C-reactive protein-complement factor H axis as a biomarker of activity in early and intermediate age-related macular degeneration

Purpose

To determine and compare the serum levels of complement Factor H (FH), monomeric C-Reactive Protein (mCRP) and pentameric C-Reactive protein (pCRP) in patients with age-related macular degeneration (AMD) and to correlate them with clinical, structural and functional parameters.

Methods

Cross-sectional observational study. One hundred thirty-nine individuals (88 patients and 51 healthy controls) from two referral centers were included and classified into three groups: early or intermediate AMD (n=33), advanced AMD (n=55), and age and sex matched healthy controls (n=51). Serum levels of FH, mCRP, and pCRP were determined and correlated with clinical and imaging parameters.

Results

Patients with intermediate AMD presented FH levels significantly lower than controls [186.5 (72.1-931.8) µg/mL vs 415.2 (106.1-1962.2) µg/mL; p=0.039] and FH levels <200 µg/mL were associated with the presence of drusen and pigmentary changes in the fundoscopy (p=0.002). While no differences were observed in pCRP and mCRP levels, and mCRP was only detected in less than 15% of the included participants, women had a significantly higher detection rate of mCRP than men (21.0% vs. 3.8%, p=0.045). In addition, the ratio mCRP/FH (log) was significantly lower in the control group compared to intermediate AMD (p=0.031). Visual acuity (p<0.001), macular volume (p<0.001), and foveal thickness (p=0.034) were significantly lower in the advanced AMD group, and choroidal thickness was significantly lower in advanced AMD compared to early/intermediate AMD (p=0.023).

Conclusion

Intermediate AMD was associated in our cohort with decreased serum FH levels together with increased serum mCRP/FH ratio. All these objective serum biomarkers may suggest an underlying systemic inflammatory process in early/intermediate AMD patients.

Identification of a new HLA-DRB1 allele, HLA-DRB1*04:361

A novel HLA-DRB1*04 allele, officially designated HLA-DRB1*04:361, was identified by next-generation sequencing.

Identification of a new HLA-B allele, HLA-B*51:371

A novel HLA-B*51 allele, officially designated HLA-B*51:371, was identified by next-generation sequencing.

Long-term anatomical and functional outcomes after autokeratoplasty

BACKGROUND

To evaluate the anatomical and functional outcomes of autologous contralateral penetrating keratoplasty (autokeratoplasty).

METHODS

Kaplan-Meier survival analyses were retrospectively performed. Anatomical failure was defined as regraft or graft permanently cloudy at any time during follow-up. Functional failure was defined as the final best-corrected visual acuity (BCVA) <20/400.

RESULTS

Thirty-one eyes of 31 patients (19 men), with a mean age of 52±18 years (range 15-81 years) were studied during a mean follow-up of 11.3 years (from 13 months to 48 years). At 12 months postoperatively, all the recipient eyes showed a transparent cornea, but 23% showed functional failure. At the final followup, 16 recipient eyes (52%) showed anatomical and functional success. Twenty-three eyes (74%) showed a clear cornea and 68% reached a better BCVA when compared with preoperative measurements. Nevertheless, 13/31 eyes (42%) displayed functional failure. The accumulative probabilities for anatomical success were 100%, 72% and 48% and 77%, 59% and 29% for functional success at 1, 10 and 40 years, respectively. The most common risk factor for failure was progression of previous glaucoma in 50% of the anatomical failures and in 77% of the functional failures.

CONCLUSIONS

Autokeratoplasty could be a successful long-term option in patients having one eye with a clear cornea but with irreversible visual dysfunction and the contralateral eye having favourable visual potential limited only by a completely opacified cornea. Progression of previous glaucoma was the most important risk factor for long-term cornea decompensation and visual functional failure in the sample.

Melatonin expression in periodontal disease

BACKGROUND AND OBJECTIVE

It was the purpose of this study to examine the relationship between periodontal diseases and melatonin level.

