Validation of an inhibition ELISA using a monoclonal antibody for foot-and-mouth disease (FMD) primary diagnosis

An inhibition ELISA (IH-ELISA) test for foot-and-mouth disease virus (FMDV) was validated using 106 epithelial samples from suspected cases of FMD in Argentina submitted to the Argentine National Diagnostics Laboratory (GELAB) over a period of 12 months and examined in parallel with the complement fixation test (CFT). IH-ELISA was found to be more sensitive, detecting 25% (26 samples) more FMDV positives than the CFT in original suspensions of field samples. The effect of storage conditions on 12S stability was examined. Plates stored at 4 degrees C blocked with 1% ovalbumin and plates stored at -20 degrees C with or without blocking buffer could be used for at least 90 days. When various brands of polystyrene plates were compared for 12ps adsorption it was found that those microplates of higher binding capacity were more efficient.     

Comparison of S(-)-bupivacaine with racemic (RS)-bupivacaine in supraclavicular brachial plexus block

Control of heart rate in critically ill patients who develop atrial fibrillation or atrial flutter can be difficult. Amiodarone may be an alternative agent for heart rate control if conventional measures are ineffective. We retrospectively studied intensive care unit patients (n = 38) who received intravenous amiodarone for heart rate control in the setting of hemodynamically destabilizing atrial tachyarrhythmias resistant to conventional heart rate control measures. Atrial fibrillation was present in 33 patients and atrial flutter in 5 patients. Onset of rapid heart rate (mean 149 +/- 13 beats/min) was associated with a decrease in systolic blood pressure of 20 +/- 5 mm Hg (p <0.05). Intravenous diltiazem (n = 34), esmolol (n = 4), or digoxin (n = 24) had no effect on heart rate, while reducing systolic blood pressure by 6 +/- 4 mm Hg (p <0.05). The infusion of amiodarone (242 +/- 137 mg over 1 hour) was associated with a decrease in heart rate by 37 +/- 8 beats/min and an increase in systolic blood pressure of 24 +/- 6 mm Hg. Both of these changes were significantly improved (p <0.05) from onset of rapid heart rate or during conventional therapy. Beneficial changes were also noted in pulmonary artery occlusive pressure and cardiac output. There were no adverse effects secondary to amiodarone therapy. Intravenous amiodarone is efficacious and hemodynamically well tolerated in the acute control of heart rote in critically ill patients who develop atrial tachyarrhythmias with rapid ventricular response refractory to conventional treatment. Cardiac electrophysiologic consultation should be obtained before using intravenous amiodarone for this purpose.     

Infraclavicular brachial plexus block effects on respiratory function and extent of the block

Epidermal growth factor (EGF) and transforming growth factor-alpha (TGF-alpha) promote the differentiation and proliferation of epithelia as well as the proliferation and chemotaxis of fibroblasts. Additionally, EGF promotes wound healing in tissues composed largely of epithelial cells and fibroblasts. We hypothesized that EGF and TGF-alpha regulate the differentiation and proliferation of the epithelial lining and the migration and proliferation of fibroblasts in the subepithelial space of the middle ear mucosa in children with otitis media. As an initial test of this hypothesis, EGF and TGF-alpha concentrations were measured in 82 middle ear effusions of children undergoing tympanostomy tube placement. EGF was present in 45% of these effusions, and TGF-alpha was present in 6%. The mean concentration +/- SEM values for EGF and TGF-alpha were 19+/-7.6 and 3.7+/-7.9 pg/mL, respectively. In addition, neutrophils, macrophages, and lymphocytes in middle ear effusions stained for EGF by immunocytochemistry. We conclude that growth factors are frequently present in middle ear effusions of children with otitis media.     

Reproducibility of coronary arteriographic reading in the coronary artery surgery study (CASS)

Eight hundred seventy arteriograms from the Coronary Artery Surgery Study (CASS) were independently read by readers at two different clinics to evaluate the reproducibility of the interpretation of coronary arteriograms. Among proximal segments, the interpretation of lesions of the left main coronary artery were the least reproducible, P less than .02. When one angiographer reads a stenosis of 50% or more in the left main coronary artery, it is estimated that a second reader will report no lesion 18.6% of the time. In 94.7% of the films, the number of significantly (greater than or equal to 70% stenosis) diseased vessels was the same for both readers (72.1%) or differed by one vessel (22.6%). The reproducibility of interpretation of films of good or acceptable quality or completeness was better than the reproducibility of readings of arteriograms judged to be of poor quality or incomplete studies. The mean absolute difference between readings of the percent stenosis decreased over the time of the patient enrollment, 1975 to 1978. This may have resulted from major collaborative efforts made during the course of the study to improve the quality of angiography and to standardize the reading of the cine films.     

