Documentation of violence against civilians in a civil war. Examples from Kashmir

Physicians for Human Rights/Denmark visited Kashmir three times in 1993 and 1994. In Indian-held Kashmir we examined victims of torture and gunshots and we assessed similar evidence collected by local lawyers and doctors. In refugee camps for Indian Kashmiries we examined ten children, who were reported to have been tortured at the age of 5-14 years, and ten other children who allegedly had been ill-treated. Furthermore, 17 adults, who reported that they had been tortured, were examined. In nearly all cases there were physical findings in accordance with the histories of torture. In many cases, including those of the children, the findings were highly remarkable by their shape and localization. We interpret them as evidence of intentionally inflicted injuries. In the refugee camps we carried out a prevalence study of exposure to organized violence. Approximately 95% of all families had been exposed to violence; 35% reported that their children had been ill-treated. The physical findings indicate that intentional traumatization of civilians including children in Indian-held Kashmir takes place; the results of the prevalence study suggest that exposure to violence is widespread.     

Treatment of humoral rejection after heart transplantation

BACKGROUND: Until a few years ago, the incidence of humoral rejection after heart transplantation was underestimated. These episodes were frequently very aggressive and often fatal, because the maintenance and emergency immunosuppression available at the time only inadequately covered the humoral branch of the immune response. In spite of individual case reports, the effects of blood purification procedures or cyclophosphamide in this situation can only be insufficiently estimated. METHODS: To evaluate this therapy concept, 20 dog-lymphocyte-antigen-matched dogs underwent heterotopic neck-heart transplantation. Fourteen dogs underwent transplantation after having been previously sensitized through multiple skin transplantations, 6 dogs were not sensitized (control). The animals received an induction with 3x 250 mg prednisolone, as well as triple immunosuppression (cyclosporine, azathioprine, and cortisone). Biopsy (light microscopy, immunofluorescence), intramyocardial voltage, electric myocardial impedance (>200 kHz, <10 kHz), and echocardiographic (left ventricular wall thickness, diastolic relaxation velocity) examinations were performed daily to monitor rejection. Rejection therapy was continued for 3 days according to the following regimen: apheresis, cortisone boluses (CB), and cyclophosphamide in group A1 (n = 4), apheresis and CB without cyclophosphamide in group A2 (n = 4), and CB only in group C (n = 6). The subsequent course under triple immunosuppression was then observed. RESULTS: In the sensitized animals the onset of severe humoral rejection on the fifth day deteriorated cardiac function down to 75% (70% to 80%) of the initial values. In groups A1 and A2, apheresis resulted in recovery to near-control values (89% to 94%) within two hours, and indeed to complete recovery (97% to 101%) after the second apheresis, that is, within 1 day. In group C recovery was delayed (2 days) and incomplete (84% to 91 %). After therapy was discontinued, rejection-related functional deterioration recurred immediately in group C, and from 2 to 3 days after apheresis, regardless of whether cyclophosphamide therapy was performed (group A1) or not (group A2). In the control group all animals showed a rejection-free posttransplantation course. CONCLUSIONS: By diluting inflammatory mediators, apheresis leads to a rapid improvement in cardiac function during severe humoral rejection after head transplantation. Neither apheresis nor cyclophosphamide therapy are able to have an immediate positive influence on the activation of the immune cascade and to prevent an ongoing rejection.     

Assessing influenza immunization rates in Medicare managed care plans: a comparison of three methods

BACKGROUND: In an effort to improve care delivered to Medicare beneficiaries, the Health Care Financing Administration (HCFA) has encouraged competitive Medicare risk plans to collaborate on quality improvement projects. PRO-West, a private, nonprofit quality improvement organization, fostered a collaboration of all Medicare risk plans in Washington State in order to assess and improve influenza immunization rates among seniors enrolled in managed care. METHODOLOGY: After the 1994-1995 influenza immunization season, immunization rates were determined for each participating plan from administrative data and medical record review. In the 1995-1996 season, these methods were supplemented with a telephone survey. The survey was used to identify perceived barriers to immunization and to estimate immunization rates. RESULTS: Immunization rates, as estimated by administrative data and medical record review, were similar for both years. The average immunization rate using administrative data for the 1995-1996 flu season was 60.6% (range, 42.8% to 72.3%). The estimated rate increased to 77.8% (95% confidence interval, 75.3% to 80.3%) when the telephone survey data were added. Medical record review contributed little additional information. CONCLUSIONS: Influenza immunization rates for seniors enrolled in Medicare risk plans in Washington State exceed those reported for fee-for-service Medicare beneficiaries. Telephone surveys resulted in higher and probably more valid estimates of influenza immunization rates than did analysis of administrative data and medical records. Plans with lower rates can emulate "benchmark" plans that are explicit about the methods they use to achieve high coverage rates. Medicare risk health plans competing in the same markets can collaborate in quality assessment activities in an effective manner.     

