Assessment of renal osteodystrophy in dialysis patients: use of bone alkaline phosphatase, bone mineral density and parathyroid ultrasound in comparison with bone histology

Bone biopsies were studied in 73 patients to determine if a two-site radioimmunometric assay for serum bone alkaline phosphatase (BAP), total serum alkaline phosphatase (ALP), serum intact parathyroid hormone (iPTH), hand X-rays, regional bone mineral density (BMD) measurements and parathyroid enlargement detected by ultrasonography could accurately predict renal osteodystrophy. In the patients studied 57 had hyperparathyroid bone disease, 4 mixed renal osteodystrophy, 3 adynamic bone disease, 1 osteomalacia and 8 normal histology. Serum BAP, ALP and iPTH correlated positively with mineral apposition rate, osteoblastic, osteoid and eroded surface. In the diagnosis of hyperparathyroid bone disease serum iPTH was the most sensitive investigation, detecting 81% of patients at a level > 100 pg/ml but with a specificity of only 66%. Serum BAP was more sensitive, 70% at a level of > 10 ng/ml, than serum total ALP, 30% at a level of 300 IU/l, with similar specificities, 92 and 100%, respectively. Ultrasound detection of an enlarged parathyroid gland had a sensitivity of 64% and a specificity of 100% for the diagnosis of hyperparathyroid bone disease. Hand X-rays had a poor sensitivity, 47%, but a high specificity, 92%, for the detection of hyperparathyroid bone disease. The majority of patients had regional BMD values within the normal reference range and this test was of poor discriminatory value. The non-invasive markers were unable to distinguish between patients with low turnover, mild hyperparathyroidism and patients with normal histology. In conclusion the measurement of serum iPTH is a useful screening tool for the detection of hyperparathyroid bone disease which can be confirmed by the finding of a raised serum BAP or parathyroid enlargement. For definitive diagnosis, however, the gold standard remains bone biopsy and at present one cannot recommend any non-invasive method as an adequate substitute.     

Pharmacokinetics of hyperimmune anti-human immunodeficiency virus immunoglobulin in persons with AIDS

Hyperimmune anti-human immunodeficiency virus immunoglobulin (HIVIG) is an intravenous immunoglobulin prepared from HIV-infected asymptomatic donors with a CD4 cell count greater than 400 cells/microl and a high titer of antibody to HIV-1 p24 protein. Twelve persons with AIDS received four doses of HMG (two at 50 mg/kg of body weight and then two at 200 mg/kg) every 28 days. Pharmacokinetics were evaluated by measurement of anti-p24 antibody. HIVIG was well tolerated, and all participants completed the study. Three subjects who were not receiving Pneumocystis carinii pneumonia (PCP) prophylaxis developed PCP. The mean value for HIVIG clearance was 3.02 ml/kg/day at 50 mg/kg and 3.65 ml/kg/day at 200 mg/kg (P = 0.027); the mean trough antibody titers (reciprocal units) were 1,442 and 4,428, respectively. This study indicates that high titers of anti-p24 antibody can be maintained with a monthly administration schedule of HIVIG and that short-term safety is acceptable. Comparisons to evaluate the therapeutic potential of HIVIG are justified.     

Reproducibility of brachial ultrasonography and flow-mediated dilatation (FMD) for assessing endothelial function

Minimally invasive plastic surgery has expanded beyond the original confines of aesthetic applications to encompass all our endeavors in an attempt to restrict the size of surgical scars, limit postoperative discomfort, and hasten recovery of function. This evolution has already delineated methods to raise our workhorse muscle flaps and has negated the risks of laparotomy for various visceral flaps. It is then only a logical progression to use these endoscopic techniques to harvest fascial flaps so as to avoid the notorious donor site morbidity of the fasciocutaneous flap, which has certainly hindered the rapid acceptance of these otherwise valuable flaps. Endoscopic-facilitated elevation of a local adipofascial flap is described for which little or no additional skin incisions need ever be made.     

Sexual dimorphism of circulating somatotropin, insulin-like growth factor I and II, insulin-like growth factor binding proteins, and insulin: relationships to growth rate and carcass characteristics in growing lambs

The effects of sex and age on patterns of circulating somatotropin (ST) concentration and plasma IGF-I, IGF-II, insulin, and IGF binding protein-3 (IGFBP-3) were studied in ram, wether, and ewe lambs (n = 7 or 8) sampled at mean ages of 81 (I1) and 158 d (I2). Between 81 and 158 d of age, rams grew more rapidly than wethers (P < .01), and wethers grew more rapidly than ewes (P < .01). The sex differences in growth were reflected in empty body weight at slaughter: rams > wethers > ewes (P < .05). Mean plasma ST concentrations, ST pulse amplitude, and integrated plasma ST concentrations were greater (P < .05) in rams than in ewes at I1 and I2. Characteristics of the ST plasma profile in wethers were generally intermediate between those of rams and ewes. The interpulse interval was greater in ewes than in wethers at I2. The IGF-I and IGFBP-3 concentrations were greater in rams than in ewes at both sampling times. Plasma IGF-II was greater in ewes than in rams at I2. Mean plasma ST was approximately two thirds less at I2 than at I1 regardless of sex. Mean plasma ST and IGF-I at both ages were positively correlated with growth. Mean plasma ST at I2 was negatively correlated with fatness at slaughter. Sex and age significantly affected patterns of circulating ST and concentrations of IGF-I and IGFBP-3 in prepubertal growing lambs, under conditions for which growth rates and composition were also sexually dimorphic.     