Vascular endothelial growth factor (VEGF) induces rapid prourokinase (pro-uPA) activation on the surface of endothelial cells

Vascular endothelial growth factor (VEGF) is the pivotal angiogenic growth factor activating endothelial cells to migrate, proliferate, and form capillary tubes. For an ordered endothelial cell migration, tissue invasion, and degradation of the extracellular matrix, proteolytic machinery is indispensable. Such machinery, suitable for localized proteolysis, is provided by the prourokinase-urokinase-plasmin system. Prourokinase (pro-uPA), the initial component of this system, is, however, synthesized in its inactive precursor form and as such bound to its cellular receptor uPAR. Here we identify a mechanism via which VEGF(165) interacting with its receptor VEGFR-2 rapidly induces prourokinase activation that is dependent on a change in integrin affinity, activation of matrix metalloproteinase 2 (MMP-2), and pro-uPA being bound to its surface receptor uPAR. This VEGF-induced pro-uPA activation on endothelial cells is responsible for VEGF-dependent local fibrinolytic activity and might be one of the initial steps in the angiogenic process.     

A conceptual scheme for assessing evenhandedness and (counter) self-serving attributional biases in relation to depression

Various hypotheses have been proposed concerning the attributional styles of depressive and nondepressive persons. Some hypotheses are compatible with others; some are mutually exclusive. In this paper we present a scheme for organizing these hypotheses. A method is offered for deciding which hypothesis best fits data from samples which are heterogeneous with regard to extent of depression. The concepts reviewed include "self-serving bias," "counter-self-serving bias," "evenhandedness," "depressive lower self-enhancement," "counter-defensive attribution," the "Abramson, et al. hypothesis" that depressed persons attribute events with bad outcomes more to internal, stable, and global causes than do nondepressed persons, and the "Seligman, et al. hypothesis" that depressed persons attribute events of good outcome less to these causes than do nondepressed persons.     

The Maudsley Addiction Profile (MAP): a brief instrument for assessing treatment outcome

AIM: To develop a brief, multi-dimensional instrument for assessing treatment outcome for people with drug and/or alcohol problems. The Maudsley Addiction Profile (MAP) is the first instrument to be developed in the United Kingdom for this purpose. DESIGN: Field testing with quota-recruitment of problem drug users and problem alcohol users in treatment with researcher and clinician-administered test-retest interviews. SETTING: Two community and two inpatient services at the Bethlem Royal and Maudsley Hospital, London. PARTICIPANTS: Subjects (160 drug users and 80 alcohol users) interviewed by eight interviews (four researchers and four clinicians), each of whom interviewed 30 subjects on two occasions. MEASURES: Sixty items across substance use, health risk, physical/psychological health and personal/social functioning domains. FINDINGS: Average completion time of the MAP was 12 minutes. The questionnaire was acceptable to a majority of subjects and performed well with both researcher and clinician interviewers. Internal reliability and feasible concurrent validity assessments of the scales and items were highly satisfactory. Test-retest reliability was good, average intraclass correlation coefficients across eight substances were 0.94 and 0.81 across health risk, health problems, relationship conflict, employment and crime measures. CONCLUSIONS: The MAP can serve as a core research instrument with additional outcome measures added as required. The collection of a set of reliable quantitative measures of problems among drug and alcohol users by research or treatment personnel for outcome evaluation purposes need not be time-consuming.     

Statistical methods for assessing measurement error (reliability) in variables relevant to sports medicine

Minimal measurement error (reliability) during the collection of interval- and ratio-type data is critically important to sports medicine research. The main components of measurement error are systematic bias (e.g. general learning or fatigue effects on the tests) and random error due to biological or mechanical variation. Both error components should be meaningfully quantified for the sports physician to relate the described error to judgements regarding 'analytical goals' (the requirements of the measurement tool for effective practical use) rather than the statistical significance of any reliability indicators. Methods based on correlation coefficients and regression provide an indication of 'relative reliability'. Since these methods are highly influenced by the range of measured values, researchers should be cautious in: (i) concluding acceptable relative reliability even if a correlation is above 0.9; (ii) extrapolating the results of a test-retest correlation to a new sample of individuals involved in an experiment; and (iii) comparing test-retest correlations between different reliability studies. Methods used to describe 'absolute reliability' include the standard error of measurements (SEM), coefficient of variation (CV) and limits of agreement (LOA). These statistics are more appropriate for comparing reliability between different measurement tools in different studies. They can be used in multiple retest studies from ANOVA procedures, help predict the magnitude of a 'real' change in individual athletes and be employed to estimate statistical power for a repeated-measures experiment. These methods vary considerably in the way they are calculated and their use also assumes the presence (CV) or absence (SEM) of heteroscedasticity. Most methods of calculating SEM and CV represent approximately 68% of the error that is actually present in the repeated measurements for the 'average' individual in the sample. LOA represent the test-retest differences for 95% of a population. The associated Bland-Altman plot shows the measurement error schematically and helps to identify the presence of heteroscedasticity. If there is evidence of heteroscedasticity or non-normality, one should logarithmically transform the data and quote the bias and random error as ratios. This allows simple comparisons of reliability across different measurement tools. It is recommended that sports clinicians and researchers should cite and interpret a number of statistical methods for assessing reliability. We encourage the inclusion of the LOA method, especially the exploration of heteroscedasticity that is inherent in this analysis. We also stress the importance of relating the results of any reliability statistic to 'analytical goals' in sports medicine.     

