COVID-19 and cardiovascular manifestations

OBJECTIVE

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as COVID-19, a viral outbreak that started in December 2019, eventually lead to a worldwide pandemic. COVID-19 usually presents with flu-like symptoms, such as headaches, dry cough, fever, fatigue, myalgia, shortness of breath, diarrhea and loss of smell or taste. However, it can also have major effects on the cardiovascular system. Based on the available relevant literature, we aimed to elaborate the possible mechanisms influencing cardiovascular damage, myocardial injury and thromboembolic disease process in particular.

MATERIALS AND METHODS

After considering our inclusion and exclusion criteria, the systematic review included 8 studies in total.

RESULTS

In general, underlying cardiovascular diseases were associated with poorer clinical outcomes. This may be due to immunological dysregulation. The disease outcomes were also positively correlated with the severity of the disease, especially with myocardial injury. Thus, cardiac biomarkers, such as Troponin T, CK-MB and myoglobin could be utilized in prediction algorithms for deciphering the clinical outcome in COVID-19 patients.

CONCLUSIONS

Venous thromboembolisms were commonly encountered complications despite the administration of thromboprophylaxis, and they mostly presented as pulmonary embolisms, warranting the need for relevant investigations in hemodynamically unstable patients. However, more studies need to be conducted to better understand the mechanisms at play and the ensuing complications, to better treat COVID-19 patients.

Liposomes modified by mono- and bis-phthalocyanines: A comprehensive EPR study

The impact of selected metallophthalocyanines, featuring diverse molecular structure, upon the fluidity of liposome membranes was studied using the spin label EPR technique. The "mono"-type MPc's (M = Zn, Sn; Pc = C₃₂H₁₆N₈ is the phthalocyanine ligand) and sandwich LnPc₂ complexes (Ln = Nd, Sm, Gd) were explored. Liposomes were obtained in a sonication process, from egg yolk lecithin (EYL) in water. TEMPO and 16-DOXYL spin labels were used to monitor the peripheral and central part of the lipid double layer, respectively, which allowed to localize the phthalocyanine additive within the bilayer, as well as to perform independent measurements of changes in fluidity upon addition thereof. All the complexes tested were found to increase the fluidity in the middle of the lipid bilayer. However, at the water-lipid interface the LnPc₂ compounds showed a relative small effect upon the phospholipids' arrangement, whereas in the case of ZnPc and SnPc it was found much more pronounced. EPR results were supplemented by measurements of static electrical charge, the investigated phthalocyanines may potentially feed into the membrane thus affecting its stability.

Tin Compounds Interaction with Membranes of Egg Lecithin Liposomes

This work is a continuation of earlier research concerning the influence of tin compounds on the dynamic properties of liposome membranes produced with lecithin hen egg yolks (EYL). The experiments were carried out at room temperature (about 25 ∞C). Four tin compounds were chosen, including three organic ones, (CH3)4Sn, (C2H5)4Sn and (C3H7)3SnCl, and one inorganic, SnCl2. The investigated compounds were admixed to water dispersions of liposomes. The content of the admixture changed within the range 0 mol-% to 11mol-% in proportion to EYL. Two spin probes were used in the experiment: 2,2,6,6-tetramethylpiperidine- 1-oxyl (TEMPO) and 2-ethyl-2-(15-methoxy-15-oxopentadecyl)-4,4-dimethyl-3-oxazolidinyloxyl (16-DOXYL-stearic acid), which penetrated through different areas of the membrane. It was found that tin compounds containing chlorine were the most active in interaction with liposome membranes. In the case of (C3H7)3SnCl, after exceeding 4% admixture content, an additional line appeared in the spectrum of the TEMPO probe which can be a result of formation of domain structures in the membranes of the studied liposomes. Compounds containing chlorine are of ionized form in water solution. The obtained results can thus mean that the activity of admixtures can be seriously influenced by their ionic character. In case of an admixture of non-ionic compounds the compound with a longer hydrocarbon chain displayed a slightly stronger effect on the spectroscopic parameters of the probes.

