Prognostic values of tumor necrosis factor/cachectin, interleukin-1, interferon-alpha, and interferon-gamma in the serum of patients with septic shock. Swiss-Dutch J5 Immunoglobulin Study Group

Serum concentrations of immunoreactive tumor necrosis factor/cachectin (TNF), interleukin-1 beta (IL-1 beta), interferon-gamma (IFN gamma), and interferon-alpha (IFN alpha) were prospectively measured in 70 patients with septic shock to determine their evolution and prognostic values. In a univariate analysis, levels of TNF (P = .002) and IL-1 beta (P = .05) were associated with the patient's outcome, but not IFN alpha (P = .15) and IFN gamma (P = .26). In contrast, in a stepwise logistic regression analysis, the severity of the underlying disease (P = .01), the age of the patient (P = .02), the documentation of infection (nonbacteremic infections vs. bacteremias, P = .03), the urine output (P = .04), and the arterial pH (P = .05) contributed more significantly to prediction of patient outcome than the serum levels of TNF (P = .07). After 10 days, the median concentration of TNF was undetectable (less than 100 pg/ml) in the survivors, whereas it remained elevated (305 pg/ml, P = .002) in the nonsurvivors. Thus, in patients with septic shock due to various gram-negative bacteria, other parameters than the absolute serum concentration of immunoreactive TNF contributed significantly to the prediction of outcome.

Treatment of gram-negative septic shock with human IgG antibody to Escherichia coli J5: a prospective, double-blind, randomized trial

In a randomized, double-blind, multicenter trial we compared the efficacy of a preparation of human IgG antibody to Escherichia coli J5 (J5-IVIG) with that of a standard IgG preparation (IVIG) for the treatment of gram-negative septic shock. At study entry, patients received a single intravenous dose of 200 mg/kg of body weight (maximal dose, 12 g) of either J5-IVIG or IVIG. Of the 100 patients randomized, 71 (30 receiving J5-IVIG and 41 receiving IVIG) had a documented gram-negative infection. Mortality from gram-negative septic shock was 50% (15 of 30) in J5-IVIG recipients and 49% (20 of 41) in IVIG recipients. In addition, treatment with J5-IVIG did not reduce the number of systemic complications of shock and did not delay the occurrence of death due to septic shock. Thus we conclude that J5-IVIG was not superior to IVIG in reducing mortality or in reversing gram-negative septic shock.

Motor and cognitive development in children with congenital hypothyroidism: a long-term evaluation of the effects of neonatal treatment

Although neonatal thyroid screening programs have been of value in preventing cerebral damage, it is still controversial whether patients with congenital hypothyroidism achieve normal motor and cognitive skills. We studied the motor and cognitive skills of 72 children with early-treated congenital hypothyroidism and 35 control subjects at the ages of 7 1/2 and 9 1/2 years. The relative influence of cause, blood thyroxine concentration at the time of screening, and age at the start of thyroxine replacement therapy on motor and cognitive development was investigated. Despite having received treatment at a mean age of 23 days, children with low neonatal thyroxine concentrations (< 50 nmol/L) at screening, particularly children with thyroid agenesis, had significant motor problems and borderline intelligence scores as late as 9 1/2 years of age. Balance and gross motor functions seemed to decline between 7 1/2 and 9 1/2 years of age, whereas language and memory functions seemed to be maintained. Significant correlations between the start of therapy and both motor scores and performance IQ scores at the age of 7 1/2 years in children with severe hypothyroidism show the importance of early treatment for these patients.

