Factors Associated with Information Breach in Healthcare Facilities: A Systematic Literature Review

This systematic review aimed to identify the factors associated with information breaches in healthcare settings. We searched electronic databases, including PubMed, Embase, Scopus, and Wiley, for all publications until March 6, 2022 (no start date restriction) and outlined the eligibility criteria framework using Population, Concept, and Context (PCC). Our search strategies yielded 2,156 results, with nine studies included in the final review. We grouped the factors attributed to data breaches into four categories: organizational, information technology (IT), professionals/employees, and clients/patients. Hospital type, hospital size (more beds), higher operationalexpenses and revenue, higher admissions and discharges, and higher Electronic Medical Record (EMR) use, being at earlier phases of EMR adoption, were associated with higher information breaches. Professional factors such as the type of personnel involved and the hospital area can potentially impact the breaches' frequency and magnitude. Patients' sociodemographic, clinical, and behavioral characteristics, such as gender and educational attainment, appear to influence the perceived breach of confidentiality in healthcare settings. Identifying different factors contributing to health information breaches is crucial to protecting healthcare organizations and patients from the devastating consequences of data breaches.

Adolescent and Parent Preferences for Hypodontia: Discrete Choice Experiment

Choosing hypodontia treatment requires young people and parents to consider a large amount of information, identify what is important to them, and make trade-offs between options. This study aimed to examine young people and parents' preferences for hypodontia treatment using discrete choice experiment (DCE). This was a cross-sectional survey of young people (12-16 y) with hypodontia of any severity, at any stage of treatment, and their parents. Participants were recruited from NHS Hospitals in England and Wales. A bespoke DCE questionnaire was developed to measure preferences for 6 attributes of hypodontia treatment (waiting time, treatment time, problems during treatment, discomfort during treatment, bite, appearance). The questionnaire was completed 1) online by young people and parents, individually or together, and 2) by child-parent dyads under observation. Preferences were analyzed using regression models. In total, 204 participants (122 young people, 56 parents, 26 dyads) completed the online questionnaire and 15 child-parent dyads completed the questionnaire under observation. The most important attribute in hypodontia treatment was improvement in appearance, but significant heterogeneity was found in preferences. Four distinct groups of participants were found: group 1 (39%): severe discomfort and problems were most important; group 2 (31%): most concerned about improvement in appearance of teeth and improvement in bite; group 3 (22%): appearance 3 times more important than any other attribute; and group 4 (9%): preferences difficult to interpret. There was variation in how child-parent dyads approached decision-making, with some negotiating joint preferences, while for others, one individual dominated. Making trade-offs in DCE tasks helped some people think about treatment and identify their preferences. Appearance is an important outcome from hypodontia treatment, but preferences vary and potential risks and functional outcome are also important to some people. There is a notable level of uncertainty in decision-making, which suggests further shared decision support would be valuable.

Mind the gap: population ageing and health financing sustainability

Background

Models used to forecast the effects of population ageing on health financing usually only explore effects on health spending, while neglecting effects on health revenues.

Methods

Using publicly available data, we construct simulation models to project how changes in the population age mix affect both public sector health revenues and expenditures across a range of countries representing a diverse mix of health financing systems in Europe as well as the Western Pacific (Australia, Bulgaria, Japan, Slovenia, United Kingdom and Vietnam).

Results

By 2100, the largest gap between health revenues and expenditures due to population ageing under current health financing arrangements is expected in Vietnam; the majority of that health financing gap (87.1%) is attributable to expected growth in health expenditures. In Slovenia and Japan, the financing gaps are forecast to reach less than half that of Vietnam by 2100; however, the reasons for the increases in gaps vary. In Slovenia, nearly half of the increase in the gap (44.2%) is due to reductions in health revenues compared with just under one-third (28.7%) in Japan.

Conclusions

There is a perception that population ageing will have deleterious effects on the sustainability of public sector health financing. However, this is highly dependent on how financing systems are designed. Our simulation models demonstrate that comparative analyses that give equal attention to both health expenditures and revenues provide decision makers a balanced set of policy options for addressing the challenges of population ageing. The options range from targeting expenditures and utilization of services to diversifying revenue generation.

