant risk. They warrant attention with respect not only to the sampling itself but also the selection of the material to be used. Drawing on our hospital experience, we propose a critical approach toward the collection of samples of biological fluids (blood, urine, dialysis fluids). Needles, catheters, tubes (open and evacuated systems), and anticoagulants on the market are likewise assessed in terms of their contaminative roles. For each one elementary rules as well as realistic choices of materials and methods for a hospital environment are proposed.

New whole blood analyzers and their impact on cardiac and critical care

Miniaturized whole blood biosensors, patient-focused hospitals, and rising expectations of patients and physicians are shifting laboratory diagnostics to the point of care. Expanding transplantation and intensive care are increasing the need for rapid test results. Whole blood analysis improves accuracy, eliminates centrifugation, reduces response time, and conserves blood volume. Several hand-held, and over 20 portable or transportable whole blood instruments are now available. Criteria for instrument evaluation include test menus, point-of-care features, analysis time, on-site performance, and information integration. Whole blood analyzers measure several vital indicators (pO2, pCO2, pH, hematocrit, K+, Ca2+, Na+, Cl-, glucose, and lactate) simultaneously in less than 2 min with less than 200 microliters of whole blood. Other in vitro tests are available (Mg2+, osmolality, CO2 content, urea nitrogen, beta-hydroxybutyrate, hemoglobin, coagulation) or under development (HCO3- phosphorus). Some can be monitored in vivo (O2 saturation, pO2, pCO2, pH, glucose) or ex vivo. The clinical impact is demonstrated by ionized calcium, now established in importance for cardiac and neurologic problems, and ionized magnesium, a promising new measurement. The hybrid laboratory (a composite of conventional clinical laboratory and patient-focused testing), performance maps, and quality paths facilitate implementation of new whole blood analyzers for optimal support of cardiac and critical care, and improved patient outcomes (prospects).

Pre-analytical, analytical and biological sources of variation of lipoprotein(a)

The pre-analytical, analytical and biological sources of variation were estimated for serum lipoprotein(a) concentrations, as measured with a new commercially available procedure. There were no significant differences between the concentrations of lipoprotein(a) measured in EDTA plasma and serum. The analyte is stable in specimens stored for up to two weeks in the refrigerator, or up to three months at-20 degrees C. Fasting is not essential before the lipoprotein(a) determination. Data on analytical (between-run coefficient of variation < 15.7%), within-subject (8.6%) and between-subject variation (85.8%) were used to calculate the analytical goal for imprecision (< 4.3%), the critical difference between serial values from an individual that represents a significant change (36.3%), the number of specimens which should be collected to estimate the homeostatic value for an individual to within +/- 5% (26), and to establish the marked individuality of lipoprotein(a) (index of individuality, 0.1).

Extra-intestinal amebiasis: clinical presentation in a non-endemic setting

37/38 patients with reciprocal titers > or = 512 against Entamoeba histolytica in Denmark over a 5-year period were evaluated retrospectively in order to establish the clinical profile of extra-intestinal amebiasis in a non-endemic area. 24 of these had extra-intestinal amebiasis, all presenting 1 or more amebic liver abscesses on ultrasonography. Fever was the most common finding, present in 91% of the cases. The most striking observation was the lack of both abdominal pain and tenderness in 22% of the patients with liver abscess. Pulmonary symptoms and abnormal chest X-rays were each recorded in 45% of the cases. Liver abscesses with or without pulmonary involvement were the only extra-intestinal manifestations recorded. The condition was initially misconceived in more than half the cases, but most of the patients responded well once treatment with metronidazole was started.

Salivary diagnosis: more than a lick and a promise

There is a growing appreciation for the use of oral fluid as an easily collected, non-invasive diagnostic medium in a variety of disease states and clinical situations. Dental applications include differential diagnosis of salivary gland disease, caries and periodontal disease activity and susceptibility tests, Candida monitoring and testing for HIV and hepatitis.