The seroepidemiology of Bordetella pertussis infection in Western Europe

High titres of pertussis toxin (PT) antibody have been shown to be predictive of recent infection with Bordetella pertussis. The seroprevalence of standardized anti-PT antibody was determined in six Western European countries between 1994 and 1998 and related to historical surveillance and vaccine programme data. Standardized anti-PT titres were calculated for a series of whole-cell and acellular pertussis vaccine trials. For the serological surveys, high-titre sera (> 125 units/ml) were distributed throughout all age groups in both high- (> 90%) and low-coverage (< 90%) countries. High-titre sera were more likely in infants in countries using high-titre-producing vaccines in their primary programme (Italy, 11.5%; Western Germany, 13.3%; France, 4.3%; Eastern Germany, 4.0%) compared to other countries (The Netherlands, 0.5%; Finland, 0%). Recent infection was significantly more likely in adolescents (10-19 years old) and adults in high-coverage countries (Finland, The Netherlands, France, East Germany), whereas infection was more likely in children (3-9 years old) than adolescents in low-coverage (< 90%; Italy, West Germany, United Kingdom) countries. The impact and role of programmatic changes introduced after these surveys aimed at protecting infants from severe disease by accelerating the primary schedule or vaccinating older children and adolescents with booster doses can be evaluated with this approach.

Nuclear transcription factor κ B activation and protein turnover adaptations in skeletal muscle of patients with progressive stages of lung cancer cachexia

BACKGROUND

Experimental models of cancer cachexia have indicated that systemic inflammation induces muscle-protein breakdown and wasting via muscular nuclear transcription factor κB (NF-κB) activation. This process may limit the efficacy of nutritional intervention.

OBJECTIVES

We assessed muscle NF-κB activity and protein turnover signaling in progressive stages of clinical lung cancer cachexia and assessed whether circulating factors can induce muscular NF-κB activity.

DESIGN

Patients with lung cancer precachexia (n = 10) and cachexia (n = 16) were cross-sectionally compared with 22 healthy control subjects. mRNA transcripts of muscle proteolytic (ubiquitin proteasome system and autophagy lysosomal pathway) and myogenic markers and protein expression of PI3K/Akt, myostatin, and autophagy signaling were measured. A multiplex analysis showed the systemic inflammatory status, whereas plasma exposure to stable NF-κB-luciferase-reporter muscle cells revealed NF-κB inducibility.

RESULTS

Compared with healthy control subjects, cachectic patients had reduced (appendicular) muscle mass (-10%), muscle fiber atrophy (-27%), and decreased quadriceps strength (-31%). Subtle alterations in the muscle morphology were also detectable in precachectic patients, without changes in body composition. Despite increased Akt phosphorylation, downstream phosphosubstrates glycogen synthase kinase 3β, mammalian target of rapamycin, and Forkhead box protein were unaltered. The expression of autophagy effectors B cell lymphoma 2/adenovirus E1B 19-kDa protein-interacting protein 3 and microtubule-associated proteins 1A/1B light chain 3B gradually increased from precachectic to cachectic patients, without differences in E3 ubiquitin ligases. Systemic and local inflammation was evident in cachexia and intermediate in precachexia, but the plasma of both patients groups caused ex vivo muscle NF-κB activation.

CONCLUSIONS

In lung cancer, muscular NF-κB activity is induced by factors contained within the circulation. Autophagy may contribute to increased muscle proteolysis in lung cancer cachexia, whereas the absence of downstream changes in phosphosubstrates despite increased Akt phosphorylation suggests impaired anabolic signaling that may require targeted nutritional intervention.

A European multicenter study of immunoblotting in serodiagnosis of lyme borreliosis

A European multicenter study of immunoblotting for the serodiagnosis of Lyme borreliosis showed considerable variation in results obtained from tests with a panel of 227 serum samples. Six laboratories used different immunoblot methods, and a wide range of bands was detected in all the assays. Multivariable logistic regression analysis of data from individual laboratories was used to determine the most discriminatory bands for reliable detection of antibodies to Borrelia burgdorferi sensu lato. These bands were used to construct individual interpretation rules for the immunoblots used in the six laboratories. Further analysis identified a subset of eight bands, which were important in all the laboratories, although with variations in significance. Possible European rules, all closely related, were formulated from these bands, although there was no single rule that gave high levels of sensitivity and specificity for all the laboratories. This is a reflection of the wide range of methodologies used, especially the use of different species and strains of B. burgdorferi sensu lato. The panel of European rules provides a framework for immunoblot interpretation which may be adapted in relation to the characteristics of Lyme borreliosis in local areas.