MATERIAL AND METHODS

Forty-six patients with periodontal disease, together with 26 age- and gender-matched healthy controls, were included. Periodontal status was assessed using the Community Periodontal Index. Plasma and salivary melatonin levels were determined using specific commercial radioimmunoassays, whereas lymphocyte subpopulations (e.g. CD3, CD4, CD8, C19 and natural killer cells) were analyzed using flow cytometry.

RESULTS

Patients with periodontal disease had significantly (p < 0.001) lower plasma (9.46 +/- 3.18 pg/mL) and saliva (2.55 +/- 0.99 pg/mL) melatonin levels than healthy control patients (14.33 +/- 4.05 and 4.22 +/- 0.87 pg/mL, respectively). A biphasic relationship was observed between plasma melatonin levels and Community Periodontal Indices. The plasma melatonin level was reduced in patients with a lower Community Periodontal Index value (1 or 2) and increased in patients with a higher Community Periodontal Index value (3 or 4). Salivary melatonin parallels the changes of plasma melatonin. The higher the Community Periodontal Index, the older the patient and the higher the total lymphocyte counts. CD4 concentrations also increased as the disease worsened.

CONCLUSION

The results obtained from this study suggest that melatonin could act as a protective function in fighting periodontal infection. However, further studies in this area are encouraged.

Effects of copper on hatching of larvae and prezoea survival of Petrolisthes galathinus (Porcellanidae): assays with ovigerous females and isolated eggs

Ovigerous females of the porcellanid crab Petrolisthes galathinus were selected for toxicological bioassays. A first assay was made on isolated eggs, exposing them to 0 (control), 0.5, or 1 mgL(-1) copper. Both copper concentrations caused significant mortality just before hatching. The few prezoeas hatched at 0.5 and 1 mgL(-1) were unable to reach the zoea stage. A second assay was conducted on the ovigerous females isolated and exposed to 0 or 0.1 mgL(-1) copper. Females were checked daily and the percentages of mortality, egg loss, and hatching larvae were recorded. No differences in either mortality of females or number of hatched larvae were noted between control and copper-exposed groups. From each of these groups, 15 recently hatched prezoeas were transferred to clean seawater, while another 15 were exposed to 0.1 mgL(-1) copper. The numbers of dead or alive prezoeas, transitional larvae, and zoeas were ascertained every 24 h. Prezoeas hatched from exposed eggs and transferred to clean seawater at hatching showed enhanced mortality and a delay in development, compared with control larvae maintained in clean water throughout. Copper at 0.1 mgL(-1) was lethal to almost all larvae exposed only after hatching, while those that had also been preexposed to copper during embryonic development showed a certain degree of tolerance to copper exposure, at least during the first 24 h after hatching.

Diffuse axonal injury with or without an evacuated intracranial hematoma in head injured patients. Are they different lesions?

The general classification of head injury proposed by Marshall et al., based on admission CT scan findings, might mask a group of patients who have Diffuse Brain Injury (DI) in addition to intracranial haematomas. The aim of this study was to assess possible differences in outcome with respect to the level of intracranial pressure (ICP) and cerebral perfusion pressure (CPP) between a group of patients with DI: III-IV (Marshall's classification) after the evacuation of an intracranial haematoma (group A) and another group with DI: III-IV in the absence of a mass lesion (group B). We prospectively studied 129 patients with isolated and closed severe head injury (GCS < 9). In group A (n = 61), the median percentage of hours with ICP > 20 mmHg and CPP < 70 mmHg was 42.8 and 18, respectively and 17 (28%) survived with GOS 4-5. In group B (n = 68), median values of 20 and 5.5 hours were obtained for ICP > 20 and CPP < 70 respectively, whilst 39 (57.3%) survived with favourable outcomes. When we analysed the effects of the DI: III-IV in both groups of patients, we found that the differences in percentage of time with ICP > 20 and CPP < 70 were statistically significant (p < 0.01) and patients in group A had a higher morbidity and mortality (p < 0.05). This study has demonstrated that the levels of ICP, morbidity and mortality in patients with DI: III-IV and an evacuated mass lesion were higher than in patients with DI: III-IV without a mass lesion.