Evaluation of a new monoclonal antibody combination reagent for direct fluorescence detection of Giardia cysts and Cryptosporidium oocysts in human fecal specimens

Giardia lamblia and Cryptosporidium parvum can cause severe symptoms in humans, particularly in the immunologically compromised. Monoclonal antibody reagents offer increased sensitivity and an excellent alternative to conventional staining methods. These reagents are helpful when screening large numbers of patients or those with minimal symptoms. Problems of false-positive and false-negative results with routine staining methods for stool parasites can be eliminated with monoclonal antibody reagents. Known positive formalinized specimens [Giardia sp. (n = 60), Cryptosporidium sp. (n = 55), and mixed Giardia-Cryptosporidium spp. (n = 10)] and negative formalinized specimens (n = 105), of which 46 contained other yeast or human cells or protozoa), were tested by the MERIFLUOR Cryptosporidium-Giardia direct immunofluorescence detection procedure. The MERIFLUOR reagent exhibited +/- to 4+ (majority, 2+ to 3+) on all Giardia cysts and 2+ to 4+ (majority, 3+ to 4+) on all Cryptosporidium oocysts. The cysts were generally oval (11 to 15 microns), while the oocysts were round (4 to 6 microns); both showed apple-green fluorescence against a background free of nonspecific fluorescence. All specimens positive for Giardia sp. and/or Cryptosporidium sp. showed fluorescence, and all specimens negative for the two organisms showed no fluorescence. There were eight specimens previously negative by the ova and parasite examination which were positive by the direct fluorescence method; four contained Giardia sp., and four contained Cryptosporidium sp. These positive results were confirmed after the examination of additional trichrome and modified acid-fast smears. The MERIFLUOR reagent was very easy to use, and even with a lower fluorescence intensity for Giardia sp. cysts, no false-negative or false-positive results among the specimens tested for either organism were found.

Comparing roadside with subsequent breath alcohol analyses and their relevance to the issue of retrograde extrapolation

Driving while intoxicated (DWI) legislation requires proving the critical breath alcohol concentration (BrAC) at the time of driving. With time delayed analysis, retrograde extrapolation is occasionally employed but has several uncertainties associated with it. The present study attempts to address whether subjects actually arrested for DWI are likely to have BrAC values near the time of driving differing largely from those performed at a subsequent time. Selected officers arrested n = 161 subjects where roadside BrAC was determined with Pre-Arrest Breath Test (PBT) devices along with subsequent duplicate evidential analyses followed by an additional PBT analysis. These two sets of duplicates, one with large time interval (mean = 63.5 min.) and one with a 2-3 min difference, were then compared by several statistical methods. The results showing duplicate variability did not differ when the long time interval existed (F = 1.0, P > 0.05). A small but significant decrease in BrAC with respect to time appeared for the duplicate PBT data. Retrograde extrapolation applied to the data employing an assumed 0.015 g/210 l/h yielded a small but significant overestimate of the actual roadside PBT result. Finally, evidentiary analyses performed within 2 h of driving will provide good estimates and certainly not overestimates, of the BrAC existing at the time of driving and it appears that extrapolation may be unwarranted in these cases.