Fluidity of Liposome Membranes Doped with Metalloporphyrins: An ESR Study

Changes in membrane fluidity of porphyrin-doped liposomes have been investigated to assess the kinetics of the fluidization process. Metal complexes of tert-butylphenyl mesosubstituted porphyrin, containing ions of Mg, Mn, Fe, Co, Ni and Cu, were used as dopants. Liposomes were obtained by sonication of hen egg yolk lecithin (EYL). Electron paramagnetic resonance (ESR) was applied using two spin probes, TEMPO (2,2,6,6-tetramethylpiperidine- 1-oxyl) and 16-DOXYL-stearic acid [2-ethyl-2-(15-methoxy-15-oxopentadecyl)-4,4- dimethyl-3-oxazolidinyloxyl], localized at different sites within the membrane to determine the spectroscopic parameters: partition (F) and rotation correlation time (τ), related to the membrane’s fluidity. It was found, that porphyrins considerably fluidize the membranes, and the dynamics of this process depends on the kind of the compound used and the membrane’s area surveyed by the probes. The Cu complex proved to be the most effective one within the surface layer, whereas the Mn complex most strongly fluidized the deeper parts of the lipid double-layer. Variations in fluidity observed after the porphyrins had been introduced into the liposome were found to stabilize inside the double-layer and within the surface layer after ca. 25 and 50 h, most probably due to hydration of the hydrophilic part of the membrane.

Effect of Organic Tin Compounds on Electric Properties of Model Membranes

The objective of the present work was to investigate the effect of selected organic tin compounds and potassium chloride (used as a reference substance) on the trans-membrane electric voltage and electric resistance of model membranes, the latter being nitrocellulose filters impregnated with butylene ester of lauric acid. The increasing KCl concentration (in the measurement chambers) caused a rapid rise of the negative trans-membrane voltage, whose value stabilized afterwards. In the case of (C3H7)3SnCl an abrupt maximum of the negative voltage was observed followed by a monotonic drop to zero. In the case of highest concentrations of this compound the voltages, after having reached zero, changed their polarization to the opposite. Within the range of small concentrations two slight voltage maxima were observed. Non-ionic tin compounds like (CH3)4Sn and (C2H5)4Sn had an insignificant influence on the electric properties of the studied membranes.

The impact of humic and fulvic acids on the dynamic properties of liposome membranes: the ESR method

This paper presents the results of research on the influence of two fractions of humic substances (HS): fulvic acids (FA) and humic acids (HA), as a function of concentration, on the liposome membranes formed from egg yolk lecithin (EYL). The concentration of HS in relation to EYL changed from 0% to 10% by weight. The influence of HS on various areas of membranes: interphase water-lipid, in the lipid layer just below the polar part of the membrane and in the middle of the lipid bilayer, was investigated by different spin labels (TEMPO, DOXYL 5, DOXYL 16). The study showed that HA slightly decreased the fluidity of the analyzed membranes on the surface layer, while FA significantly liquidated the center of the lipid bilayer. The strong effect of both fractions of HS on the concentration of free radicals as a function of time was also described.

Two-step impact of Amphotericin B (AmB) on lipid membranes: ESR experiment and computer simulations

In this study, the electron spin resonance (ESR) method was used to examine the effect of Amphotericin B (AmB) molecules on the fluidity of model membranes made of dipalmitoylphosphatidylcholine (DPPC). The changes occurring under increased AmB concentrations in the spectroscopic parameters of spin probes placed in liposomes were determined. Three probes were used, penetrating the membrane at different depths which allowed the changes in its fluidity to be found in the transverse section. A computer model of the surface layer of membrane, with AmB admixture, was developed and subjected to computer simulation. The effect of changing concentration of the admixture on the binding energy in the system of dipoles representing the surface of the membrane was examined. The ESR studies showed that the process of accumulation of AmB molecules in the membrane has two stages, marked by local maxima in the ESR spectra. The first appears for concentrations of ca. 0.25-0.5% and the second appears for ca. 2.5-3% AmB of its molar ratio to DPPC. The computer simulations permitted reconstructing the two-stage mechanism of interaction between the molecules and the membrane. They demonstrated that, at low concentrations, the AmB molecules position themselves flat on the membrane surface. After the threshold concentration is exceeded, they re-orientate to a vertical position. This process leads to the perforation of the membrane.

