Mutation of the alpha 2 domain disulfide bridge of the class I molecule HLA-A*0201. Effect on maturation and peptide presentation

This report documents the introduction of standard-setting in the haemato-oncological reverse-isolation unit of the Kanton hospital, Basle. The topic is the prevention or reduction of nausea, choking and vomiting, and the treatment of patients who are receiving prolonged chemotherapy. The objective was quality assurance in nursing care. The definition of the desired outcome was the well-being and safety of patients. In addition the wish of the staff to increase their security in dealing with antiemetics was taken into consideration. The authors describe the basic problems they encountered in their strategies and actions for standard setting. By extensive use of measurement and evaluation it was possible, in cooperation with medical leadership, to develop instructional leaflets and checklists. Approximation to the intended outcome was achieved. The well being of patients and satisfaction of the safety-needs of staff and patients reached a high level. The report shows that the introduction of nursing standards requires great effort and a high level of commitment of the entire team. It also shows that the effort is worthwhile for patients and staff.     

Test-retest reliability of high-frequency thresholds at bedside with sensorineural hearing-impaired listeners

Previous investigations have established the reliability of high-frequency thresholds performed in a sound suite using headphones. In addition, test-retest reliability of high-frequency thresholds in adults with normal hearing in a hospital room versus a sound-treated booth has also been established. The current study evaluated the test-retest reliability of thresholds in the 8000- to 18000-Hz range in 15 hearing-impaired adults (26 ears) with varying degrees of sensorineural hearing loss. A high-frequency audiometer and supra-aural earphones were used to measure thresholds in a typical hospital room. Results revealed no significant difference between repeated threshold measures. This study represents the third phase of an ongoing project to develop reliable bedside monitoring of patients undergoing ototoxic medical treatment.     

CMV-specific immune responses and HLA phenotypes of AIDS patients who develop CMV retinitis. HNRC Group. HIV Neurobehavioral Research Center

HLA phenotype and immune responses to CMV were studied to determine whether the subset of AIDS patients who developed CMV retinitis were immunogenetically or immunologically predisposed. CMV retinitis develops in approximately 28-35% of AIDS patients and CMV encephalitis develops in 40% of those with retinitis, often leading to death. T-cell proliferation responses to CMV and HIV were assayed prospectively in individuals enrolled in a longitudinal study at the HIV Neurobehavioral Research Center (HNRC) in San Diego. Seventy-three participants, at various stages of disease, have been HLA typed and followed, clinically and immunologically, for up to 5 years. Six HIV infected individuals who eventually developed CMV retinitis, and were assayed prospectively, had a history of low T-cell proliferation to CMV antigens before they were profoundly immunosuppressed. All 10 individuals with CMV retinitis had at least one of three HLA alleles (or combinations): A2B44 (p = 0.02), B51(p = 0.02), or DR7 (p = 0.01) (collective p value = 0.007). Three of the 10 had two or more of these alleles. Of AIDS patients with CD4 counts below 100 and actively at risk for retinitis, 7/15 with A2B44,51, or DR7 have developed retinitis compared to 0/13 without these HLA alleles (relative risk = 23.8). All 4 patients with these alleles who have died, had retinitis. These results suggest that HIV infected individuals with HLA phenotypes A2B44, B51, and DR7 have low T-cell immune responses to CMV and are predisposed to CMV retinitis and encephalitis as immunodeficiency progresses.     

Determination of resistance mechanism in Culex quinquefasciatus Say 1823 and its operational implication in the correct use of insecticides for its control

Resistance to organophosphorous insecticides such as malathion, chlorpyrihos, and pyrimiphos-methyl; pyrethroids such as deltametrine and lambda cialotrine; and the propoxur carbamate was determined in 4 strain of Culex quinquefasciatus of the Eastern, Central and Western parts of Cuba. The increase of esterase enzymes was the main mechanism involved in resistance, followed by altered acetylcholinesterase (AChe). Gene frequencies were high for esterases (1), and moderate for acetylcholinesterase (0.52) in the four strains under study, as an average. Bioassays showed resistance to malathion and propoxur. The use of DEF as esterase inhibitor showed that pyrimiphos-methyl was not affected by this mechanism of resistance, and chlorpyriphos was slightly affected. After 5 years of using pyrethroids such as deltametrine and lambda cialotrine, these are still useful agents for the control of C. quinquefasciatus; the alternate use of these and pyrimiphos-methyl or chlorpyriphos could prevent the development of resistance in a short or medium term.     