Adaptation of transferrin protein and glycan synthesis

We report the patterns of variability in transferrin structure in pregnancy, iron deficiency anemia, women using oral contraceptives, nonanaemic rheumatoid arthritis, iron deficient rheumatoid arthritis and anemia of the chronic diseases. Changes in microheterogeneity were assessed by crossed immuno isoelectric focusing of serum transferrin. Intra-individual variation in the control group was minimal. Equally, inter-individual variation in controls and groups with established stable disease was very limited. In pregnancy an increase in transferrin concentration was accompanied by redirection of glycan synthesis to the highly sialylated and highly branched glycans, an effect also shown in women using oral contraceptives. Iron deficiency anemia was accompanied by increased protein core synthesis without the large shifts in the microheterogeneity pattern as seen in pregnancy at similar transferrin concentration. In contrast to this, rheumatoid arthritis was accompanied by decreased protein synthesis while the microheterogeneity pattern shifted significantly towards the highly branched glycans. Interpreted in the respective pathophysiological contexts results show that: (1) N-linked glycosylation of transferrin is a strictly controlled process, both in the physiological states and in disease. (2) Microheterogeneity is determined independently from transferrin protein synthetic rate. (3) Provisionally observed changes in the glycosylation can modulate the biological activity of the glycoprotein and as a result redirect internal iron fluxes. This proposition can be applied to altered iron metabolism in both pregnancy, oral contraceptives and rheumatoid arthritis. Changes are not operative in iron deficiency because qualitatively iron metabolism is not altered in this state.

Reactive oxygen species and the central nervous system

Radicals are species containing one or more unpaired electrons, such as nitric oxide (NO.). The oxygen radical superoxide (O2.-) and the nonradical hydrogen peroxide (H2O2) are produced during normal metabolism and perform several useful functions. Excessive production of O2.- and H2O2 can result in tissue damage, which often involves generation of highly reactive hydroxyl radical (.OH) and other oxidants in the presence of "catalytic" iron or copper ions. An important form of antioxidant defense is the storage and transport of iron and copper ions in forms that will not catalyze formation of reactive radicals. Tissue injury, e.g., by ischemia or trauma, can cause increased metal ion availability and accelerate free radical reactions. This may be especially important in the brain because areas of this organ are rich in iron and CSF cannot bind released iron ions. Oxidative stress on nervous tissue can produce damage by several interacting mechanisms, including increases in intracellular free Ca2+ and, possibly, release of excitatory amino acids. Recent suggestions that free radical reactions are involved in the neurotoxicity of aluminum and in damage to the substantia nigra in patients with Parkinson's disease are reviewed. Finally, the nature of antioxidants is discussed, it being suggested that antioxidant enzymes and chelators of transition metal ions may be more generally useful protective agents than chain-breaking antioxidants. Careful precautions must be used in the design of antioxidants for therapeutic use.

Biological variation of the leukocyte differential count quantities

The biological variation of the blood concentration and number fraction of the different kinds of leukocytes have been estimated, over a one-year period in a group of 19 women and 20 men, apparently healthy volunteers. All measurements have been performed with a Toa E-5000 haematological analyser. The medians of the within-subject biological coefficients of variation, separated by sex when significant differences exist, are the following for concentrations: 9.4% in men and 15.4% in women for the leukocytes, 16.9% in men and 26.9% in women for the neutrophils, 12.3% for the lymphocytes, 14.9 for the basophils+eosinophils+monocytes (as measured by Toa E-5000); and for number fraction are the following: 8.6% for neutrophils, 0% in men and 7.2% in women for lymphocytes, and 16.7 for basophils+eosinophils+monocytes (as measured by Toa E-5000). With these data the index of individuality, the critical difference for significant change detection and the desirable imprecision have been calculated.

Biological activities of human interferon and 2'-5' oligoadenylates in plants

Exogenous human interferon 2 (IFN) and 2'-5' oligoadenylates (2-5A) have been shown to cause at least a dual physiological effect in tobacco and wheat: (i) increased cytokinin activity and (ii) induced synthesis of numerous proteins, among which members of two groups of stress proteins have been identified, namely pathogenesis-related (PR) and heat shock (HS) proteins. These effects were observed only by low concentrations of these substances: IFN at 0.1-1 u/ml and 2-5A at 1-10 nM.

