Blood lactate concentrations during incremental exercise in subjects with sickle cell trait

The need for lateral release or "venting" of the A2 and A4 pulleys either to facilitate repair of the flexor tendon(s) or to allow free gliding of the repair(s) was examined in 126 consecutive zone 2 flexor tendon injuries within the tendon sheath and distal to the distal edge of the A2 pulley (zones 2A and 2B of Tang's classification) in which at least one flexor tendon had been completely divided. This study showed that 81 (64%) of these repairs required venting of one or the other pulley. It was necessary to vent the A4 pulley between 10 and 100% of its length in 71 (56%) of the fingers and to vent the distal edge of the A2 pulley by 4 to 10 mm in 10 (8%) of the fingers.     

Plasma and red cell lipids in sickle cell disease

Lipids, in particular phospholipids, are essential components of membrane systems, and the measurement of phospholipids and cholesterol in plasma and tissues is helpful in diagnosis. Phospholipids represent about 60 to 70% of total red cell (RBC) lipids, while about 25% is free cholesterol. Lipids in RBC are present in a dynamic state of equilibrium, and the RBC have the capacity for rapid exchange of lipids with plasma in several ways. The present study examined the cholesterol and phospholipid levels of plasma and erythrocytes in male patients with sickle cell anemia and in healthy male individuals of comparable age. This was performed with a view to detecting possible differences that might be related to some of the RBC abnormalities which accompany the disease. The results show that plasma lipids are significantly reduced in patients with sickle cell anemia and that RBC cholesterol was higher in sickle cell patients than in normal subjects.     

Late manifestations of sickle cell trait (author''s transl)

As a result of a previous trial in which factors influencing swelling of the hand after fasciectomy were studied it was found that unacceptable oedema occurred in hands elevated in a roller towel by night and a high sling by day. An alternative system of elevation in a vacuum splint was investigated and found to reduce post-operative oedema. The advantages and disadvantages of the vacuum splint in the management of the hand after surgery or injury are discussed.     

Taurolidine联合X射线对小鼠恶性黑色素瘤细胞周期进程的影响

目的:观察taurolidine联合X射线照射对小鼠恶性黑色素瘤(B16-4A5和B16-F10)细胞周期进程的影响,探讨其诱导肿瘤细胞凋亡的发生机制.方法:选择B16-4A5和B16-F10细胞系按给药浓度随机分为4组,taurolidine剂量分别为0、25、50和100 μmol·L-1,同时进行1、2和4 Gy X射线照射,采用流式细胞术检测细胞凋亡率和细胞周期,Western blotting分析cyclin B、cdc2和caspase-3的表达.结果:与25 μmol·L-1 taurolidine组比较,50和100 μmol·L-1 taurolidine组诱导B16-4A5和B16-F10细胞发生G0/G1期阻滞,细胞数分别升高54.9%、73.7%和36.8%、55.5%(P＜0.05); 50 μmol·L-1 taurolidine联合2和4 Gy X射线照射组,细胞G2/M期阻滞消除,细胞数分别降低52.1%、44.2%和59.3%、52.7%(P＜0.05).与对照组、单纯taurolidine组及单纯照射组比较,联合4 Gy X射线照射组cyclin B和cdc2的表达降低,caspase-3的表达升高(P＜0.05).结论:taurolidine联合X射线照射可去除G2/M期阻滞,可选择地抑制肿瘤细胞cyclin B和cdc2的表达、增强caspase-3的表达,共同诱导细胞凋亡.     

Acute normovolemic red cell exchange for cardiopulmonary bypass in sickle cell disease

A patient with sickle cell disease (hematocrit, 28.5%; hemoglobin S fraction, 79%), required mitral valve repair. Partial red cell removal and blood component sequestration with an autotransfusion device before cardiopulmonary bypass initially decreased the sickle red cell mass. This was followed by an acute one-volume whole blood exchange transfusion performed upon the initiation of cardiopulmonary bypass, resulting in a further reduction. Both techniques yielded fresh autologous plasma for use; sequestration yielded a platelet-pheresis product. Adequate postbypass hemostasis was demonstrated.     