Hyperhomocyst(e)inemia and endothelial dysfunction in IDDM

OBJECTIVE: While elevated blood levels of homocyst(e)ine represent an independent risk factor for macrovascular disease, we assessed the link between hyperhomocyst(e)inemia and diabetic microvascular diseases. RESEARCH DESIGN AND METHODS: Plasma levels of homocyst(e)ine and thrombomodulin (TM), markers of endothelial cell damage, were measured before and 3 h after oral methionine loading in 75 patients with IDDM and 40 healthy control subjects matched for sex and age. Exclusion criteria were hyperlipidemia, hypertension, smoking, or positive family history for cardiovascular disease. RESULTS: IDDM patients had higher pre- and postload plasma levels of homocyst(e)ine than did healthy control subjects (12.0 vs. 7.7 mumol/l and 27.6 vs. 16.0 mumol/l; P < 0.001). Of 75 IDDM patients, 26 had plasma homocyst(e)ine levels above the normal range (means +/- 2 SD of values obtained in the control group). These IDDM patients with hyperhomocyst(e)inemia had higher plasma TM levels (62.2 vs. 38.2 ng/ml, P < 0.001), higher albumin excretion rates (485 vs. 115 mg/l, P < 0.005), and a higher prevalence of late diabetic complications (nephropathy, 76 vs. 33%; retinopathy, 69 vs. 51%; neuropathy, 57 vs. 41%; and macroangiopathy, 57 vs. 33%) compared with IDDM patients with normal plasma homocyst(e)ine. In vitro experiments with human umbilical vein cells showed an increased release of TM into the culture supernatant only when endothelial cells were pretreated with advanced glycation end product (AGE)-albumin before L-homocystine was added. A synergistic action of homocyst(e)ine and AGEs might contribute to vascular complications in patients with diabetes. CONCLUSIONS: Hyperhomocyst(e)inemia is common in nephropathic diabetic patients and may contribute to the enhanced morbidity and mortality from cardiovascular diseases characteristically observed in IDDM patients with diabetic nephropathy.     

Role of ultrasonography in attention to multiple pregnancy (author's transl)

Ultrasonic examination, 482 in totality, were applied to 199 cases of multiple pregnancy, between the twelfth and 41st weeks of gestation. Gestation periods were successfully extended by improved early diagnosis and well-timed prophylaxis of premature births which had all been enabled by the availability of ultrasonography. The period under review was from 1977 to 1979, and gestational periods of 37 weeks and more were reached, within these three years, by 76 per cent of all women with twin pregnancy. Reference is made to issues relating to the use of ultrasonography on multiple pregnancies both prior to the 20th week and in a highly advanced stage. -- Great importance to diagnosis and monitoring of multiple pregnancies with differentiated growth is being assumed by ultrasonic cephalometry and thoracometry. Intensive treatment is, in any case, required by twin pregnancies in which biparietal diameters differ by 5 mm or more.     

Acute brachial neuritis (Parsonage-Turner syndrome): MR imaging appearance--report of three cases

Magnetic resonance (MR) imaging findings in three patients with acute onset of neuritic shoulder pain and weakness included high signal intensity in supra- and infraspinatus muscles (n = 2), partial involvement of infraspinatus muscle (n = 1) and of deltoid muscle (n = 1), and atrophy of supra- and infraspinatus muscles (n = 2). Clinical diagnosis of acute brachial neuritis (Parsonage-Turner syndrome) correlated with MR imaging results in all cases.     