Metalloporphyrin intercalation in liposome membranes: ESR study

Liposomes characterized by membranes featuring diverse fluidity (liquid-crystalline and/or gel phase), prepared from egg yolk lecithin (EYL) and dipalmitoylphosphatidylcholine (DPPC), were doped with selected metalloporphyrins and the time-related structural and dynamic changes within the lipid double layer were investigated. Porphyrin complexes of Mg(II), Mn(III), Fe(III), Co(II), Ni(II), Cu(II), Zn(II), and the metal-free base were embedded into the particular liposome systems and tested for 350 h at 24°C using the electron spin resonance (ESR) spin probe technique. 5-DOXYL, 12-DOXYL, and 16-DOXYL stearic acid methyl ester spin labels were applied to explore the interior of the lipid bilayer. Only the 16-DOXYL spin probe detected evident structural changes inside the lipid system due to porphyrin intercalation. Fluidity of the lipid system and the type of the porphyrin complex introduced significantly affected the intermolecular interactions, which in certain cases may result in self-assembly of metalloporphyrin molecules within the liposome membrane, reflected in the presence of new lines in the relevant ESR spectra. The most pronounced time-related effects were demonstrated by the EYL liposomes (liquid-crystalline phase) when doped with Mg and Co porphyrins, whereas practically no spectral changes were revealed for the metal-free base and both the Ni and Zn dopants. ESR spectra of the porphyrin-doped gel phase of DPPC liposomes did not show any extra lines; however, they indicated the formation of a more rigid lipid medium. Electronic configuration of the porphyrin's metal center appeared crucial to the degree of molecular reorganization within the phospholipid bilayer system.

Membrane fluidity and the surface properties of the lipid bilayer: ESR experiment and computer simulation

Penetration of the liposome membranes formed in the gel phase from DPPC (DPPC liposomes) and in the liquid-crystalline phase from egg yolk lecithin (EYL liposomes) by the TEMPO (2,2,6,6-tetramethylpiperidine-1-oxyl) and 16 DOXYL (2-ethyl-2-(15-methoxy-oxopentadecyl)-4,4-dimethyl-3-oxazolidinyloxy) spin probes has been investigated. The penetration process was followed by 120 hours at 24(0)C, using the electron spin resonance (ESR) method. The investigation of the kinetics of the TEMPO probe building into the membranes of both types of liposomes revealed differences appearing 30 minutes after the start of the experiment. The number of TEMPO particles built into the EYL liposome membranes began to clearly rise, aiming asymptotically to a constant value after about 100 minutes, whereas the number of the TEMPO particles built into the DPPC liposome membranes was almost constant in time. The interpretation of the obtained experimental results was enriched with those of computer simulation, following the behavior of the polar heads (dipoles) of the lipid particles forming a lipid layer due to the change in the value of the model parameter, k, determining the mobility of the dipoles. The possibility of the formation of an irregular ordering of the polar part of lipid membranes was proved, which leads to the appearance of spaces filled with of water for k > 0.4. The appearance of these defects enables the penetration of the bilayer by the TEMPO particles. The limited mobility of lipid polar heads (k < 0.2) prevents the appearance of such areas facilitating the penetration of the lipid membrane by alien particles in the gel phase.

The influence of tin compounds on the dynamic properties of liposome membranes: a study using the ESR method

The influence of organic and inorganic compounds of tin on the dynamic properties of liposome membranes obtained in the process of dipalmitoylphosphatidylcholine (DPPC) sonication in distilled water was investigated. This was carried out by means of the spin ESR probe method. The probes were selected in such a way as to penetrate different areas of the membrane (a TEMPO probe, 5-DOXYL stearic acid, 16-DOXYL stearic acid). Four compounds of tin were chosen: three organic ones, (CH(3))(4)Sn, (C(2)H(5))(4)Sn and (C(3)H(7))(3)SnCl, and one inorganic one, SnCl(2). The investigated compounds were added to a liposome dispersion, which was prepared prior to that. The concentration of the admixture was changed within the values from 0 to 10%-mole in proportion to DPPC. The studies indicated that the chlorides of tin display the highest activity in their interaction with liposome membranes. Since these compounds have ionic form in a water solution, the obtained result can mean that this form of admixture has a considerable influence on its activity. Furthermore, it was found that there is a slightly stronger influence of tin compounds with a longer hydrocarbon chain on changes in the probes' spectroscopic parameters.