Two distinct pathways mediate the formation of intermediate density cells and hyperdense cells from normal density sickle red blood cells

In sickle cell anemia (SS), some red blood cells dehydrate, forming a hyperdense (HD) cell fraction (>1.114 g/mL; mean corpuscular hemoglobin concentration [MCHC], >46 g/dL) that contains many irreversibly sickled cells (ISCs), whereas other SS red blood cells dehydrate to an intermediate density (ID; 1.090 to 1.114 g/mL; MCHC, 36 to 46 g/dL). This study asks if the potassium-chloride cotransporter (K:Cl) and the calcium-dependent potassium channel [K(Ca2+)] are participants in the formation of one or both types of dense SS red blood cells. We induced sickling by exposing normal density (ND; 1.080 to 1.090 g/mL; MCHC, 32 to 36 g/dL) SS discocytes to repetitive oxygenation-deoxygenation (O-D) cycles in vitro. At physiologic Na+, K+, and Cl-, and 0.5 to 2 mmol/L Ca2+, the appearance of dense cells was time- and pH-dependent. O-D cycling at pH 7.4 in 5% CO2-equilibrated buffer generated only ID cells, whereas O-D cycling at pH 6.8 in 5% CO2-equilibrated buffer generated both ID and HD cells, the latter taking more than 8 hours to form. At 22 hours, 35% +/- 17% of the parent ND cells were recovered in the ID fraction and 18% +/- 11% in the HD fraction. Continuous deoxygenation (N2/5% CO2) at pH 6.8 generated both ID and HD cells, but many of these cells had multiple projections, clearly different from the morphology of endogenous dense cells and ISCs. Continuous oxygenation (air/5% CO2) at pH 6.8 resulted in less than 10% dense cell (ID + HD) formation. ATP depletion substantially increased HD cell formation and moderately decreased ID cell formation. HD cells formed after 22 hours of O-D cycling at pH 6.8 contained fewer F cells than did ID cells, suggesting that HD cell formation is particularly dependent on HbS polymerization. EGTA chelation of buffer Ca2+ inhibited HD but not ID cell formation, and increasing buffer Ca2+ from 0.5 to 2 mmol/L promoted HD but not ID cell formation in some SS patients. Substitution of nitrate for Cl- inhibited ID cell formation, as did inhibitors of the K:Cl cotransporter, okadaic acid, and [(dihydroindenyl) oxy]alkanoic acid (DIOA). Conversely, inhibitors of K(Ca2+), charybdotoxin and clotrimazole, inhibited HD cell formation. The combined use of K(Ca2+) and K:Cl inhibitors nearly eliminated dense cell (ID + HD cell) formation. In summary, dense cells formed by O-D cycling for 22 hours at pH 7.4 cycling are predominately the ID type, whereas dense cells formed by O-D cycling for 22 hours at pH 6.8 are both the ID and HD type, with the latter low in HbF, suggesting that HD cell formation has a greater dependency on HbS polymerization. A combination of K:Cl cotransport and the K(Ca2+) activities account for the majority of dense cells formed, and these pathways can be driven independently. We propose a model in which reversible sickling-induced K+ loss by K:Cl primarily generates ID cells and K+ loss by the K(Ca2+) channel primarily generates HD cells. These results imply that both pathways must be inhibited to completely prevent dense SS cell formation and have potential therapeutic implications.     

Central retinal artery occlusion (reversible in sickle trait with glaucoma

We report a case of central retinal artery occlusion in an 18-year-old black woman with sickle-trait haemoglobinopathy and acute glaucoma after hyphaema. The central retinal artery occlusion occurred immediately after treatment of the glaucoma with osmotic agents, raising the possibility that they played a precipitating role. We suggest that osmotic agents be used with extreme caution in sickle patients with glaucoma. The occlusion was treated by anterior chamber paracentesis with eventual return of good vision. The reversibility of retinal and optic nerve function after total ischaemia is discussed.     

Circulating activated endothelial cells in sickle cell anemia

BACKGROUND: The vascular wall participates in the pathogenesis of sickle cell disease. To determine whether the endothelium is activated in this disease, we studied the number, origin, and surface phenotype of circulating endothelial cells in patients with sickle cell anemia. METHODS: We used immunohistochemical examination of buffy-coat smears to enumerate circulating endothelial cells, and we evaluated the surface phenotype by applying preparations of circulating endothelial cells. An immunofluorescence microscopy panel of antibodies was used, including a specific anti-endothelial-cell antibody, P1H12. RESULTS: Mean (+/-SD) numbers of circulating endothelial cells in normal blood donors, patients with sickle cell trait, and patients with hemolytic anemias not due to hemoglobin S were 2.6+/-1.6, 3.0+/-2.6, and 2.0+/-0.8 per milliliter of whole blood, respectively. Patients with sickle cell anemia who presented with acute painful episodes had 22.8+/-18.2 circulating endothelial cells per milliliter of blood (P<0.001 for the comparison with normal donors), and patients with no such events within one month before or after blood sampling had 13.2+/-11.8 circulating endothelial cells per milliliter of blood (P=0.002 for the comparison with normal donors and P=0.019 for the comparison with patients with acute events). Serial observations of three patients showed a tendency toward higher levels of circulating endothelial cells at the onset of acute painful crises. The average viability of circulating endothelial cells was 66+/-30 percent. In patients with sickle cell anemia, regardless of clinical status, the circulating endothelial cells were predominantly microvascular in origin (CD36-positive), and most of the cells expressed four markers of endothelial-cell activation: intercellular adhesion molecule 1, vascular-cell adhesion molecule 1, E-selectin, and P-selectin. CONCLUSIONS: Our studies suggest that the vascular endothelium is activated in patients with sickle cell anemia, regardless of the patients' clinical status. Adhesion proteins on activated endothelial cells may have a role in the vascular pathology of sickle cell disease.     