Eliciting Preferences in Dentistry with Multiattribute Stated Preference Methods: A Systematic Review

BACKGROUND

Preference experiments are used to understand how patients and stakeholders value aspects of health care. These methods are gaining popularity in dentistry, but quality and breadth of use have not been evaluated.

OBJECTIVES

To describe multiattribute stated preference experiment use in dentistry through illustration and critique of existing studies.

DATA SOURCES

Systematic literature search of PubMed, Econlit and Ovid for Medline, Embase, PsychINFO, PsychARTICLES, and All EBM Reviews, as well as gray literature.

STUDY ELIGIBILITY

Multiattribute stated preference experiments eliciting preferences for dental service delivery, treatments, and oral health states from the perspective of patients, the public, and dental professionals. Outcomes of interest were preference weights and marginal rates of substitution. Study selection was independently performed by 2 reviewers.

APPRAISAL

Ten-point checklist published by the International Society of Pharmacoeconomics and Outcomes Research was used for quality assessment.

SYNTHESIS

Descriptive analysis.

RESULTS

Searches identified 12 records published between 1999 and 2015, mostly in nondental academic journals. Studies were undertaken in high-income countries in Europe and the United States. The studies aimed to elicit preference for service delivery, treatment, or oral health states from the perspective of the patients, dentists, or the public via discrete choice experiment methods. The quality scores for the studies ranged from 53% to 100%.

LIMITATIONS

A detailed description and critique of stated preference methods are provided, but it was not possible to provide synthesized preference data.

CONCLUSIONS

Multiattribute stated preference experiments are increasingly popular, but understanding the methods and outputs is essential for designing and interpreting preference studies to improve patient care. Patient preferences highlight important considerations for decision making during treatment planning. Valuation of health states and estimation of willingness-to-pay are important for resource planning and allocation and economic evaluation. Preference estimates and relative value of attributes for interventions and service delivery inform development and selection of treatments and services (PROSPERO 21.3.17: CRD42017059859).

KNOWLEDGE TRANSFER STATEMENT

Understanding patient, professional, and public preferences is fundamental for evidence-based decision making and treatment delivery. Preference elicitation methods can be used to estimate the value given to health states, service delivery, individual treatments, and health outcomes. By describing and appraising the methodology and application of multiattribute stated preference experiments in dentistry, this review provides an essential first step to wider use of well-designed, high-quality preference elicitation methods.

Generation of Ramped Current Profiles in Relativistic Electron Beams Using Wakefields in Dielectric Structures

Temporal pulse tailoring of charged-particle beams is essential to optimize efficiency in collinear wakefield acceleration schemes. In this Letter, we demonstrate a novel phase space manipulation method that employs a beam wakefield interaction in a dielectric structure, followed by bunch compression in a permanent magnet chicane, to longitudinally tailor the pulse shape of an electron beam. This compact, passive, approach was used to generate a nearly linearly ramped current profile in a relativistic electron beam experiment carried out at the Brookhaven National Laboratory Accelerator Test Facility. Here, we report on these experimental results including beam and wakefield diagnostics and pulse profile reconstruction techniques.

Planar-dielectric-wakefield accelerator structure using Bragg-reflector boundaries

We report experimental measurements of narrow-band, single-mode excitation, and drive beam energy modulation, in a dielectric wakefield accelerating structure with planar geometry and Bragg-reflector boundaries. A short, relativistic electron beam (∼1  ps) with moderate charge (∼100  pC) is used to drive the wakefields in the structure. The fundamental mode of the structure is reinforced by constructive interference in the alternating dielectric layers at the boundary, and is characterized by the spectral analysis of the emitted coherent Cherenkov radiation signal. Data analysis shows a narrow-band peak at 210 GHz corresponding to the fundamental mode of the structure. Simulations in both 2D and 3D provide insight into the propagating fields and reproduction of the electron beams dynamics observables and emitted radiation characteristics.

Mandibular condylectomy in a cow with a chronic luxation of the temporomandibular joint

A cow, presented after being struck by a motor vehicle, continued to have difficulty eating after mandibular fracture repair. Imaging showed a temporomandibular luxation and a mandibular condylectomy was performed. Mastication improved greatly but the cow was euthanized due to infection. This is the first report of mandibular condylectomy in cattle.

