Submersion injuries in children and adults

Drowning and near drowning remain a common cause of childhood death and disability. Toddlers aged one through four drown in private swimming pools. Submersions greater than 10 minutes and lack of CPR at the scene or the need for greater than 20 minutes of resuscitation portends a poor prognosis. Management of respiratory failure without neurologic impairment has the most successful outcome. Prevention of drowning morbidity is dependent on constant parental supervision, and immediate and expert CPR.     

Metabolic delivery of ketone groups to sialic acid residues. Application To cell surface glycoform engineering

The development of chemical strategies for decorating cells with defined carbohydrate epitopes would greatly facilitate studies of carbohydrate-mediated cell surface interactions. This report describes a general strategy for engineering the display of chemically defined oligosaccharides on cell surfaces that combines the concepts of metabolic engineering and selective chemical reactivity. Using a recently described method (Mahal, L. K., Yarema, K. J., and Bertozzi, C. R. (1997) Science 276, 1125-1128), we delivered a uniquely reactive ketone group to endogenous cell surface sialic acid residues by treating cells with the ketone-bearing metabolic precursor N-levulinoylmannosamine (ManLev). The ketone undergoes highly selective condensation reactions with complementary nucleophiles such as aminooxy and hydrazide groups. The detailed quantitative parameters of ManLev metabolism in human and nonhuman-derived cell lines were determined to establish a foundation for the modification of cell surfaces with novel epitopes at defined cell-surface densities. Ketones within the glycoconjugates on ManLev-treated cells were then reacted with synthetic aminooxy and hydrazide-functionalized carbohydrates. The remodeled cells were endowed with novel lectin binding profiles as determined by flow cytometry analysis. The simplicity and generality of this method make it well suited for use in the study of carbohydrate-mediated cell surface interactions.     

Seasonal variations in T-lymphocyte response to grass pollen allergens from pollen-allergic patients and healthy controls

Recurrence of membranous nephropathy after renal transplantation has been reported either anecdotally or in a few series. In the present study, the potential risk factors as well as hitherto unreported actuarial risk for recurrence and graft loss due to recurrence were evaluated by combining data of a series of transplanted patients with MN at Louvain Medical School (n = 12) and at Lyon (n = 18; previously reported by Couchoud et al. 1995) giving a total of 30 patients. No risk factor for recurrence was identified as there was no statistical difference between the patients with and without recurrence for duration of MN in native kidneys or of pretransplant hemodialysis, presence of HLA-DR3, graft origin and use of cyclosporin. Actuarial risk for recurrence reached 29% at 3 years, plateauing up to 10 years. The outcome of recurrence was poor since the actual risk for graft loss among patients with recurrent MN was 38 and 52% at 5 and 10 years, respectively.     

Morphometric analysis of heparin coated versus standard intra-aortic balloons

The adverse effects of systemic heparin administration has led to the development of heparin coated devices. Intra-aortic balloons are frequently used in clinical settings in which complications of systemic heparin, especially bleeding, are feared. The current study evaluated the thromboresistance of heparin coated intra-aortic balloons. Six bovine calves were chosen for the experiment. In each animal, three intra-aortic balloons were inserted, and set to the automatic mode: two in the vena cava for 15 min and 45 min, respectively, and one in the aorta for 6 hr. There were nine standard and nine heparin coated intra-aortic balloons. At the end of the procedures, three samples of each intra-aortic balloon were analyzed with scanning electron microscopy for computed analysis of the balloon surface covered with fibrin and cells. The scanning electron microscopy analysis showed no deposit at any time interval on the heparin coated sample surfaces, whereas 3.6% +/- 9.2% (mean +/- SD) of the standard sample surfaces were covered with deposits at 15 min (p = 0.06), 14.8% +/- 24.3% at 45 min (p = 0.01), and 4.4% +/- 12.4% at 6 hr (p = 0.06). Strikingly, none of the 27 heparin coated samples showed any microscopic deposits, whereas 11 of the 27 standard samples did (p < 0.002). Heparin coated intra-aortic balloons appear to be a promising strategy, especially for patients with absolute or relative contraindications to systemic heparinization.     