Polymerase chain reaction assay for pertussis: simultaneous detection and discrimination of Bordetella pertussis and Bordetella parapertussis

A polymerase chain reaction (PCR) assay which allows the simultaneous detection and discrimination of the two causative agents of pertussis, Bordetella pertussis and Bordetella parapertussis, was developed. Primer pairs were based on insertion sequence elements IS481 and IS1001. IS481 is specific for B. pertussis and is present in about 80 copies per cell, while IS1001 is specific for B. parapertussis and is found in 20 copies per cell. An internal control was included in the PCR assay to monitor the performance of the PCR and to identify possible inhibitory components in clinical samples. Discrimination of amplified DNA derived from the internal control, B. pertussis, or B. parapertussis was accomplished by differential spacing of the primers. The sensitivity of the combined PCR method was found to be very high and allowed the detection of one cell of either pathogen. The usefulness of the method was investigated by using a limited number of clinical samples derived from patients with serologically proven pertussis.

A clinical validation of Bordetella pertussis and Bordetella parapertussis polymerase chain reaction: comparison with culture and serology using samples from patients with suspected whooping cough from a highly immunized population

The aim of this study was to validate the performance of the polymerase chain reaction (PCR) assay for Bordetella pertussis and Bordetella parapertussis in comparison with both culture and serology. The number of samples positive in PCR was 2.4-fold higher than the number of samples positive in culture. In serologically confirmed cases, the sensitivity of PCR and culture depended on the duration of disease and the age of the patient, being less sensitive in older age and later in disease. The sensitivity of the PCR in patients with < 10 days of symptoms was 70%, 50%, and 10% in the age groups < 1 year, 1-4 years, and > or = 5 years, respectively. Evidence suggested that the effect of age on sensitivity may be due to differences in immune responses. The low IgA response in the < 1 year age group may be related to the high number of samples positive in PCR and culture, even late in disease.

European Sero-Epidemiology Network: standardisation of the assay results for pertussis

A standardisation process was developed in order to compare and harmonize serological results of pertussis toxin (PT) antibody measurements performed by laboratories using different technical procedures for detection. This involved the development of a common panel, of sera by a designed reference centre, the distribution of the panel to each participating laboratory for testing with their routine methods, the comparison of the obtained results to those of the reference centre, and the calculation of standardisation equations by regressing the quantitative results against those of the reference centre. As a cut-off indicative of protection against pertussis has not yet been defined, a particular emphasis was laid upon achieving standardisation of high titre results that would allow epidemiological evaluations based on the estimation of the incidence of recent infections rather than on the traditional approach of determining the population immunity profile. A generally good agreement was achieved between the participating laboratories, all using ELISA procedures very similar in many crucial aspects, and standardisation equations were produced useful to enable inter-country comparison during the next stages of the European Sero-Epidemiology Network (ESEN) project concerning the serological surveillance of immunity to pertussis in Europe.

Test-retest reliability of the Isernhagen Work Systems Functional Capacity Evaluation in patients with chronic low back pain