Evaluation of an inductively coupled plasma mass spectrometry method for the analysis of sweat chloride and sodium for use in the diagnosis of cystic fibrosis

BACKGROUND

Cystic fibrosis (CF) is an autosomal recessive condition that has an incidence of 1:2500 live births in Northern Europe. Due to the large number of mutations that can result in classical or atypical CF phenotype, the sweat test, which quantifies the amount of chloride and sodium in sweat, is vital in supporting the diagnosis of CF. Patients with CF have raised concentrations of chloride and sodium in their sweat; however, it is the concentration of chloride in sweat which provides the greatest diagnostic sensitivity for CF.

METHOD

An inductively coupled plasma mass spectrometry (ICP-MS) method for the analysis of sweat chloride and sodium was evaluated for the routine measurement of sweat collected using the Wescor Macroduct(®) Sweat Collection System. The precision, linearity and agreement with the all laboratories trimmed means (ALTMs) and 'weighed-in' concentrations of sodium and chloride in samples supplied by the UK NEQAS external quality assessment (EQA) Sweat Testing Scheme were assessed.

RESULTS

This ICP-MS method for the quantification of chloride and sodium in sweat samples was shown to be accurate, precise and suitable for the routine analysis of sweat chloride and sodium.

CONCLUSION

The method performs well and is now used in the routine analysis of sweat in this laboratory.

Dielectric wakefield acceleration of a relativistic electron beam in a slab-symmetric dielectric lined waveguide

We report first evidence of wakefield acceleration of a relativistic electron beam in a dielectric-lined slab-symmetric structure. The high energy tail of a ∼60  MeV electron beam was accelerated by ∼150  keV in a 2 cm-long, slab-symmetric SiO2 waveguide, with the acceleration or deceleration clearly visible due to the use of a beam with a bifurcated longitudinal distribution that serves to approximate a driver-witness beam pair. This split-bunch distribution is verified by longitudinal reconstruction analysis of the emitted coherent transition radiation. The dielectric waveguide structure is further characterized by spectral analysis of the emitted coherent Cherenkov radiation at THz frequencies, from a single electron bunch, and from a relativistic bunch train with spacing selectively tuned to the second longitudinal mode (TM02). Start-to-end simulation results reproduce aspects of the electron beam bifurcation dynamics, emitted THz radiation properties, and the observation of acceleration in the dielectric-lined, slab-symmetric waveguide.

Effects of nanomaterials on luciferase with significant protection and increased enzyme activity observed for zinc oxide nanomaterials

This principle goal of this research was to examine the effects of various nanomaterials on the activity and behavior of the firefly enzyme luciferase. Nanomaterials have been found to stabilize, and in some instances, shown to increase the activity of enzymes. In this study gold, manganese oxide (MnO), and zinc oxide (ZnO) nanomaterials were utilized in order to test their effects on enzyme activity. Luciferase was used because its activity is easy to analyze, as it typically produces a large amount of bioluminescence easily detected by a Microtiter plate reader. Following incubation with the various nanomaterials, luciferase was subjected to degradation by several protein denaturing agents, such as heat, SDS, urea, ethanol, protease, hydrogen peroxide, and pH changes. Results indicated that luciferase activity is indeed affected when combined with nanomaterials, accompanied by both increases and decreases in enzyme activity depending on the type of nanomaterial and denaturing agent used. In most of the experiments, when incubated with ZnO nanomaterials, luciferase depicted significant increases in activity and bioluminescence. Additional experiments, in which human A375 cells were treated with luciferase-nanomaterial mixtures, also depicted increased enzyme activity and bioluminescence for luciferase incubated with ZnO nanomaterials. Ultimately, our findings indicated that when luciferase was subjected to multiple types of denaturation, zinc oxide nanomaterials dramatically preserved and increased enzyme activity and bioluminescence.