Discordant CD4 T lymphocyte responses to antiretroviral therapy for HIV infection are associated with ex-vivo rates of apoptosis

Our purpose was to determine if changes in CD4 cell counts in HIV-infected patients with good viral suppression on stable antiretroviral regimens could be predicted by ex-vivo rates of apoptosis of peripheral blood mononuclear cells (PBMC). Patients were grouped by lowest pre-treatment and highest on-treatment CD4 cell counts and classified as complete immune responders, partial responders, or non-responders. Whole blood was collected from a subgroup of patients and controls, and rates of the ex-vivo apoptosis of PBMC were assessed. Non-responders exhibited significantly increased apoptosis, whereas good immune responses were associated with decreased apoptosis. Persistently accelerated apoptosis may contribute to persisting immune deficiency independent of the viral load.

Survival and molting of the pea crab larvae Tunicotheres moseri Rathbun 1918 (Brachyura, Pinnotheridae) exposed to copper

The acute lethal toxicity of copper, as well as its sublethal effect on molting, was studied on larval and postlarval stages of the pinnotherid crab Tunicotheres moseri. The most sensitive stage was zoea I, presenting a significant mortality above 0.5 microg x L(-1). Abnormal setation of the maxillipeds was observed in zoeae II moulted from zoeae I exposed to 100 microg x L(-1) and higher copper concentrations, causing a reduced swimming activity of the larvae. This pathology could be reverted after molting of affected zoea II to megalopa, which would be the first report in crustacean larvae that states the possibility of reverting morphological abnormalities after molting. For zoeae II and megalopae, the inhibition of molting and high mortality was registered at 1,000 microg x L(-1). The effect of copper on the duration of the larval and postlarval stages was differential: It retarded the duration of the stage zoea I, did not modify that of zoea II, and accelerated the ecdysis of the megalopae to first crab. However, precocious molting to megalopae was associated with a smaller body size at the concentration of 100 microg x L(-1). This differential effect of copper on the larval stages throughout the larval development could be ecologically relevant. Because of their lecithotrophia, their short developmental period, their good survival in control conditions, and the high sensitivity showed to copper (especially zoea I), larvae of T. moseri have shown that they are an excellent model for studying the effect of pollutant on survival, molting rate, growth, and morphogenetic changes during development.

Prognostic value of early computerized tomography scanning following craniotomy for traumatic hematoma

OBJECT

Patients with head injuries traditionally were categorized on the basis of whether their lesions appeared to be diffuse, focal, or mass lesions on admission computerized tomography (CT) scanning. In the classification of Marshall, et al., the presence of a hematoma (evacuated or not evacuated) is more significant than any diffuse injury (DI). The CT scan appearance after evacuation of a mass lesion has not been analyzed previously in relation to outcome. The authors have investigated the importance of: 1) neurological assessment at hospital admission; 2) the status of the basal cisterns and associated intracranial lesions on the admission CT scan; and 3) the degree of DI on the early CT scan obtained after craniotomy to identify patients at risk for development of raised intracranial pressure (ICP) and lowered cerebral perfusion pressure (CPP) and to discover the influence of the postoperative CT appearance of the lesion on patient outcome.

METHODS

The authors prospectively studied 82 patients with isolated, severe closed head injury (Glasgow Coma Scale [GCS] score < or = 8), all of whom had intracranial hematoma. Both ICP and CPP were continuously monitored, and a CT scan was obtained within 2 to 12 hours after craniotomy. The CT images were categorized according to the classification of Marshall, et al. The mortality rate during the hospital stay was 37%, and 50% of the patients achieved a favorable outcome. Compression of the basal cistern on the admission (preoperative) CT scan was associated with raised ICP and a CPP of less than 70 mm Hg but not with any other features or with poor patient outcome. In 53 patients the postoperative CT scan revealed DIs III or IV and 29 patients had DIs I or II. The percentages of time during the hospital stay in which ICP was higher than 20 mm Hg and CPP was lower than 70 mm Hg as well as unfavorable outcome were higher in the group of patients in whom DI III or IV was present (p < 0.001). Raised ICP, CPP lower than 70 mm Hg, DI III or IV, and unfavorable outcome were more frequently observed in patients who presented with a motor (m)GCS score of 3 or less, bilateral unreactive pupils, associated intracranial injuries, and hypotension (p < 0.001). When logistic regression analysis was performed, an mGCS score of 3 or less (p = 0.0013, odds ratio [OR] 10.8), bilateral unreactive pupils (p = 0.0047, OR 31.8), and DI III or IV observed on CT scanning after surgery (p = 0.015, OR 8.9) were independently associated with poor outcome.