Stormwater reuse: designing biofiltration systems for reliable treatment.

Stormwater reuse is increasing in popularity as a technique for overcoming water shortages in urban Australia. However, technology for the reliable treatment of stormwater for reuse is still not fully developed. This paper presents the first steps in refining biofilters for stormwater reuse. Six different filter media were selected, to target specific stormwater pollutants, as well as support plant growth. They were tested in the laboratory, where the filters were dosed three times per week with semi-synthetic stormwater for five weeks. Pollutant removal performance was monitored, and revealed that all soil-based filters performed similarly (while sand filters behaved somewhat differently). All filters removed more than 80% of solids and greater than 90% of lead, copper, and zinc. Three filter types were able to remove some phosphorus (particularly in the top 30 cm of the media). Apart from sand, all filter media were net producers of nitrogen, leading to an important conclusion that non-vegetated, soil-based filters are not suitable for targeting nutrients. However, since heavy metals are the primary pollutant of concern with respect to stormwater reuse for irrigation (the most popular end-use), it was concluded that biofilters may be promising technologies for treatment of stormwater for reuse.     

Occurrence of Lawn Care and Agricultural Pesticides in the Don River and Humber River Watersheds (1998–2002)

Between 1998 and 2002, surface water samples were collected from several sites in the Don River and Humber River watersheds, both tributaries to Lake Ontario, and analyzed for a variety of pesticides, including those used for urban lawn care. Analyses included 152 pesticide active ingredients and eight metabolites. Samples were collected during base flow periods (i.e., dry events) and rainfall events (i.e., wet events). The objectives of the study were to determine which pesticides were detectable, whether there was a difference in the detection frequency between the two watersheds and between upstream and downstream in each river, and whether precipitation influenced the frequency of detection. Eleven pesticides and one metabolite were detected in surface waters of the Don and Humber rivers or their tributaries, with approximately 72% of samples containing at least one pesticide attributable to lawn care use. The pesticides and pesticide metabolite detected in this study included 2,4-D, atrazine, bromacil, carbofuran, chlorpyrifos, cypermethrin, diazinon, dicamba, MECOPROP, metolachlor, metribuzin, and an atrazine metabolite (des-ethyl atrazine). Four pesticides exceeded federal or provincial water quality guidelines/objectives. Diazinon exceeded the provincial water quality objective in 28% of the samples taken. For the three other pesticides (atrazine, carbofuran and chlorpyrifos) exceedance of a water quality criteria occurred in less than 1% of the samples.     

Long-term recovery of pressurized water reactors following a large break loss-of-coolant accident

The U.S. Nuclear Regulatory Commission recently identified a possible safety concern for pressurized water reactors. Following the reflood phase of a large break loss-of-coolant accident, long-term cooling of the reactor core may not be ensured. Specifically, the concern is that, for a pump discharge cold leg break, the loop seals in the reactor coolant pump suction piping will refill with liquid and the post-reflood steam production may depress the liquid levels in the downflow sides of the loop seals. A loop seal depression would cause a corresponding depression of the core liquid levels and possibly a fuel rod heatup in the upper core region. This paper is intended as an introduction of the safety issue that: (1) describes the important aspects of the problem, (2) provides an initial analysis of the consequences, and (3) discusses ongoing work in this area. Because the elevation of the loop seals is near the mid-core elevation in plants of Westinghouse design, the concern is greatest for those plants. There is less concern for most plants of Combustion Engineering design, and likely no concern for plants of Babcock and Wilcox design. This issue was addressed by employing both steady-state and transient systems analysis approaches. Two approaches were used because of uncertainties regarding actual reactor coolant system behavior during the post-reflood period. The steady-state approach involved the development and application of a simple computer program to investigate reactor coolant system behavior assuming quiescent post-reflood conditions. The transient systems approach involved investigating this behavior using the RELAP5/MOD2 computer code and a comprehensive RELAP5 model of a Westinghouse pressurized water reactor. The steady-state analysis indicated only a moderate fuel rod heatup is possible. The transient systems analysis indicated boiling and condensation-induced flow oscillations are sufficient to prevent fuel rod heatup. Analysis uncertainties are discussed.