Utility of serum progesterone and prolactin analysis for assessing reproductive status in the Asian elephant (Elephas maximus)

Concentrations of serum progesterone and prolactin were assessed during the perioestrous period and throughout gestation in the Asian elephant (Elephas maximus) as a means of generating information of potential use to managers. In > 95% of perioestrous periods (n=35), behavioural oestrus (as determined by bull interest, mounting and/or breeding) coincided with the onset of increased serum progesterone concentrations at the beginning of the luteal phase and continued through Day 7 (Day 1 = first significant serum progesterone rise). Within individuals, 1- to 2-day transient decreases (P < 0.05) in serum progesterone occurred between Days 2 and 9. Notably, no sexual behaviour was observed in any female after this transient fall in progesterone. Prolactin concentrations fluctuated randomly throughout the perioestrous period, with no clear pattern. During the study, four females conceived (one conceived twice), and two delivered three viable offspring. Serum progesterone was elevated above baseline throughout gestation, and then declined precipitously 2-3 days before parturition. Serum prolactin concentrations were significantly elevated above baseline (P < 0.05) after 5-6 months of gestation and remained high until after parturition. This study confirms that serum progesterone and prolactin analyses are useful tools for monitoring the reproductive status of Asian elephant females. Specifically, the transition from low to high progesterone secretion during the late interluteal/early luteal phase is predictive of oestrus and can be used to coordinate breeding efforts. Pregnancy can be confirmed by elevated serum prolactin after 6 months postbreeding, whereas the late gestational decrease in progesterone is predictive of impending parturition.     

Ingestive contrast medium (sonographics) in abdominal ultrasonography. In-vitro and in-vivo studies

In-vitro tests of new ingestive contrast media (known as "sonographics") are reported. A catalogue comprising 6 points for standards of an "ideal" sonographicum is outlined by systematic comparison to echogenicity of liver parenchyma in n = 49 healthy persons. Preliminary clinical tests show significant improvement of diagnostics in the upper abdomen; however problems do exist in the evaluation of these contrast media, too: Different echogenicities of sonographics can serve variable aims in diagnostic ultrasonography. Simultaneous application of several transducers may enable complete cross-sections of the human torso as in CT, based on further evaluation of ingestive contrast media.     

Impairment of endothelial function induced by glyc-oxidized lipoprotein a [Lp(a)]

Diabetic patients develop endothelial dysfunction early in the course of the disease. Atherogenic lipoproteins such as LDL and Lp(a) are important risk factors for endothelial dysfunction and undergo nonenzymatic glycation in hyperglycaemia. Here we assessed whether glycation of Lp(a) potentiates its damaging influence on endothelial function. Human Lp(a) was glycated by dialyzation for 7 days against buffer containing 200 mmol/l glucose, or sham-treated without glucose and oxidized by incubation with Cu++. The degree of glycation accounted to 32 +/- 4%, and glycation rendered Lp(a) more susceptible to oxidative modification when exposed to Cu++. Isolated rings of rabbit aorta were superfused with physiological salt solution, and isometric tension was recorded. Incubation of the aortic rings with sham-treated or with 30 microg/ml glycated Lp(a), not oxidized, had no influence on acetylcholine-induced, endothelium-dependent relaxation. Exposure of the aortic rings to 30 microg/ml oxidized non-glycated (ox) Lp(a) caused a significant inhibition (19% at 1 microM acetylcholine) of the endothelium-dependent relaxation. Incubation of aortic rings with 30 microg/ml oxidized glycated (glyc-ox) Lp(a) attenuated endothelium-dependent relaxation more potently than oxLp(a) (by 34% at 1 microM acetylcholine). The presence of diethyl-dithio-carbamate (DDC), an inhibitor of the endogenous superoxide dismutase (SOD), potentiated the inhibition of relaxation induced by oxLp(a) and by glyc-oxLp(a) [38% inhibition at 1 microM acetylcholine for oxLp(a), and 49% inhibition at 1 microM acetylcholine for glyc-oxLp(a)]. Co-incubation with the O2- scavenger 4,5-dihydroxy-1,3-benzene disulfonic acid disodium salt (TIRON) prevented the inhibition of relaxation by the oxidized lipoproteins, suggesting that enhanced NO-inactivation by O2- could be the underlying mechanism for the impairment of endothelium-dependent dilations by ox- and glyc-oxLp(a). The concentration of lysophosphatidycholine, a lipoprotein oxidation product and stimulus for O2- formation, was significantly enhanced in oxLp(a) and in glyc-oxLp(a) compared to native lipoproteins. Conclusion: Glycation enhances the endothelium-damaging influence of oxLp(a), presumably by enhancing oxidative stress. The likely mechanism for attenuation of endothelium-dependent dilations is increased formation of O2-, resulting in inactivation of nitric oxide. This mechanism may play an important role in diabetic patients and may contribute to disturbed organ perfusion.