Different missense mutations at the tissue-nonspecific alkaline phosphatase gene locus in autosomal recessively inherited forms of mild and severe hypophosphatasia

Hypophosphatasia is a heritable form of rickets/osteomalacia with extremely variable clinical expression. Severe forms are inherited in an autosomal recessive fashion; the mode of transmission of mild forms is uncertain. The biochemical hallmark of hypophosphatasia is deficient activity of the tissue-nonspecific isozyme of alkaline phosphatase (TNSALP). Previously, we demonstrated in one inbred infant that an identical missense mutation in both alleles of the gene encoding TNSALP caused lethal disease. We have now examined TNSALP cDNAs from four unrelated patients with the severe perinatal or infantile forms of hypophosphatasia. Each of the eight TNSALP alleles from these four individuals contains a different point mutation that causes an amino acid substitution. These base changes were not detected in at least 63 normal individuals and, thus, appear to be causes of hypophosphatasia in the four patients. (Two additional base substitutions, found in one allele from each of the four patients, are linked polymorphisms.) Twenty-three unrelated patients (of 50 screened), who reflect the entire clinical spectrum of hypophosphatasia, possess one of our of the above eight mutations. In two of these additional patients, mild forms of the disease are also inherited in an autosomal recessive fashion. Our findings indicate that hypophosphatasia can be caused by a number of different missense mutations and that the specific interactions of different TNSALP mutant alleles are probably important for determining clinical expression. Severe forms, perinatal and infantile disease, are largely the result of compound heterozygosity for different hypophosphatasia alleles. At least some cases of childhood and adult hypophosphatasia are inherited as autosomal recessive traits.

A hypothesis for the local control of osteoclast function by Ca2+, nitric oxide and free radicals

Several important conclusions have recently emerged from in vitro studies on the resorptive cell of bone, the osteoclast. First, it has been established that osteoclast function is modulated locally, by changes in the local concentration of Ca2+ caused by hydroxyapatite dissolution. It is thought that activation by Ca2+ of a surface membrane Ca2+ receptor mediates these effects, hence providing a feedback control. Second, a number of molecules produced locally by the endothelial cell, with which the osteoclast is in intimate contact, have been found to affect bone resorption profoundly. For instance, the autocoid nitric oxide strongly inhibits bone resorption. Finally, reactive oxygen species have been found to aid bone resorption and enhance osteoclastic activity directly. Here, we will attempt to integrate these control mechanisms into a unified hypothesis for the local control of bone resorption.

Specific serum immunopatterns in clinical phases of allergic bronchopulmonary aspergillosis

Immunoblotting, radioallergosorbent test (RAST), and enzyme-linked immunosorbent assay (ELISA) were performed to determine specific IgE and IgG responses to Aspergillus fumigatus (Af) allergens (IgE-Af; IgG-Af). Serology results were compared in patients with allergic bronchopulmonary aspergillosis (ABPA) (n = 43), patients with Aspergillus fumigatus-associated asthma (Af-asthma) (n = 26), and healthy individuals (n = 3). In patients with different clinical phases of ABPA, three specific immunopatterns were found by immunoblotting. It is proposed to classify ABPA into the active, intermediate, and remission phase with respect to the specific immunoresponse to Af-allergens and asthma symptoms. First, the active phase of ABPA is characterized by a fully developed specific immunoresponse to Af-allergens and severe asthma. Second, the intermediate phase includes patients with elevated specific immunologic findings without asthma symptoms. Third, the remission phase is characterized by a weak specific immunoresponse to Af-allergens after a long-term asymptomatic period. No correlation occurred between specific immunopatterns and irreversible brochopulmonary lesions. The IgE-Af RAST and IgG-Af ELISA titers of patients with ABPA in the active and intermediate phase were significantly higher compared with patients with ABPA in remission phase and with patients with Af-asthma. In particular, the demonstration of positive IgG-Af ELISA titer generally allows the serologic discrimination of patients with asthma and ABPA from patients with Af-asthma in clinical practice. The present study revealed that immunoblots of most patients with Af-asthma were negative. Immunoblotting demonstrated an IgG reactivity exclusively to low molecular weight (MW) Af-allergens in 8 out of 26 patients with Af-asthma and in the three healthy individuals, and this IgG response may reflect naturally occurring antibodies.