pH-induced conformational changes of membrane-bound influenza hemagglutinin and its effect on target lipid bilayers

Influenza virus hemagglutinin (HA) has served as a paradigm for both pH-dependent and -independent viral membrane fusion. Although large conformational changes were observed by X-ray crystallography when soluble fragments of HA were subjected to fusion-pH conditions, it is not clear whether the same changes occur in membrane-bound HA, what the spatial relationship is between the conformationally changed HA and the target and viral membranes, and in what way HA perturbs the target membrane at low pH. We have taken a spectroscopic approach using an array of recently developed FTIR techniques to address these questions. Difference attenuated total reflection FTIR spectroscopy was employed to reveal reversible and irreversible components of the pH-induced conformational change of the membrane-bound bromelain fragment of HA, BHA. Additional proteolytic fragments of BHA were produced which permitted a tentative assignment of the observed changes to the HA1 and HA2 subunits, respectively. The membrane-bound HA1 subunit undergoes a reversible conformational change, which most likely involves the loss of a small proportion of beta-sheet at low pH. BHA was found to undergo a partially reversible tilting motion relative to the target membrane upon exposure to pH 5, indicating a previously undescribed hinge near the anchoring point to the target membrane. Time-resolved amide H/D exchange experiments revealed a more dynamic (tertiary) structure of membrane-bound BHA and its HA2, but not its HA1, subunit. Finally BHA and, to a lesser degree, HA1 perturbed the lipid bilayer of the target membrane at the interface, as assessed by spectral changes of the lipid ester carbonyl groups. These results are discussed in the context of a complementary study of HA that was bound to viral membranes through its transmembrane peptide (Gray C, Tamm LK, 1997, Protein Sci 6:1993-2006). A distinctive role for the HA1 subunit in the conformational change of HA becomes apparent from these combined studies.     

Longitudinal trends and gender differences in physical fitness and lifestyle factors in career U.S. Navy personnel (1983-1994)

This study examines long-term health and physical readiness trends in the U.S. Navy. We mailed lifestyle questionnaires to all participants in baseline studies between 1983 and 1989 who were still on active duty in 1994. Commands provided body composition and physical readiness test scores for the participants. Two longitudinal cohorts were created: an 8-year sample (N = 640) with matched data from 1986, 1989, and 1994; and an 11-year sample (N = 1,576), with data from 1983 and 1994. Analyses of both cohorts revealed significant improvements in cardiovascular fitness, muscle strength, exercise, lean body mass, dietary habits, and sleep, as well as significant decreases in tobacco and alcohol use and job stress. However, hypertension rates, percentage of body fat, and body mass index increased over time. Women's scores were significantly better than men's on a number of factors. Overall, these findings suggest that the Navy's health promotion efforts have had a significant positive effect on the fitness and health behaviors of career Navy men and women.     

Thiopurine methyltransferase genotype predicts therapy-limiting severe toxicity from azathioprine

BACKGROUND: Substantial hematologic toxicity limits the use of azathioprine. OBJECTIVE: To evaluate 1) polymorphic inactivation of azathioprine by thiopurine methyltransferase and 2) clinical toxicity. DESIGN: Prospective cohort study. SETTING: Two rheumatology units. PATIENTS: 67 patients for whom azathioprine was prescribed as second-line therapy for rheumatic disease. MEASUREMENTS: Polymerase chain reaction-based assays were used to detect mutations in thiopurine methyltransferase. The primary end point was discontinuation of azathioprine therapy because of toxicity. RESULTS: Six of 67 patients (9%) were heterozygous for mutant thiopurine methyltransferase alleles. Five of the 6 patients discontinued therapy within 1 month of starting treatment because of low leukocyte counts. The sixth patient did not adhere to treatment. Patients with wild-type thiopurine methyltransferase alleles received therapy longer than did patients with mutant alleles (median duration of therapy, 39 weeks [range, 6 to 180 weeks] and 2 weeks [range, 2 to 4 weeks], respectively; P = 0.018). CONCLUSION: Analysis of thiopurine methyltransferase genotype is a quick way to identify patients at risk for acute toxicity from azathioprine.