The aim of this study was to investigate test-retest reliability of the Isernhagen Work System Functional Capacity Evaluation (IWS FCE) in a sample of patients (n = 30) suffering from Chronic Low Back Pain (CLBP) and selected for rehabilitation treatment. The IWS FCE consists of 28 tests that reflect work-related activities like lifting, carrying, bending, etc. In this study, a slightly modified IWS FCE was used. Patients were included in the study if they were still at work or were less than 1 year out of work because of CLBP. Participants' mean age was 40 years, the duration of low back pain ranged between 5 and 10 years. Fifteen patients (50%) were out of work for a mean of 17 weeks, and they all received financial compensation. Two FCE sessions were held with a 2-week interval in between. Means per session, 95% confidence intervals of the mean difference, one-way random Intra Class Correlations (ICC), limits of agreement, Cohen's kappa and percentage of absolute agreement were calculated where appropriate. An ICC of 0.75 or more, a kappa value of more than 0.60 and a percentage of absolute agreement of 80% were considered as an acceptable reliability. Tests of the IWC FCE were divided into tests with and tests without an acceptable test-retest reliability on the basis of the kappa values, the percentage of absolute agreement and the ICC values. Fifteen tests (79%) showed an acceptable test-retest reliability based on Kappa values and percentage of absolute agreement. Eleven tests (61%) showed an acceptable test-retest reliability based on ICC values.

Identification of four genomic groups of Borrelia burgdorferi sensu lato in Ixodes ricinus ticks collected in a Lyme borreliosis endemic region of northern Croatia

We investigated the presence of Borrelia burgdorferi sensu lato in Ixodes ricinus ticks collected in a Lyme borreliosis (LB) endemic region of northern Croatia. Ticks (n = 124) were collected at five locations and analysed by the polymerase chain reaction (PCR). A DNA fragment from the internal transcribed spacer (ITS2) of I. ricinus was detected in all tick lysates, indicating that PCR inhibitors were not present. Borrelia burgdorferi sensu lato DNA was detected in 56 out of 124 ticks (45%). Four genomic groups were identified: Borrelia afzelii (n = 26), Borrelia garinii (n = 5), group VS116 (n = 5) and B. burgdorferi sensu stricto (n = 1). Mixed infections of B. afzelii with group VS116 (n = 10) and B. afzelii with B. burgdorferi sensu stricto (n = 1) were also detected. Eight ticks contained B. burgdorferi sensu lato, which could not be typed. The detection of B. afzelii and B. garinii in ticks was in agreement with manifestations of LB found locally. The occurrence of group VS116 in northern Croatia and in an earlier study in The Netherlands, infers that this genomic group may be well established in European I. ricinus.

Immediate and delayed after-effects of long lasting mentally demanding work

This study investigates the hypothesis that long lasting mental work demands are reflected in after-effects on attention demanding post-test probe tasks. Sixteen subjects were engaged in 2 simulated workdays consisting of mentally demanding tasks. On the difficult day the afternoon consisted of highly demanding information processing tasks; on the easy day the demands during the afternoon were low. The mornings of both days were equally demanding. At the start (pre-test) and the end (post-test) of both days, after 5 min (immediate post-test) as well as after approximately 2 h of recuperation (delayed post-test), a probe task was carried out. A memory-search task (varied mapping) is used as probe task. After-effects were expected in terms of a shift in the ratio between performance and effort on the post-test probe tasks compared with the pre-test probe task. Performance measures were reaction time and errors; effort was indicated by heart rate variability in the 0.07-0. 14 Hz band, referred to as 0.1 Hz component. Dayload manipulation appeared to be effective because of the load-related differences between the urinary excretion rates of adrenaline during both afternoons. Compared with the pre-test, only the number of errors was significantly increased in the post-test, carried out immediately at the end of the difficult afternoon. However, compared with the easy day, in the delayed post-test probe task after the difficult day, subjects tended to shorten reaction times, made significantly more errors, and invested significantly less effort. Moreover, at that time they felt more fatigued and deactivated as indicated by the results of the 'Scale of Experienced Load' (SEB) (fatigue) and 'Groninger Adjective Checklist' (GACL) (mood) questionnaires. The observed shift towards low-effort, more 'risky' task strategies in the post-tests fits well with Hockey's (1993) fatigue after-effects degradation pattern expected after periods of high workload. The repeated measurement of the relation of performance, effort and feelings reveals the dynamics of the pattern of fatigue after-effects over the (recovery) time.