Hepatitis A cases in a travelling community in southeast England

Two suspected cases of hepatitis A have been reported in a 40 year old man and his 7 year old son who are part of a travelling community in southeast England

The comparative serum disposition kinetics of subcutaneous administration of doramectin, ivermectin and moxidectin in the Australian Merino sheep

This study evaluates the comparative serum disposition kinetics of injectable formulations of doramectin (DRM), ivermectin (IVM) and moxidectin (MXD) in Australian Merino sheep. Thirty-six, 2-year-old sheep were allocated by weight into six groups of six animals. Animals in each group received 200 microg/kg of DRM, MXD, IVM or a combination of two of these drugs by subcutaneous (s.c.) injection. Blood was collected at designated intervals (between 1 h and 40 days after treatment) and the serum analysed by high performance liquid chromatography (HPLC) using fluorescence detection. The results indicated that MXD administration produced a significantly higher maximum serum concentration and a more rapid absorption as compared with DRM and IVM. MXD and DRM had a significantly larger area under the concentration vs. time curve (AUC) than IVM, suggesting a more persistent effect for the former two products in sheep. The AUC for DRM was significantly higher when administered alone as compared with that observed when given in combination with MXD or IVM, suggesting preferential elimination of DRM compared with IVM and MXD from concurrent s.c. administration.

A prospective study of quantitative ultrasound in children and adolescents

The accrual of optimal bone mass during childhood and adolescence is essential for the formation of a skeleton that will meet structural needs throughout life. Assessing bone health of children is becoming increasingly important in order to identify those who require interventions, and quantitative ultrasound (QUS) has appeal for these assessments. The purpose of this prospective study was to characterize changes in QUS values in 328 healthy children and adolescents over a 3-yr period. Measurements of QUS, height, weight, nutrient intake, fracture history, and Tanner stage were made at baseline and 3 yr later. Both females and males experienced significant increases in QUS values during the study. The rate of change of QUS peaked at an earlier age in females than in males, and maximum accumulation rates in both genders occurred at ages at which highest accumulation rates are seen with densitometry. Females exhibited higher QUS values than males during puberty, also similar to results for dual X-ray absorptiometry (DXA). This is the first report of prospective data of QUS in children and adolescents. Our findings that QUS values change during childhood and adolescence in a manner similar to DXA values, the "gold standard," provide support for the validity of using QUS to assess bone health in children and adolescents.

Symmetric tests and confidence intervals for survival probabilities and quantiles of censored survival data

We describe existing tests and introduce two new tests concerning the value of a survival function. These tests may be used to construct a confidence interval for the survival probability at a given time or for a quantile of the survival distribution. Simulation studies show that error rates can differ substantially from their nominal values, particularly at survival probabilities close to zero or one. We recommend our new constrained bootstrap test for its good overall performance.

A comparative study of the 1992 and 1997 recovery positions for use in the UK

In April 1997 the ILCOR Basic Life Support advisory statements were announced in conjunction with changes to the recovery position for use in the UK. This study compared the new and old positions by using a questionnaire to assess how well each position satisfied the ILCOR statements. The study was carried out over six different hospital trusts by eight resuscitation training officers. Each tutor alternately taught the 1992 or 1997 recommended positions. After the practical session each student completed a questionnaire on ease of learning and use of the position, as well as other factors such as spinal stability. They were also asked to score the position when they were placed in recovery by other students. Their competency was assessed using the ALS criteria. Over the duration of the study 687 forms were suitable for analysis. For every question there was a significant trend in favour of the 92 position, with students finding the technique easier to learn and use, simpler for positioning for CPR and with less spinal movement during rolling. Possible sources of bias such as previous training, tutor or staff grade made no statistical difference to the results. When performed competently the 1997 position appears to cause less brachial compression, but other problems with learning or use of the 97 position outweigh this advantage. The 1992 position currently provides the best compromise between ease of use, spinal stability and other factors, and better satisfies the ILCOR advisory statements.

Allogeneic bone marrow transplantation: implications of herpesvirus screening and diagnosis

Allogeneic bone marrow transplantation is used increasingly as a treatment for haematological diseases. Pre-transplant conditioning is necessary to eradicate the host immune response, and post-transplant immunosuppressive therapy is continued to prevent graft-versus-host disease. Thus, bone marrow transplant recipients are severely immunocompromised for a prolonged period. Herpesvirus infections are a common complication because they are ubiquitous, latent and may be transmitted in donations of bone marrow and blood. Screening for herpesvirus, and subsequent diagnosis, is important because infection or reactivation may be prevented by the prophylactic use of anti-viral agents, the passive transfer of immunoglobulin, vaccination and/or infection control measures, and progression of severe disease may be halted by the therapeutic use of anti-viral agents, especially when intervention is early.

Patient education for discharge after coronary bypass surgery in the 1990s: are patients adequately prepared?