CONCLUSIONS

Features on CT scans obtained shortly after craniotomy constitute an independent predictor of outcome in patients with traumatic hematoma. Patients in whom DI III or IV appears on postoperative CT scanning, who often present with an mGCS score of 3 or less and nonreactive pupils, are at high risk for the development of raised ICP and lowered CPP.

Comparison of bronchoscopic diagnostic techniques with histological findings in brain dead organ donors without suspected pneumonia

BACKGROUND

The techniques for recognising pneumonia in mechanically ventilated patients were evaluated as no "gold standard" is available to establish the diagnosis in these patients.

METHODS

A prospective study was performed on nine brain dead organ donors not suspected of having pneumonia to assess the specificity of bacteriological results from different samples by comparing them with the histological findings from an open pulmonary biopsy specimen taken immediately after death through a mini-thoracotomy.

RESULTS

Seven of the nine organ donors without clinical evidence of pulmonary infection and not on antibiotic therapy showed histological features of bronchopneumonia. There was no association between the histological findings and quantitative cultures of the lung biopsy specimen.

CONCLUSIONS

Histological evidence of pneumonia was common in this group of ventilated patients who had no clinical signs of the disease.

[Children's accidents treated at health centers]

OBJECTIVES

To find the characteristics of accidents to children treated at our Health Centres.

DESIGN

A descriptive crossover study.

SETTING

Almanjayar and Cartuja Health Centres, Granada.

PATIENTS

The 0 to 14 age-group treated at our centres because of an accident.

MEASUREMENTS AND MAIN RESULTS

The number of accidents to children treated at our health centres during 1994 was 217. The most common accidents were, in descending order: falls, 27%; burns, 20.7%; traffic accidents, 17%; poisoning, 15%; inhalation of foreign bodies, 10.5%; bites and aggressions, 9.2%. 48.3% of the accidents occurred at home, 37.7% in the street and 13.8% at school. In the relation of type of accident to age group, we found that burns affected children under 5 to a greater extent. Poisoning was more common between 5 and 9. Traffic accidents and falls affected children between 10 and 14 more. The relationship between age and type of accident is significant (p < 0.005). There is no significant connection between gender and type of accident.

CONCLUSIONS

Age and some types of accident are directly related. The majority of accidents tend to occur at home and in the street. We consider that prevention is the best way of decreasing accidents to children. Programmes involving children, parents and teachers should be set up.

Removal of infected dual chambered transvenous pacemaker and implantation of a new epicardial dual chambered device with cardiopulmonary bypass: experience with seven cases

Seven patients with infected transvenous dual chambered pacemakers have undergone removal of the device using cardiopulmonary bypass. There were four women and three men with a mean age of 58 years. Six patients had localized infection in the generator pocket (mean of 4.6 previous unsuccessful operations for surgical sterilization). Four infections were due to Staphylococcus epidermidis, two to Staphylococcus aureus, and one patient presented septicemia caused by Staphylococcus epidermidis and Pseudomonas aeruginosa. The atrial and ventricular transvenous electrodes were removed under direct vision using cardiopulmonary bypass. A new dual chambered epicardial pacemaker was implanted. The procedure was well-tolerated, and all patients are infection free with working pacemakers after a mean follow-up of 25.4 months.