Electric interactions at the lipid membrane surface

This work presents the results of an experimental study and of computer simulations concerning electric interactions in the surface layer of egg yolk lecithin (EYL) liposome membranes. The surface layer is formed by EYL polar heads, which possess features of electric dipoles, and positive charged polar heads belonging to admixtures of quaternary ammonium salts (AS). The results of the experimental study are in good agreement with the ones of the computer simulations. It was found that fluidity of the membranes, at a given concentration of AS, obtains the extremal (minimal) value. Similarly, the binding energy of the dipoles-positive charges system behaves like that in computer simulations. Moreover, the locations of the fluidity extremum and those of the binding energy depend on the charge of the AS polar heads as well as on the degree of electric interactions screening by the environment. At a certain optimal value of the screening coefficient, the energy of the system is the lowest (the most negative) and together with the rise in AS charge, the minimum of the energy moves towards its higher concentrations.

Computer simulations of the electric interactions between the phospholipid head-groups and ionic admixtures in the membrane surface

Some phospholipids (e.g. lecithin) form a system of electric dipoles on the membrane surface layer. In the case of lecithin the positive dipole charge is located on the choline and the negative one on the phosphoric molecule group. These dipoles are arranged almost parallel to the membrane surface. Taking the dipole membrane structure as a base for further investigations, a computer model of the electrostatic interaction between the dipole system and the ionic admixture was investigated. The model presumes hexagonal centered or a rectangular flat geometry of the 121 dipoles distribution. The dipoles may rotate freely around round the motionless symmetry axis perpendicular to the system surface. The initial state is given by fixing the geometry of the dipole matrix and ionic admixture distribution. Subsequently this system underwent a computer simulation which consisted of a calculation of resultant force moments acting on each dipole caused by other dipoles and ions. These force moments lead the system to the equilibrium state (minimum of the binding energy). The minimum energy value of the dipoles system depends on concentration and charge of the admixtured ions. The results of repeated simulations indicate that the system achieve the least of all binding energy (the most stable equilibrium state) at 1.5% concentration of admixtured ions in case of ion charge equal to 1Q (where Q denotes arbitrary unit of ion charge) and at 2.5% concentration of admixtured ions in case of ion charge equal to 2Q. The calculated results are in a good agreement with the experimental.

3D H(aro)-NOESY-CH3NH and C(aro)-NOESY-CH3NH experiments for double labeled proteins

Precision in the determination of the 3D structures of proteins by NMR depends on obtaining an adequate number of NOE restraints. Ambiguity in the assignment of NOE cross peaks between aromatic and other protons is an impediment to high quality structure determination. Two pulse sequences, 3D H(aro)-NOESY-CH3NH and 3D C(aro)-NOESY-CH3NH, based on a modification of a technique for simultaneous detection of 13C-1H (of CH3) and 15N-1H correlations in one measurement, are proposed in the present work. These 3D experiments, which are optimized for resolution in the 13C and 15N dimensions, provide NOE information between aromatic protons and methyl or amide protons. CH2 moieties are filtered out and the CH groups in aromatic rings are selected, allowing their NOE cross peaks to be unambiguously assigned. Unambiguous NOEs connecting aromatic and methyl or amide protons will provide important restraints for protein structure calculations.

The use of autologous platelet-rich plasma (platelet gel) and autologous platelet-poor plasma (fibrin glue) in cosmetic surgery

The purpose of this study was to evaluate a new technique of harvesting and preparing autologous platelet gel and autologous fibrin glue (body glue) and to evaluate their effectiveness in stopping capillary bleeding in the surgical flaps of patients undergoing cosmetic surgery. A convenience sample of 20 patients ranging from 25 to 76 years of age undergoing cosmetic surgery involving the creation of a surgical flap were included in the study. The types of surgical procedures included face lifts, breast augmentations, breast reductions, and neck lifts. Platelet-poor and platelet-rich plasma were prepared during the procedure from autologous blood using a compact, tabletop, automated autologous platelet concentrate system (SmartPReP, Harvest Autologous Hemobiologics, Norwell, Mass.). The platelet-poor and platelet-rich plasma were combined with a thrombin-calcium chloride solution to produce autologous fibrin glue and autologous platelet gel, respectively. Capillary bed bleeding was present in all cases and effectively sealed within 3 minutes following the application of platelet gel and fibrin glue. The technique for making the solution and for evaluating its effectiveness in achieving and maintaining hemostasis during cosmetic surgical procedures is described. Autologous platelet gel and fibrin glue prepared by the automated concentrate system are compared with autotransfusor-prepared platelet gel and Tisseel (Baxter Healthcare Corp.), a commercially prepared fibrin sealant preparation.