Short hospitalizations for patients undergoing coronary artery bypass grafting (CABG) require continuous nursing evaluation of patients' discharge education. Six institutions collaborated in surveying 300 postoperative patients with CABG to identify learning priorities and patients' perceptions of the effectiveness of discharge education. Data analysis from the self-administered questionnaire demonstrated consistent patient priorities across institutions. Differences in teaching methods and content did not affect perceived preparedness or importance scores. Regional experience demonstrates that variable teaching efforts meet patients' priorities and provide high overall patient preparedness for discharge. Patients with the shortest hospitalizations had higher preparedness scores.

Evaluation of bacteriological transport swabs

Ten commercial transport swabs were evaluated for their ability to preserve bacteria for 24 and 48 hours. Microorganisms included ATCC strains of Gram-positive and Gram-negative aerobes and anaerobes. There was a wide variation in performance. Swabs using Amies plus charcoal medium or Stuart's medium had better recovery rates than those using Amies medium alone. The nature of the tips of the swabs had little influence. Performance was not correlated with cost of the swabs. These data will assist institutions to make cost-effective decisions when purchasing bacteriological transport systems.

Reversal of human platelet aggregation by low concentrations of nitroglycerin in vitro in normal subjects

The potential reversal of platelet aggregation in vitro by nitroglycerin in low concentrations was explored using both optical aggregometry and electron microscopy. Venous blood was collected from a cohort of normal volunteers (20 men and 10 women) aged 21 to 65 years. Aggregation in platelet-rich plasma was induced by adenosine diphosphate in concentrations just sufficient to maintain a steady state of aggregation, without a spontaneous disaggregation phase (3.5 to 5 microM). Administration of nitroglycerin after the induction of aggregation caused both inhibition of the primary wave of developing aggregation and marked disaggregation. This combined effect was maximal when nitroglycerin was added at 0.5 minute after the beginning of aggregation. The observed reversal of platelet aggregation by nitroglycerin was concentration-dependent. Significant effects occurred with nitroglycerin concentrations greater than or equal to 10(-8) M. Concentration associated with 50% reversal of aggregation was 1.52 +/- 0.24 (SEM) x 10(-6) M. Electron microscopy revealed that 10(-6) M nitroglycerin induced a significant reduction in both platelet clumping and morphologic changes associated with aggregation. The results of the current study suggest a beneficial antiplatelet effect of nitroglycerin in restoring homeostasis in the face of incipient platelet aggregation. The clinical use of nitroglycerin in patients with acute ischemic syndromes may rest on this action.

Integrating the UMLS into VNS Retriever

We are developing a networked resource for the National Library of Medicine's Unified Medical Language System. We call this resource the UMLS Retriever, which is an instance of our VNS Retriever architecture. Our prototype user interface makes use of the Virtual Notebook System Browser. The development of a networked UMLS service will result in numerous advantages to our user community.

The MEDLINE Retriever

Baylor College of Medicine has developed the MEDLINE Retriever, a tool to query MEDLINE, the data-base of medical literature at the National Library of Medicine. The MEDLINE Retriever communicates via the Internet to achieve excellent response time for MEDLINE queries. It uses the X Window System and the Motif toolkit, and employs the Knowbot Operating Environment developed by the Corporation for National Research Initiatives. We discuss the architecture of the MEDLINE Retriever, focusing on the graphical user interface that we have developed, as well as our experiences in developing and deploying the MEDLINE Retriever at Baylor. The MEDLINE Retriever is an extension of Baylor's IAIMS design concept that brought forth the Virtual Notebook System, and fits well with Baylor's aims with regard to the High Performance Computing Initiative.

Pathobiology of papillomavirus-related cervical diseases: prospects for immunodiagnosis

In recent years, the relationship between human papillomaviruses (HPV) and genital neoplasia has been explored intensively, and a molecular basis for the role of HPV in the genesis of these diseases has been convincingly demonstrated. These findings have provided justification for efforts to apply this molecular information to the early detection and possible prevention of HPV-related neoplasia. The technology of detecting viral nucleic acids in genital fluids brought with it initial hopes that it would serve to identify women at risk for having or developing precancers or cancers of the cervix. Subsequent studies, however, have demonstrated limitations of the technology for predicting future disease. Recently, molecular immunology has complemented these prior efforts, with the intent to identify serological indices of exposure to HPV and perhaps delineate individuals at risk. The molecular basis for this approach, its limitations, and future prospects for immunodiagnosis are the subject of this review.