Effect of alpha-interferon on erythrocyte and hepatocyte plasma membranes derived from cirrhotic rats

Interferons are recognized to inhibit collagen production. Since fibrosis has been associated with liver dysfunction, we investigated the effects of alpha-interferon on the function and lipid composition of hepatocyte and erythrocyte plasma membranes derived from CCl4-cirrhotic male Wistar rats. In both cell types, CCl4 decreased Na+/K+ and Ca(2+)-ATPase activity and increased the cholesterol to phospholipids (CH/PL) ratio (p < 0.05). Administration of interferon (80,000 IU/kg s.c. for 8 weeks) increased survival from 40 to 90%, and preserved normal ATPase activity and CH/PL ratio. Our results show that administration of alpha-interferon to CCl4-cirrhotic rats improves survival, and liver and erythrocyte membrane function and composition, probably as a result of its antifibrogenic effect.

The spatial location of EEG electrodes: locating the best-fitting sphere relative to cortical anatomy

The location of the international 10-20 system electrode positions and 14 fiducial landmarks are described in cartesian coordinates (+/- 1.4 mm average accuracy). Six replications were obtained on 3 separate days from 4 normal subjects, who were compared to each other with a best-fit sphere algorithm. Test-retest reliability depended on the electrode position: the parasagittal electrodes were associated with greater measurement errors (maximum 7 mm) than midline locations. Location variability due to head shape was greatest in the temporal region, averaging 5 mm from the mean. For each subject's electrode locations a best-fitting sphere was determined (79-87 mm radius, 6% average error). A surface-fitting algorithm was used to transfer the electrode locations and best-fitting sphere to MR images of the brain and scalp. The center of the best-fitting sphere coincided with the floor of the third ventricle 5 mm anterior to the posterior commissure. The melding of EEG electrode location information with brain anatomy provides an empirical basis for associating hypothetical equivalent dipole locations with their anatomical substrates.

[Dehydroepiandrosterone sulfate and lipids in acute myocardial infarct]

To establish the possible relationship between acute myocardial infarction (AMI) and dehydroepiandrosterone-sulfate (DHEA-S) in a group of 15 patients with AMI, blood levels of DHEA-S and certain lipids (total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides) were determined at admission in the hospital and after 10 days. As controls a group of healthy individuals or with minor diseases, and a group of 24 severely ill non-cardioischaemic patients have been studied. DHEA-S and HDL-cholesterol levels have been found significantly lowered both in patients with AMI (at 10th day) as well as in the severely ill non-cardioischaemic patients, in comparison with the healthy volunteers group. We conclude, then, than the lowering in DHEA-S and HDL-cholesterol seems not to be specifically relates with AMI but has a certain relationship with severe disorders in general.

Tetrahedral recording of 3-D BAEPs: evidence for the centered dipole model

Three-dimensional brain-stem auditory evoked potentials (3-D BAEPs) were recorded from 12 normal subjects using a new tetrahedral montage, as well as two other bipolar montages previously described for 3-channel Lissajous' trajectories (3-CLTs). Mean responses, as well as between-subject and within-subject variability were described. A mathematical transformation was applied to the recorded trajectories to render them in a common canonical form to test the assumption that the BAEP conforms to a centrally generated dipolar field. Apex, segment, and plane orientations were measured for each trajectory, and discrepancies between montages were evaluated to judge the adequacy of the centered dipole model. For the vector means of apices, segments, and planes, median angles of discrepancy between montages ranged from 10 to 23 degrees. These results support the validity of a centered dipole model for the BAEP and affirm the rationale for employing the 3-channel recording technique. Among the montages studied, the tetrahedron provided maximum economy by using fewer electrodes, avoided certain problematic recording sites, and produced less variable data.

Stress-induced gastroduodenal lesions and total parenteral nutrition in critically ill patients: frequency, complications, and the value of prophylactic treatment. A prospective, randomized study

OBJECTIVE

To assess the frequency, complications, and value of prophylactic treatment of stress-induced gastroduodenal lesions.

DESIGNS

Patients were prospectively randomized to treatment with total parenteral nutrition, either alone, with sucralfate, or with ranitidine.