Effect of dexamethasone therapy on fibronectin and albumin levels in lung secretions of infants with bronchopulmonary dysplasia

The influence of dexamethasone on levels of total fibronectin (tFn), cellular fibronectin (cFn), plasma fibronectin (pFn), and albumin in lung secretions was determined in tracheal aspirate samples collected from 45 infants with bronchopulmonary dysplasia during a 6-week course of dexamethasone therapy. Secretory component for IgA (SC) was used as a reference protein. Thirty-seven infants (82%) survived and had their endotracheal tubes successfully removed. Corticosteroid therapy was associated with a significant decrease in the cFn/SC ratio. There was also a significant decrease in albumin/SC and pFn/SC ratios, suggesting decreased capillary permeability with corticosteroid therapy. Four of the remaining infants did not improve while receiving corticosteroids and died of respiratory failure at 3 to 8 weeks of age. In these "no response" infants, tFn/SC, cFn/SC, pFn/SC, and albumin/SC ratios when corticosteroid therapy was initiated were threefold to fourfold greater (p < 0.01) than ratios in survivors. Another group of four infants initially responded to corticosteroids but subsequently died with severe pulmonary cystic degeneration at 4 to 6 months of age; in these infants, tracheal aspirate tFn/SC, cFn/SC, and albumin/SC ratios were significantly lower than in survivors and remained unchanged during corticosteroid therapy. The decrease in the concentrations of plasma fibronectin and albumin in tracheal aspirate samples from the survivors suggests that the rapid clinical improvement seen in infants with bronchopulmonary dysplasia after the initiation of dexamethasone therapy is due in part to improvement in the integrity of the alveolar-capillary barrier. In addition, the decrease in the aspirate levels of cFn suggests the potential for corticosteroids to limit pulmonary fibrosis in the surviving infants. The depressed levels of fibronectin observed in the infants with severe cystic lung disease may represent an impaired healing response to lung injury.

Increased activity of ionised calcium in gall bladder bile in gall stone disease

The actual activity of ionised calcium (Ca2+) in gall bladder bile determined with an ion-selective electrode was significantly higher in patients with gall stone disease (n = 15) than in patients without gall stones (n = 10) (0.43 mmol/kg v 0.31 mmol/kg; p < 0.05). No change in the Ca2+ activity in any of the gall bladder bile samples was observed during equilibration with CO2. During titration with HCl/NaOH, however, the Ca2+ activity fell with increasing pH in a biphasic manner, with the breaking point occurring at a significantly lower median pH in patients with gall stones than in patients without (pH 7.1 v 8.2; p < 0.0001). The combination of a higher activity of calcium in bile and precipitation of bile salts taking place at a lower pH in patients with gall stone disease than in patients without gall stones suggests a major role for calcium and pH in the pathogenesis of gall stones. Strict anaerobic sampling is not necessary for the measurements of Ca2+ in gall bladder bile, because the Ca2+ was not significantly affected by the changes in pCO2. The metabolic studies suggest, however, that simultaneous measurements of the activity of Ca2+ and pH is important in order to interpret data for the calcium activity in gall bladder bile.