Sensitivity enhancement of HCACO by using an HMQC magnetization transfer scheme

Previous theoretical calculations have demonstrated that the multiquantum relaxation rate of (1)H(alpha)-(13)C(alpha)(R(MQ)) is, on average, 1.3 +/- 0.4 or 1.7 +/- 0.6 times slower than the single-quantum relaxation rate of (13)C(alpha)(R(C)) for a sample with or without, respectively, amide protons. By taking advantage of this fact and by using the PEP sensitivity enhancement scheme, an HMQC version of the HCACO experiment has been developed. We demonstrate that this new experiment is 23 and 55% more sensitive than the original HSQC version of the HCACO experiment, at constant times of 7 and 27 ms, respectively, for a sample of the BC domain of the ciliary neurotrophic factor receptor protein dissolved in D(2)O at 20 degrees C.

The influence of permanent magnetic field therapy on wound healing in suction lipectomy patients: a double-blind study

The authors present their experience with the healing influence of permanent magnets on postoperative wounds. The responses of 20 patients who underwent suction lipectomy and postoperative negative magnetic field therapy were studied in a double-blind fashion. Magnets in the form of patches (10 patients) or sham magnet patches (10 patients) were placed over the operative region in each of the patients. Pain, edema, and discoloration (ecchymosis) were evaluated at 1, 2, 3, 4, 7, and 14 days postoperatively. Our results show that the treatment group had significant reductions in pain on postoperative days 1 through 7, in edema on days 1 through 4, and in discoloration on days 1 through 3 when compared with the control group. These results demonstrated that commercially available magnets have a positive influence on the postoperative healing process in suction lipectomy patients.

Community-based empowerment programme for families with a brain injured survivor: an outcome study

Rehabilitation of brain injured persons has been one of the challenges of the modern health care team. Brain injured persons' problems are termed complex and multiple, and may persist long after the acute management stage. Families caring for their brain-injured members are, however, ill prepared to face this long-term rehabilitation process. A previous study of an empowerment framework applicable among these Hong Kong Chinese families resulted in the development of a 52-item empowerment questionnaire with four interpretable factors (efficacy, knowledge, support and aspiration). This can also serve as a valid and reliable outcome measure of their empowerment efforts. As a follow-up of this development, an 8-week community-based empowerment programme was thus designed and implemented for a total of 50 family members in six repeated groups. Outcome indicators including empowerment questionnaire, psychological well-being, self-efficacy, subjective experience of the burdens in care-giving, and support systems were used to monitor changes in empowerment status during the periods of pre- and post-programme, and during the 3 month follow-up. The programmes were found to be effective in empowering family members in the four postulated empowering dimensions, and improving all other outcome measures. The follow-up studies reflect stability in empowerment, though there were no further improvement. From regression analysis, it was suggested that, for optimum empowerment to take place, important predictors included careers' education levels, age ranges and work status.

ESR study of the liposome membrane physical parameters in the heating-cooling cycles

Changes of dynamic and structural parameters of egg yolk lecithin (EYL) liposome membranes in the heating-cooling cycles have been studied using the ESR spin probe method. The investigations were conducted in the range of temperatures from -18 degrees C to +60 degrees C. It has been found that in the range of temperatures -15 degrees C to +45 degrees C in both the heating and the cooling run the spectroscopic parameters changed practically along the same curve (reversible changes). However, after exceeding this range of temperatures one of the parameters (partition coefficient of the spin probe 2,2,6,6--tetramethylpiperidine -1-oxyl; TEMPO) changed along a closed curve, showing the phenomenon of thermal hysteresis. In the heating process the TEMPO content in liposome membranes was smaller than this in the cooling process. We assume that during the heating, the lipid molecules of the outer liposome layers dissolve in the aqueous medium. In the cooling process they can aggregate and form new liposomes, what in turn increases the surface of liposome membranes, accessible for the TEMPO probe (active surface).