SETTING

A multidisciplinary ICU from a tertiary care referral center.

PATIENTS

Ninety-seven patients submitted to prolonged mechanical ventilation, with normal hepatic and renal function, in metabolic stress, and receiving total parenteral nutrition.

INTERVENTIONS

On admission, we determined the Acute Physiology and Chronic Health Evaluation II score and the catabolic index score. We also performed an endoscopic examination on day 3, every 7 days subsequently, and whenever needed. Thirty patients received total parenteral nutrition alone. Twenty-four patients received total parenteral nutrition and sucralfate (1 g by nasogastric tube every 4 hrs). Nineteen patients received total parenteral nutrition and ranitidine (50 mg iv every 6 hrs).

MAIN RESULTS

The overall occurrence rate of gastroduodenal mucosal damage was 29.6%. The overall frequency rate for stress ulcerations was 15.6% and was 6.2% for stress hemorrhage. There were no deaths secondary to stress hemorrhage. The difference in the frequency of stress-induced mucosal lesions and stress hemorrhage between the studied groups was not statistically significant.

CONCLUSIONS

Additional prophylaxis to total parenteral nutrition in the form of sucralfate and ranitidine to prevent acute upper gastrointestinal bleeding is not required in this group of ICU patients.

[Evaluation of nutritional status in patients admitted to an internal medicine department. Study of 100 cases]

We have confirmed that malnutrition is very frequent in hospitalized patients. There is no agreement about which are the indexes or criteria agreement about which are the indexes or criteria that can be used to define malnutrition, specially in early stages. In the present work, we have studied 100 patients randomly chosen amongst the admissions that occurred in the Internal Medicine Department over a period of one year. The patients were submitted to a protocol which included the following: anthropometric measurements, seric proteins and routine determinations (sugar level, cholesterol, uric acid, etc.) It has been considered as malnourished those patients who presented some marker with a value lower than 90% of the standard value. According to these criteria, 25 of them had a caloric-protein malnutrition, 24 had a proteic malnutrition and 25 of them had mixed malnutrition. The most sensible parameters had been the triceps skin fold and retinal transporting protein.

Computerized system in intensive care medicine

A complete understanding of the computer's capabilities and an exact identification and definition of the ICU problems/needs are essential for the complete control of patient records and the full utilization of the computer as a clinical tool.

[Pediatric intensive care (author's transl)]

In the Intensive Care Unit of our General Hospital, where an important obstetric-pediatric unit exists, 392 infants have been treated from August 1974 to 1976. Although the results of all age groups are shown, the neonatal one is specially considered. All those patients who recovered and were discharged from the hospital were called for revision and the results of those whom attended are shown. The convinience of the regionalisation and hierarchisation of these intensive care units and the necessity of adequately organise the communication and transport of these patients from the peripheral small units to the regional one, is emphasized.

[Intermittent mandatory ventilation (author's transl)]

Intermittent mechanical ventilation is a frequent form of therapy for respiratory failure in children. Due to its difficult application in patients with high respiratory rate and difficult synchronization with the respirator, intermittent mandatory ventilation (I.M.V.) was tried on these patients, introducing a unidirectional valve, connected to a continuous flow of gases, on the inspiratory side of the respirator. With I.M.V. the patient is able to breath spontaneously the gases coming from the unidirectional valve and at the same time the respirator provides periodical insuflations at a frequency previously determined by us. The pressure generated by the respirator in the respiratory circuit, closes the unidirectional valve sending gases to patient. This technique not only reduced time of application of mechanical ventilation but made weaning shorter, easier and safer.

[Decanulation of tracheostomised children (author's transl)]

It is described eight tracheostomised patients, advising an early and gradual tracheal decanulation using silver tracheostomy tube with a window in the posterior curvature (fenestrated tube, Alder Hey pattern) and proper sedation at the moment of definitive decanulation. Decanulation techniques and the mechanical and functional difficulties that can occur and how to avoid them are described: Finally the tracheostomy tubes that have been used are mentioned.