Coexpression of the human papillomavirus type 16 E4 and L1 open reading frames in early cervical neoplasia

Although the E4 open reading frame (ORF) of human papillomaviruses (HPV) encodes an abundant protein in cutaneous warts, the location and extent of HPV E4 expression in genital precancers, specifically those associated with HPV-16, has not been described. Expression plasmids (pATH) containing segments of the HPV-16 E4 (3401-3620) and L1 (6151-6792) open reading frames (ORFs) were induced and expressed in bacteria and the resulting fusion proteins were used to elicit antisera in rabbits. Antisera reacting to the E4 and L1 components of the fusion proteins were used to screen biopsies from 150 cervical precancers (cervical intraepithelial neoplasia) and condylomata. Six biopsies exhibiting specific immunostaining with the anti-E4 sera. Staining was cytoplasmic, and occurred virtually always in foci containing immunostaining for L1 proteins. Moreover, analysis of these 6 cases and 22 others for HPV-16 RNA by RNA-RNA in situ hybridization demonstrated a similar correlation between E4 immunostaining and the presence of abundant transcripts specific to HPV-16. These data are consistent with the hypothesis that expression of the HPV-16 E4 ORF is dependent upon viral replication and epithelial differentiation, similar to L1 expression, and that the E4 epitopes identified by the rabbit antisera may be unique to HPV-16 relative to other common cervical papillomaviruses.

Sensitivity and specificity of endocervical curettage and the endocervical brush for the evaluation of the endocervical canal

A series of 87 consecutive conization specimens was studied to evaluate the accuracy of endocervical curettage for the detection of dysplasia in the endocervical canal and to investigate the role of the endocervical brush for the outpatient management of patients with atypical Papanicolaou smears. For patients having cervical intraepithelial neoplasia within the endocervical canal in conization specimens, the false-negative rate observed for endocervical curettage was 45% and the false-positive rate for the detection of endocervical involvement was 25%. The false-negative rate for the endocervical brush was only 8.4%, but the false-positive rate for endocervical involvement was 62.5%. The false-negative rate of endocervical curettage could be reduced to 16.7% if an abundant volume of endocervical material (as determined by point counting) was required. The utility of endocervical curettage to detect cervical intraepithelial neoplasia in the endocervical canal appears to be dependent on the adequacy of the specimen. The determination of adequacy is a critical factor for the proper interpretation of specimens obtained by endocervical curettage.

Fitzgerald factor deficiency in an Australian aborigine

This case reports the first description of Fitzgerald factor (high molecular weight kininogen) deficiency in Australia. Since this homozygous abnormality was found in an Aborigine it is suggested that the defective gene may be prevalent in some tribes and that abnormal results of clotting tests in Aborigines should be investigated carefully.

Early knee motion after open and arthroscopic anterior cruciate ligament reconstruction

The hypothesis proposed in this study was that the initiation of active and passive knee motion within 48 hours of major intraarticular knee ligament surgery would not have the deleterious effects of increasing knee effusion, hemarthrosis, periarticular soft tissue edema, and swelling. We conducted a prospective study with randomized assignment of 18 patients into two groups: 9 patients in the "motion" group began 10 hours of daily continuous passive motion (CPM) on the 2nd postoperative day, while the remaining 9 in the "delayed motion" group used a soft hinged knee brace with knee hinges locked at 10 degrees of flexion and entered into the motion program on the 7th postoperative day. All knees were allowed full 0 degrees to 90 degrees of motion except for a total of seven knees with concomitant mensicus repairs and extraarticular reconstructions where 20 degrees to 90 degrees of motion was allowed, limiting the last 20 degrees of knee extension for the first 4 postoperative weeks to protect the repair. In all other respects, the rehabilitation program after surgery was the same for the two groups, including postoperative compression dressings, exercises, and weight-bearing status. Ten of the eighteen patients had acute ACL disruptions and 8 had chronic ACL insufficiencies. There was an even distribution of acute and chronic knee cases and of open and arthroscopic ligament procedures in the early and delayed motion groups. Associated surgery included four meniscus repairs, three medial collateral ligament repairs, and one lateral collateral ligament repair. Special suturing and fixation techniques were used at surgery to maintain the integrity of ligament and meniscus structures, allowing the surgeon to feel safe in subjecting the joint to early postoperative motion. The objective parameters measured were KT-1000 arthrometer measurements, Cybex isokinetic testing, girth measurements at four lower limb locations, range of motion goniometer measurements, postoperative pain medications, and days of hospitalization. Starting intermittent passive motion on the 2nd postoperative day did not increase joint effusion, hemarthrosis, or soft tissue swelling. In both motion groups, postoperative joint effusions were absent after the 14th postoperative day. There was no statistically significant difference in knee extension or flexion limits, pain medication used, or hospital stay in comparing the two knee motion programs. An important finding of this study was the significant decreases in thigh circumference that occurred within the first few weeks of surgery, which progressed despite a closely supervised inpatient and outpatient rehabilitation program.(ABSTRACT TRUNCATED AT 400 WORDS)