Epidemiological features of invasive and noninvasive group A streptococcal disease in the Netherlands, 1992-1996

A prospective, nationwide, laboratory-based surveillance of invasive group A streptococcal infections was conducted in the Netherlands from 1992 through 1996. Clinical and demographic data were obtained and all isolates were T/M typed. All noninvasive group A streptococcal isolates were registered from 1994 through 1996. A total of 880 patients with invasive streptococcal disease were identified. The annual incidence was found to be 2.2 per 100,000. Predominant M types were M1 (21%), M3 (11%), M6 (5%), M12 (5%), and M28 (8%). Particular age and M-type distributions were observed in different clinical entities. The case-fatality rate was 18% overall, but it reached 59% among cases of toxic shock-like syndrome. Older age, necrotizing fasciitis, sepsis without focus, pneumonia, infection with type M1 or M3 strains, and underlying cardiopulmonary disease were associated with fatality. A total of 10,105 patients with noninvasive group A streptococcal disease were registered. These patients differed significantly from patients with invasive disease with regard to age distribution and primary foci of infection.

The micro-structure of tapping movements in children

In order to investigate the development of movement speed in relation to movement organization, children of 5, 6, 7, 8 and 9 years of age and adults carried out a reciprocal tapping task, in which time pressure and distance were manipulated. The duration, velocity, acceleration and accuracy of the movements were compared between age groups. Age differences appeared mainly in the homing time, not in the duration of the distance covering movement phase. Accuracy and velocity of the distance covering movement phase differed with age. Time pressure affected the homing time, but not the duration of the distance covering phase. Distance manipulation affected mainly the velocity and duration of the distance covering movement phase and the homing time. In the discussion it is contended that age differences in homing time may be related to both the accuracy of the distance covering movement phase and the rate of information processing of the subject.

Visually guided hand movements in children with minor neurological dysfunction: response time and movement organization

Many children with signs of minor neurological dysfunction (MND) are unable to adapt precisely their movements to external goals, in particular when they are under time pressure. Pilot studies in our laboratories suggested that response times in various sorts of tapping tasks were longer in such children than in controls with an optimal neurological status. In the present study an experimental tapping task, presented in 'self-paced mode', is applied to explore further the relationships between response time and spatio-temporal organization of movements in children with MND as compared to optimal controls. Differences were found with respect to inter-response intervals as well as to the organization of the movements; children with MND have longer overall response times than controls, more movement elements per tap and shorter first movement elements. Further, the moment of maximal acceleration comes later in the children with MND than in the controls. Such differences in response time and movement organization may be due to information processing limitations and increased attentional demands for the execution of movements in MND children.

Cross-reactivity of monoclonal antibodies against lipopolysaccharides of gram-negative bacteria

Monoclonal antibodies were produced against Escherichia coli O111, Escherichia coli J5, and the rough (R) mutant of Salmonella typhimurium M206, and tested by enzyme-linked immunosorbent assay against lipopolysaccharides of several gram-negative strains. The monoclonal antibodies were also identified with an immunoblotting assay. Anti-Escherichia coli O111 monoclonal antibodies reacted only with homologous O antigens. Anti-J5 monoclonal antibodies cross-reacted with core lipopolysaccharide, especially with Rc lipopolysaccharide. IgM anti-J5 monoclonal antibodies showed more extensive cross-reactivity than IgG3 monoclonal antibodies. Anti-Re monoclonal antibodies cross-reacted weakly with all rough lipopolysaccharide tested. Thus, the varying specificity of these monoclonal antibodies seems to indicate that the core regions in the lipopolysaccharides of various gram-negative bacteria are not similar.