Bimodal effect of amphiphilic biocide concentrations on fluidity of lipid membranes

Using the spin label method (ESR) it has been shown that biologically active, amphiphilic compounds (quaternary ammonium salts (AS) containing polar heads with single and double positive charge caused, at low concentrations, decrease fluidity of liposome membranes formed with egg yolk lecithin (EYL). At higher concentrations an increase in fluidity was observed. With compounds having a single positive charge minimum fluidity of membrane structure occurs in the range of 1 to 3%, with compounds containing double positive charge-in the range of 4-6%. That effect does not depend on polar head size and length of alkyl chains of the AS used. Analysis of the electrostatic interaction between positive charges and dipole system suggest that at low ion concentrations the binding energy of the system increases, while it decreases at high concentrations. For the model presented, maximum of binding energy of the system occurs at 3% of positive monovalent ions and at 6% of positive divalent ions admixed.

A new addition to face lift surgery: the argon gas surgical unit

In the quest to improve the technique of performing face lift surgery, we have encountered a device, the argon gas surgical unit, that offers a number of advantages over current techniques. These advantages include significant reductions in the amount of both intraoperative and postoperative blood loss, depth of tissue damage, amount of postoperative swelling, and amount of postoperative pain. This paper describes our experience with the use of the argon gas surgical unit compared with conventional electrocautery in 30 patients undergoing face lift. On histologic examination of the skin specimens, there was a consistent decrease in the depth of tissue damage with the argon gas surgical unit. With regard to blood loss, as a whole there was a marked decrease in the argon gas surgical unit group. Additionally, there is a clinically significant decrease in postoperative swelling in the patients in whom the argon gas surgical unit was employed that contributes to improved wound healing and an overall improved postoperative course.

Stretching and tissue expansion for rhytidectomy: an improved approach

Intraoperative expansion of the skin of the face supplies additional tissue that permits closure of the face lift incision with minimal tension. This paper presents the findings in rhytidectomy patients over the last 3 years using both intraoperative stretching and intraoperative stretching combined with tissue expansion utilizing the Man face lift expander. Sixty-seven patients underwent rhytidectomy surgery, of whom 50 were treated with stretching techniques alone and 17 were treated with the combined stretching and expansion method. The patients' ages ranged from 28 to 78 years. Results indicate that the patients treated with combined stretching and expansion had significantly more skin removed. This new technique appears to offer significant clinical advantages over usual face lifts.

Neutral and acidic species of human intestinal mucin. Evidence for different core peptides

Highly purified human mucins from postmortem intestinal tissue were fractionated on anion exchange columns to generate separate neutral and acidic species. The neutral mucin (less than 1.0 mol % sialic acid) was the major species (greater than 80% by weight) and contained a higher molar proportion of fucose, galactose, and N-acetylglucosamine, and a lower proportion of sialic acid and N-acetylgalactosamine than the acidic species (greater than 10 mol % sialic acid). Amino acid analyses revealed a highly significant enrichment in serine, aspartate, and alanine in the neutral species and proline, threonine, and glycine in the acidic species. Thiol reduction of each species to remove their integral 118,000-dalton component did not alter the essential interspecies differences. Differences in threonine, proline, and serine also remained after removal of all "naked" or pronase-susceptible peptide regions from each species. These results indicate that neutral and acidic mucins contain glycopeptide segments exclusive of their 118,000-dalton and naked peptide components, which differ in amino acid composition. The key amino acid markers are similar to those observed for fuco- and sialoglycopeptides obtained after proteolytic digestion of human colonic mucin by Gold et al. (Gold, D.V., Schochat, D., and Miller, F. (1981) J. Biol. Chem. 256, 6354-6358). The oligosaccharide composition of small intestinal and colonic mucin may therefore depend upon transcriptional control of the synthesis of specific mucin peptides as well as the post-translational activity of glycosyltransferases. These findings may have significance for the quality and functions of mucus produced in a variety of pathological states.