Hemoglobin Woodville: alpha (2)6(A4) aspartic acid----tyrosine

Hemoglobin Woodville was detected in a Vietnamese woman during antenatal and cord blood screening programs for families of South East Asian origin. The variant constitutes 9% of total hemoglobin and structural analysis demonstrated the substitution alpha 6 Asp----Tyr. Hematological data on the proposita were normal. No apparent clinical or pathological findings were associated with this abnormal hemoglobin.

Breast cancer markers: comparison between sialyltransferase and human mammary epithelial antigens (HME-Ags) for the detection of human breast tumors grafted in nude mice

Sialyltransferase (CMP-sialic acid:asialofetuin sialyltransferase) and human mammary epithelial antigens (HME-Ags, cell surface antigens specific to human mammary epithelial cells) were determined in plasma of nude mice grafted with breast and non-breast human tumors to assess their possible usefulness as breast cancer markers. The plasma transferase activity was significantly higher (p less than 0.01) in tumor groups relative to the control. However, no significant difference (p less than 0.05) could be found in the transferase level between breast and non-breast tumor groups, showing the enzyme's lack of specificity for breast cancer. Furthermore, the surgical procedure performed on the control normal healthy group (no tumor), resulted in an important increase of the enzyme level, while HME-Ags remained unchanged. HME-Ags were essentially negative in control as well as non-breast tumor groups. After surgical removal of breast tumors, HME-Ags level dropped drastically to the background level (from 122 to less than 30 ng/ml plasma). These data indicate that HME-Ags are more sensitive and specific than sialyltransferase as markers for human breast tumor, and suggest that HME-Ags may be clinically useful in the early detection of breast cancer as well as in the followup of patients with metastatic breast tumor.

Congenital anti-thrombin III deficiency with mesenteric venous thrombosis--functional and immunological estimations

Familial antithrombin III (AT III) deficiency, with mesenteric venous thrombosis, is reported in an Australian family. Antithrombin III was assayed chromogenically, fluorometrically, and immunologically. The deficiency was further analysed using crossed-immunoelectrophoresis. It is suggested that when AT III deficiency is suspected, both a functional and an immunological assay should be performed.

Surface markers of human gingival fibroblasts in vitro. Characterization and modulation by enzymes and bacterial products

Surface markers of human gingival fibroblasts in vitro were investigated using monoclonal and heterologous antisera against a range of cell surface antigens, together with rosetting techniques to characterize surface receptors for IgG and C3. WI-38 fibroblasts and human peripheral blood monocytes were used as control cells. Human gingival fibroblasts exhibited complement receptors and beta2-microglobulin, as did WI-38 cells. Ten per cent of the human gingival fibroblasts were positive for HLA-DR antigens and additionally exhibited a granulocyte antigen not apparent on WI-38 cells. Monolayers of the gingival fibroblasts were further exposed for short periods to varying concentrations of enzymes (trypsin, collagenase and neuraminidase), bacterial extracts (lipopolysaccharide and lipoteichoic acid) and crude supra- and subgingival plaque sonicates. Surface-marker analysis was then carried out. The most noticeable effects were obtained with Vibrio cholerae neuraminidase which enhanced C3 receptor and surface antigen expression, and supragingival plaque sonicate which depressed the expression of HLA-DR and granulocyte antigens while not affecting beta2-microglobulin expression. Trypsin reduced antigen expression to a degree, but its effects were mainly on cell adherence.