Fecal osmotic gap and pH in experimental diarrhea of various causes

Although the osmotic gap of fecal fluid is often used to distinguish osmotic diarrhea from secretory diarrhea, there has never been a scientific evaluation of the validity of this concept. Similarly, although a low fecal fluid pH value is used to indicate that diarrhea is mediated by carbohydrate malabsorption, the validity of this method is unproven. Therefore, in the present study, diarrhea was induced in normal subjects by different mechanisms and fecal fluid osmotic gap (using an assumed fecal fluid osmolality of 290 mOsm/kg) and pH were measured. In secretory diarrhea caused by phenolphthalein, the osmotic gap was always less than 50 mOsm/kg, whereas in osmotic diarrhea caused by polyethylene glycol, magnesium hydroxide, lactulose, and sorbitol, the osmotic gap always exceeded 50 mOsm/kg. In osmotic diarrhea caused by sodium sulfate, the fecal fluid osmotic gap was less than 50 mOsm/kg, but phenolphthalein-induced secretory diarrhea could be distinguished from sodium sulfate-induced osmotic diarrhea by the fecal chloride concentration. When diarrhea was caused by carbohydrate malabsorption (lactulose or sorbitol), the fecal fluid pH was always less than 5.6 and usually less than 5.3; by contrast, other causes of diarrhea rarely caused a fecal pH as low as 5.6 and never caused a pH less than 5.3. It is concluded that measurement of fecal fluid osmotic gap and pH can distinguish various mechanisms of experimental diarrhea in normal subjects. The concepts on which these tests are based are therefore verified experimentally.

Platelet aggregation and coronary heart disease risk factor variation in Australian populations with different coronary heart disease mortality

In a cross-sectional analytic study, we examined the differences in coronary heart disease (CHD) risk factors, including coagulation factors and platelet aggregation, among males from southern European countries and those of Anglo-Celtic descent who had widely different CHD standardized mortality ratios. The participants included 169 men aged 40 to 49 years, 27% of whom were born in southern European countries. The subjects had no history of heart disease and no other clinical conditions, or were not taking medications known to affect hemostasis. Data obtained included their medical history and CHD-related risk behaviors, blood pressure, height, weight, abdominal and pelvic circumference, and coagulation, fibrinolysis, platelet activity, lipids, and lipoproteins profiles. There were significant differences between the two groups in the prevalence of a positive family history, mean apolipoprotein A1 levels, and platelet aggregation responses to ADP. Other established risk factors, including coagulation factor levels, were not significantly different.

Selenium content of goat milk and its distribution in protein fractions

This study reports on selenium distribution in goat milk. Skim milk was found to contain the major part (94%) of total milk selenium. The selenium distribution over casein and whey protein fractions depends on the separation method used, but irrespective of these methods, skim milk selenium is mainly associated with the casein fraction (greater than 69%). Approximately 9%, 7% and 24% of selenium is removed by dialysis (molecular cutoff 10-12 kDa) from skim milk, casein and whey respectively, indicating a major association of selenium with milk proteins. This observation is confirmed by selenium analysis of individual caseins and whey proteins isolated through ion-exchange chromatography and gel filtration. Selenium concentrations of the different isolated milk proteins show considerable variation (caseins: 294-550 ng Se/g; whey proteins: 217-457 ng Se/g).

Within-subject and between-subject biological variation of prothrombin time and activated partial thromboplastin time

The within-subject and between-subject biological variation of prothrombin time (PT) and activated partial thromboplastin time (APTT) have been studied in a group of 19 women and 20 men over a period of 9 months. All measurements were performed with a mechanical coagulometer. The between-subject coefficients of variation were 6.8% for PT and 8.9% for APTT. The medians and the 90th percentiles of within-subject coefficients of variation were 1.7% and 5.9%, respectively, for PT, and 0.0% and 6.1% for APTT. These data were used to calculate the critical difference for significant change detection and the desirable between-day imprecision.

Measurement of aluminium in clinical samples

Measurement of aluminium in clinical samples is important for the protection of patients with chronic renal failure, and for investigations of dementia. The types of specimen that need to be analysed include body fluids and tissues, dialysis fluids, water and foods and the concentrations that may be found can range from around 1 microgram/L to several mg/L. Although techniques must afford exceptional sensitivity they will also be susceptible to the effects of external contamination and it is imperative that those involved with the analysis, from sample collection through to the determination, ensure that precautions are taken to prevent undue addition of the metal. Of the methods that may be used ETAAS is clearly the most appropriate. Great care is required to achieve reliable performance but with experienced personnel very good results can be obtained. Regular reviews of recent analytical developments are presented in the Atomic Spectrometry Updates series and these are recommended to those who may wish to look for further information.