Vascular cell adhesion molecule-1 is involved in mediating hypoxia-induced sickle red blood cell adherence to endothelium: potential role in sickle cell disease

We investigated the effects of hypoxia on red blood cell (RBC)-endothelial cell (EC) adherence and the potential mechanism(s) involved in mediating this effect. We report that hypoxia significantly increased sickle RBC adherence to aortic EC when compared with the normoxia controls. However, hypoxia had no effect on the adherence of normal RBCs. In additional studies, we found that the least dense sickle RBCs containing CD36+ and VLA-4+ reticulocytes were involved in hypoxia-induced adherence. We next evaluated the effects of hypoxia on the expression of EC surface receptors involved in RBC adherence to macrovascular ECs, including vascular cell adhesion molecule-1 (VCAM-1), intracellular adhesion molecule-1 (ICAM-1), and the vitronectin receptor (VnR). Hypoxia upregulated the expression of both VCAM-1 and ICAM-1, whereas no effect on VnR was noted. Potential involvement of VCAM-1 and ICAM-1 in mediating hypoxia-induced sickle RBC-EC adhesion was next investigated using monoclonal antibodies against these receptors. Whereas anti-VCAM-1 had no effect on basal adherence, it inhibited hypoxia-induced sickle RBC adherence in a concentration-dependent manner, with 50% to 75% inhibition noted at 10 to 60 micrograms/mL antibody (n = 6, P < .05 to P < .01). Anti-ICAM-1 (10 to 60 micrograms/mL, n = 8) had no effect on either basal or hypoxia-induced adherence. As noted in the bovine aortic ECs, hypoxia stimulated the adherence of sickle RBCs to human retinal capillary ECs, and this response appeared to be mediated via mechanisms similar to those observed with macro-endothelium, ie, via the adhesive receptor combination VCAM-1-VLA-4. Our studies show that hypoxia enhances sickle RBC adhesion to both macrovascular and human microvascular ECs via the adhesive receptor VCAM-1. Our findings are of interest because hypoxia is an integral part of the pathophysiology of the vaso-occlusive phenomenon in sickle cell anemia.     

Enhanced fetal hemoglobin production by phenylacetate and 4-phenylbutyrate in erythroid precursors derived from normal donors and patients with sickle cell anemia and beta-thalassemia

In both sickle cell (SS) anemia and beta-thalassemia (beta-thal), an increase in fetal hemoglobin (HbF) ameliorates the clinical symptoms of the underlying disease. Several pharmacologic agents have been used to elevate HbF levels in adults; however, concerns regarding adverse effects of the prevailing drugs raise an urgent need for other agents capable of stimulating HbF production. We show here that sodium phenylacetate (NaPA) and its precursor, sodium 4-phenylbutyrate (NaPB), can enhance HbF production in cultured erythroid progenitor derived from normal donors and patients with SS anemia or beta-thal, when used at pharmacologic concentrations. Treatment resulted in (1) reduced cell proliferation, (2) elevated hemoglobin (Hb) content per cell (mean cellular Hb [MCH]), and (3) an increased proportion of HbF produced, associated with elevated levels of gamma-globin mRNA. Moreover, the active phenyl-fatty acids, with NaPA as a prototype, potentiated HbF induction by other drugs of clinical interest, including hydroxyurea (HU), sodium butyrate, and 5-azacytidine (5AzaC). Efficacy could be further enhanced by introducing chlorine substituents at the phenyl ring to increase drug lipophilicity. Our findings indicate that NaPA and NaPB, both already proven safe and effective in treatment of children with urea cycle disorders, might benefit also patients with severe hemoglobinopathies. The two-phase liquid culture procedure used in this study should prove valuable in further studies exploring the mechanisms of HbF induction by these agents, and might provide an assay to predict patient response in the clinical setting.     