X-ray structure at 1.76 A resolution of a polypeptide phospholipase A2 inhibitor

The high resolution crystal structure of a natural PLA2 inhibitor has been determined by Patterson search methods. In the heterodimeric, neurotoxic complex, vipoxin, isolated from the venom of Bulgarian viper, PLA2 inhibitor represents the non-toxic subunit. The model was refined to a crystallographic R-factor of 15.5% for data between 6 and 1.76 A resolution. The packing of the inhibitor in the crystal reveals close contacts between the molecules, which are symmetry-related by the 2-fold axes of the lattice. These pairs associate as a crystallographic dimer, stabilized by a set of interactions, including van der Waals contacts between residues from symmetry-related pairs, denoted as the recognition site and the recognition surface. Residues Ph3, Trp31 and Tyr119 represent the recognition site of inhibitor which possibly fits to the hydrophobic wall of the target PLA2. The topology of the inhibitor represents the PLA2 type of folding: three long helices and a beta-hairpin. Superposition of the structure of the inhibitor shows an almost complete overlap with different mammalian and viper PLA2 in the backbone and in the position of the sidechains of the residues that belong to the active centre and the hydrophobic wall. A "lock and key" mechanism of recognition of its native PLA2 in gland cells and other toxic PLA2 in vitro has been suggested. The mechanism includes complementary "head to tail" interactions between the recognition site of the inhibitor and a recognition surface located on the hydrophobic wall of the target PLA2. Having a high spatial homology with the PLA2 family of enzymes but opposing their action, the inhibitor from vipoxin presents an example of a divergent evolution of an ancient PLA2. The presence of a space for binding calcium in the inhibitor is believed to be a rudiment and proof of a common origin with PLA2.     

Transient up-regulation of ciliary neurotrophic factor receptor-alpha mRNA in axotomized rat septal neurons

PURPOSE: To determine prospectively the feasibility, complications, and mid- and long-term advantages of peripheral insertion of central catheters in infants and children. MATERIALS AND METHODS: During a 15-month period between March 1995 and June 1996, a total of 285 catheter placement attempts were made to peripherally insert central catheters in 183 pediatric patients (89 boys, 94 girls). Phlebographic guidance was used, and the catheters were inserted below the elbow in 99% of cases. Catheter insertion was indicated for prolonged antibiotic therapy in 108 patients (158 catheter placement attempts), hematologic or oncologic care in 24 patients (40 attempts), total parenteral nutrition in 16 patients (46 attempts), and venous access for fluid or blood in 35 patients (41 attempts). The success rate and complications were recorded along with the indication, patient age, and duration of catheter placement. RESULTS: One hundred fifty-two of 158 (96%) catheter placement attempts were successful in outpatients (n = 108), 124 of 127 (98%) in hospitalized patients (n = 75), and 70 of 73 (96%) in patients aged less than 1 year. Infection and pericatheter venous thrombosis were the main complications and were seen in 17 of 276 (6%) and one of 276 (0.3%) catheter placement attempts, respectively. Catheter occlusion occurred in 23 of 276 (8%) catheter placement attempts. CONCLUSION: Peripheral insertion of central catheters was highly feasible in infants and children with this protocol. Such catheters were well tolerated in the pediatric population with a low frequency of complications.     

Use of cell ELISA for the screening of neurotrophic activities on minor cell populations in retinal monolayer cultures

BACKGROUND: Whereas the secretion of the male vesicular gland in most mammals is amorphous, that of the tree shrew, Tupaia glis, was observed to be stored as globules. METHODS: Vesicular and prostate glands from Tupaia, fixed in glutaraldehyde and osmium, were studied in the light and electron microscopes. Other materials considered included the Tupaia ejaculate produced by electroejaculation and, for comparative purposes, sections of the vesicular gland from a dermopteran, the flying lemur. RESULTS: The vesicular gland epithelium in Tupaia secretes small granular aggregates and occasionally a denser aggregate that is associated with cells having obvious apical Golgi lamellae. In the alveolar lumen, these aggregates unite with others to form, respectively, granular and some dense globules of up to approximately 15 mu in diameter, which appear as such in semen produced by electroejaculation. In contrast to the prostate, however, precursor secretion vesicles were rare in the vesicular epithelium. Although poorly fixed, the vesicular gland secretion from a flying lemur also appeared to form globules. CONCLUSIONS: Although it is unlike the homogeneous secretion elaborated in most mammals, including primates and insectivores, the globular product of the Tupaia vesicular gland seems comparable to that in a variety of mega- and microbats, among representative species of which it appears to provide the bulk material for the vaginal copulation plug. Because a museum specimen examined here also indicates its occurrence in a flying lemur, the globular vesicular gland secretion common to Tupaiidae, to at least some Mega- and Microchiroptera, and apparently to Dermoptera may provide a soft tissue feature of some value in the cladistic approach to phylogenetic reconstruction within the Archonta. Anat.     

T-cell epitope mapping by flow cytometry

From March 1994 to September 1996, 39 patients underwent stenting of the unprotected left main coronary artery because of high surgical risk. Stenting appeared to improve clinical outcome, but there was a significant mortality rate at long-term follow-up.     

Prenatal diagnosis of Apert syndrome

Apert syndrome (AS) is clinically characterized by typical facial features and symmetrical syndactyly of the digits. AS is inherited as an autosomal dominant trait. Recently, a fibroblast growth factor receptors 2 (FGFR2) mutation, either C934G or C937G, was identified in exon IIIa. Our report documents an affected mother and son in whom one of the two mutations in AS had occurred sporadically in the mother. The diagnosed of AS was based on associated abnormal physical features and on molecular genetic analysis. A C-to-G transversion at position 937 of the cDNA resulting in a proline-to-arginine substitution at codon 259 was found in the mother. In her second pregnancy, prenatal diagnosis by both restriction analysis and direct sequencing was undertaken and this showed that the female fetus had not inherited the mutation.