Drug allergy: incidence in terms of age and some drug allergens

The authors studied the incidence of drug allergy in 3 groups of subjects. In the first group the incidence was established in terms of the subjects' age: 1.8% in children up to 14 years old (323 subjects), 5.8% in middle-aged subjects (389 subjects) and 2.9% in the elderly (243 subjects). In the second partly selected group, drug allergy was studied in patients admitted to the 3rd Medical Clinic--Craiova between 2 Jan. 1981 and 31 Dec. 1982; 103 of the 8,760 patients admitted presented allergic reactions, a relatively high incidence rate (1.01%) as compared to other published reports. The third group of previously selected cases consisted of 197 patients who had come to the allergology service with complaints of present or past sensitivity to drugs. The total number of patients was 336 selected or preselected from about 10,000 subjects, to which 17 patients with a diagnosis of "asthmatic triad" must be added. Drug allergy in terms of the drug used was dominated by penicillin, pyramidon-algocalmin, aspirin, iodine preparations, etc.; foremost among the clinical syndrome were the dermatologic syndromes types I, III and IV; syndromes of the "anaphylactic shock" type, "serum sickeness" bronchial asthma, angioneurotic oedema.

The biceps femoris myocutaneous advancement flap: a useful modification for ischial pressure ulcer reconstruction

We describe a modification of the biceps femoris myocutaneous flap for reconstruction of ischial pressure ulcer defects. In this modification, all neural and vascular pedicles are preserved and the flap is advanced into the ischial defect rather than transposed as described in the literature. With this method, no transferred tissue is lost. Besides ensuring good tissue survival, the flap preserves a maximum number of reconstructive options in the event of ischial pressure ulcer recurrence. These advantages make the biceps femoris myocutaneous advancement flap our first choice for reconstruction of ischial pressure ulcer defects.

Desmoplastic malignant melanoma: a case report

A further case of desmoplastic malignant melanoma of the cheek is presented, bringing the total number of reported cases to 15. Its clinicopathological features and treatment are discussed.

The microarterial anatomy of the dorsalis pedis flap and its clinical applications

This study was undertaken to clarify the microanatomic details of the cutaneous branches of the dorsalis pedis artery. The microarterial anatomy of the dorsalis pedis flap area and its clinical implications are described.

Immunological, structural and functional relationships between an anti-complementary protein from Crotalus atrox venom, cobra venom factor and human C3

An anti-complementary protein which cross-reacts with antiserum to cobra venom factor (CoF) has been highly purified from Crotalus atrox venom (CAV). On an equal weight basis, the C. atrox factor (CA-F) had one-third the anti-complementary activity of CoF and similarly consumed the terminal components of complement via the alternative pathway. The subunit compositions of CoF and CAV were similar, each being composed of alpha and beta chains held together by covalent and non-covalent bonds. Agarose gel diffusion analysis using monospecific antiserum to CoF detected a reaction of partial immunological identity between CoF and CA-F and between C3 and CA-F with the CoF and C3 precipitin lines spurring over the CA-F lines. Thus CA-F probably represents a C. atrox C3 protein which is capable of activating the alternative complement pathway via the amplification loop in a manner analogous to that of C3b and CoF.

Kinetic studies on the fragmentation of the third component of complement (C3) by trypsin

The kinetics of cleavage of C3 by trypsin was analyzed by electrophoresis in agarose and in polyacrylamide gels containing sodium dodecyl sulfate and the data obtained were used to construct an anatomical model for C3 showing the sites of tryptic attack, the fragments generated, and their composition. Trypsin was shown to cleave C3 in a stepwise fashion. The attack was initially directed at the alpha-polypeptide chain and resulted in the generation of C3a and C3b. Further cleavage of the alpha-chain of C3b, converted it into C3b1 and then into C3d and C3c. Cleavage of the beta-chain by trypsin occurred only at the C3c stage with the release of a small peptide (m.w. 12,000) from C3c and the formation of C3c'. On immunoelectrophoresis, C3c' had a less anodal mobility compared to the beta1A mobility of C3c. C3a, once formed could be further cleaved to give residual fragments with decreasing net positive charge. Exposure of C3 to acid conditions, pH 5.0 or below, rendered the molecule exceedingly susceptible to tryptic degradation.