Post-transfusion hyperhaemolysis in a patient with sickle cell disease: use of steroids and intravenous immunoglobulin to prevent further red cell destruction

Forty nine multiple drug resistant strains of E. coli isolated from UTI were serotyped. The pattern was found to be 057 (eight strains); 0109 (four strains); 020, 038, 068, 0106, 0148. Rough (three each). 012, 054, 0101, 0160 (two each) and 02, 032, 046, 053, 060, 065, 090, 091, 0117, 0118, untypable (one each). The resistance pattern of all E. coli were identified and matted with recepient strain in penassay broth and in human urine. In a penassay broth transfer of resistance was demonstrated in 38 strains (77.5%) while in human urine transfer was demonstrated only in 14 strains (28.57%).     

Use of stem cells from mismatched related donors

Mismatched haploidentical bone marrow transplantations from a related donor have been the topic of clinical and laboratory research for more than 20 years. During that time, new treatment strategies have been designed based on animal experiments, and, since our group introduced the megadose inoculum which combines T-cell-depleted bone marrow cells with a large number of granulocyte colony-stimulating factor-mobilized peripheral blood stem cells and a more intensive conditioning regimen, have done much to overcome the problems of graft-versus-host disease and graft rejection. As most patients have a full haplotype mismatched relative available, this technique means that a far greater number of patients with hematologic malignancies can be offered a T-cell-depleted transplantation as curative therapy.     

Tissue factor expression by endothelial cells in sickle cell anemia

The role of the vascular endothelium in activation of the coagulation system, a fundamental homeostatic mechanism of mammalian biology, is uncertain because there is little evidence indicating that endothelial cells in vivo express tissue factor (TF), the system's triggering mechanism. As a surrogate for vessel wall endothelium, we examined circulating endothelial cells (CEC) from normals and patients with sickle cell anemia, a disease associated with activation of coagulation. We find that sickle CEC abnormally express TF antigen (expressed as percent CEC that are TF-positive), with 66+/-13% positive in sickle patients in steady-state, 83+/-19% positive in sickle patients presenting with acute vasoocclusive episodes, and only 10+/-13% positive in normal controls. Repeated samplings confirmed this impression that TF expression is greater when sickle patients develop acute vasoocclusive episodes. Sickle CEC are also positive for TF mRNA, with excellent concurrence between antigen and mRNA expression. The TF expressed on the antigen-positive CEC is functional, as demonstrated by a binding assay for Factor VIIa and a chromogenic assay sensitive to generation of Factor Xa. By establishing that endothelial cells in vivo can express TF, these data imply that the vast endothelial surface area does provide an important pathophysiologic trigger for coagulation activation.     

Stable transduction of recombinant adeno-associated virus into hematopoietic stem cells from normal and sickle cell patients

The effectiveness of a health education programme for prevention of alcohol abuse and tobacco smoking among adolescents was assessed by an intervention study with a non-randomized control group. The study was carried out among 7th-9th grade school students in a Local Health Unit of the Brescia province, North Italy. Students were enrolled in either the intervention or the control group, based on the participation of their teachers to the educational programme. A total of 428 students were involved in the programme representing the intervention group, and 658 students not involved in the programme formed the control group. The health education programme included the prevention of alcohol abuse in the first school year (1989-90) and the prevention of tobacco smoking in the second year (1990-91). Each part of the programme included a series of lessons taken by the teachers for about 20 hours. Alcohol use and smoking habits, knowledge about, and attitudes toward alcohol and tobacco use of the students have been assessed by anonymous questionnaires. The questionnaires have been administered during school time at the beginning and the end of each school year, giving a total of 6 questionnaires, from Q1 to Q6. All the questionnaires included the same questions on alcohol and tobacco use, knowledge and attitudes. Of the 1086 students who attended the 7th grade in the year 1989-90, 428 were enrolled as intervention group and 658 as control group. As regards alcohol, the following findings were observed: 1. no difference was found in the percentages of students drinking at least one glass of wine or beer daily between the 2 groups at Q6; 2. no substantial change in the percentage of students aware of the health risks of alcohol abuse from Q1 to Q6 was observed. As regards tobacco smoking, the results of the study showed: 1. no difference between the 2 groups was found at Q6 as regards the proportion of students who smoked one or more cigarettes a month; 2. the percentages of students planning to smoke in the future were similar in the 2 groups in Q6; 3.the percentage of students with a high score on the health consequences of smoking was higher in the intervention than the control group at Q4, but again no difference between the groups was evident at Q6. In conclusion, the health education programme seemed to be unsuccessful in modifying behaviors and attitudes regarding alcohol and tobacco use during the 3-year follow-up.