A high-throughput Taqman approach for the discrimination of HLA-E alleles

An association between human leukocyte antigen (HLA) molecules and the incidence of various diseases has been recognized for years. Molecules of the HLA system also exert an important role on the clinical outcome after transplantation such as stem cell transplantation. The conventional HLA typing method is sequence based typing (SBT) which is reliable but laborious. The goal of this study was to develop a high-throughput Taqman assay to screen large panels for HLA-E alleles. Two functional HLA-E alleles, *0101 and *0103, have been identified. We set up the Taqman assay with genomic DNA as template to discriminate the three HLA-E genotypes: homozygous HLA-E*0101, heterozygous *0101, *0103 and homozygous *0103. This Taqman approach was validated by the comparison of results obtained with the typing results acquired by sequenced base typing (SBT). Additional screening of a large panel showed the pronounced discriminative capacity of the Taqman assay for HLA-E allele typing. The Taqman assay is a fast, reliable and consistent HLA-E allele typing method, especially useful to screen large panels.

Timing variability in children with early-treated congenital hypothyroidism

This study reports on central and peripheral determinants of timing variability in self-paced tapping by children with early-treated congenital hypothyroidism (CH). A theoretical model of the timing of repetitive movements developed by Wing and Kristofferson was applied to estimate the central timekeeper (clock) and peripheral implementation (motor delay) variances from the variability in the response intervals. Before it is diagnosed and treated, CH is known to affect proper development of the cerebellum. If this would affect the time-keeper function of the cerebellum, it should be reflected by an increased central clock variability rather than by an increased peripheral motor-delay variability in terms of the Wing and Kristofferson model. Results of 46 children with early-treated CH, differing in severity (21 severe, 25 mild), and 34 normal controls are reported. A refinement of the Wing and Kristofferson model is applied to estimate central clock and peripheral motor delay timing variability more precisely than has been done before. Results show that for children with early-treated CH the estimate of the motor delay variance is four times higher than for the controls, while the estimate of the clock variance does not differ between the groups. It is concluded that motor problems in early-treated CH are associated with peripheral rather than with central timing deficiencies.

NK-KIR ligand identification: a quick Q-PCR approach for HLA-C epitope typing

Interaction of donor natural killer (NK)-cell-associated killer cell immunoglobulin-like receptors (KIRs) with the patient's human leukocyte antigen-C (HLA-C) ligands can result in an alloreactive NK response after haematopoietic stem cell transplantation. In many retrospective studies, additional HLA-C-typing data are required to predict NK-cell alloreactivity. We developed a Taqman assay using the quantitative polymerase chain reaction (Q-PCR) technique that facilitates HLA-C epitope typing, allowing the assignment of HLA-C group 1 or 2 alleles based on the dimorphism at residues 77 and 80 rather than based on the sequence specific priming (SSP) and sequence-based typing allele types. Q-PCR analysis for HLA-C epitope detection showed three clusters reflecting homozygous group 1 or 2 and heterozygous samples. This new approach introduces a quick HLA-C epitope screening method to define the presence of the ligand for the KIR-HLA-C interaction.

Wages, secondary workers, and fertility: a working-class perspective of the fertility transition in England and Wales

The focus of the analysis in this study is on the economic benefits parents derive from their children and the impact of these on fertility transitions. Particular attention is given to the working class in Victorian England and Wales. The life-cycle drop-off in adult productivity among this class created a need for additional income at later stages of the family life-cycle. This income was mostly generated by children and adolescents. Hence, it is suggested, that not until the substantial rise in real wages during the last quarter of the nineteenth century could fertility among the working class in England and Wales have started its decline. This hypothesis is shown to be consistent with data on occupation-specific fertility levels taken from the 1911 Fertility Census.

Economic change and infant mortality in England, 1580-1837

Adaptation of the results from a recent family-reconstitution study of twenty-six parishes in pre-transition England reveals that long-term trends in post-neonatal mortality follow trends in a real-wage index, and that trends in neonatal mortality correlate with other economic factors. Thus, the hypothesis that infant mortality and economic performance in pre-transition England were related is consistent with the family-reconstitution data.