Analysis of three 2,3-dihydroxybiphenyl 1,2-dioxygenases found in Rhodococcus globerulus P6. Identification of a new family of extradiol dioxygenases

The polychlorobiphenyl-degrading bacterium Rhodococcus globerulus P6 contains three bphC genes encoding 2,3-dihydroxybiphenyl 1,2-dioxygenases. One of them, bphC1, is clustered with the bphB gene which encodes 2,3-dihydroxy-4-phenylhexa-4,6-diene dehydrogenase and constitutes part of the bph operon specifying the degradation of biphenyl. The nucleotide sequence of bphB and the three bphC genes has been determined. The protein products of the bphBC1 gene cluster were found to exhibit significant homology with the corresponding proteins of analogous degradative pathways in Gram-negative bacteria; the highest homology was in those of the toluene degradation pathway of Pseudomonas putida strain F1. No homology was found between bphC2 and bphC3 and any other sequence in the database. At least two of the three meta cleavage enzymes are inducible by biphenyl. 2,3-Dihydroxybiphenyl 1,2-dioxygenase II, encoded by the bphC2 gene, was purified to apparent homogeneity from a recombinant Escherichia coli strain. The enzyme differed from other extradiol dioxygenases in having a subunit molecular mass of 21 kDa and a hexameric structure. The enzyme contains one tightly bound iron per subunit. These characteristics demonstrate that the 2,3-dihydroxybiphenyl 1,2-dioxygenases encoded by bphC2 and bphC3 belong to a new class of extradiol dioxygenases.     

Pedophiles' ratings of adult and child photographs using a semantic differential

Recent knowledge of the widespread extent of child sexual abuse and its consequences has led to an increasing interest in the understanding and treatment of perpetrators. This study examined a group of pedophiles in an English Special Hospital to determine possible characteristics that make children attractive and adults unattractive to them, using Repertory Grid technique and Semantic Differential. A small number of significant findings suggest that pedophiles may perceive some children and women in an unusual way. The large number of insignificant findings are discussed with reference to the sensitivity of the instrument; the pedophiles' desire to give socially acceptable answers; and subject characteristics of low IQ and "psychopathic disorder." Future directions for research are suggested.     

Rhesus monkey behavior during exposure to high-peak-power 5.62-GHz microwave pulses

Limits on the exposure to high-peak-power, short-duration microwave pulses have only recently been adopted. Additional data, however, are needed to understand the effects that may be produced by exposure to high-peak-power pulsed microwaves. Four male rhesus monkeys (Macaca mulatta) were trained on an operant task for food pellet reward to investigate the behavioral effects of very high-peak-power 5.62 GHz microwaves. The operant task required monkeys to pull one plastic lever on a variable interval schedule (VI-25 s) and then respond to color signals and pull a second lever to obtain food. The monkeys were conditioned to perform a color discrimination task using one of three colors displayed by a fiber-optic cable. A red signal was the discriminative stimulus for responding on the first lever. A response on the second lever when a green signal was presented (1 s duration) delivered a food pellet. If a response on the second lever was made in the presence of a white signal, a 30-s timeout occurred. While performing the behavioral task, the monkeys were exposed to microwave pulses produced by either a military radar (FPS-26A) operating at 5.62 GHz or the same radar coupled to a Stanford linear energy doubler (SLED) pulse-forming device (ITT-2972) that enhanced peak power by a factor of nine by adding a high power pulse to the radar pulse. The effects of both types of pulses were compared to sham exposure. Peak field power densities tested were 518, 1270, and 2520 W/cm2 for SLED pulses and 56, 128, and 277 W/cm2 for the radar pulses. The microwave pulses (radar or SLED) were delivered at 100 pps (2.8 microseconds radar pulse duration; approximately 50 ns SLED pulse duration) for 20 min and produced averaged whole-body SARs of 2, 4, or 6 W/kg. Compared to sham exposures, significant alterations of lever responding, reaction time, and earned food pellets occurred during microwave exposure at 4 and 6 W/kg but not at 2 W/kg. There were no differences between radar or SLED pulses in producing behavioral effects.     

Study of the beta -delayed neutron decay of 18N

The shortage of suitable liver donors for children has motivated the use of ABO-incompatible (ABO-I) grafts for transplantation in urgent situations. However, survival after ABO-I liver grafts has been reported at about 30% as compared with 80% in cases of ABO-identical or -compatible liver grafts. This difference has been attributed to antibody-mediated, hyperacute or chronic liver rejection, due to preformed ABO antibodies (alloantibodies). In this study, we report our results with ABO-I livers in children without alloantibodies at the time of transplantation. From January 1988 to June 1993, 143 OLT were performed in 122 children. Eight children received 8 ABO-I liver grafts. Of these, 7 patients were included in the study. All 7 were alloantibody free before OLT. Five children were spontaneously alloantibody free, while in 2 children, the plasma alloantibodies were eliminated before and after transplantation using intravenous infusion of specific blood group antigens of the donor blood group (soluble antigens). Immunosuppression consisted of a triple-drug treatment combining CsA, AZA, and steroids. The follow-up period was between 10 and 48 months. One child died from a surgical complication. Six children survived, but 1 died 10 months later from intestinal obstruction. There were no graft losses and no episodes of hyperacute or chronic rejection. The graft and patient survival rate was 71%. There was a 28% incidence of rejection, but all were mild (requiring steroid boluses only). Our results suggest that the absence of ABO alloantibodies at the time of and after transplantation can protect ABO-I liver grafts against antibody-mediated rejection, whether hyperacute or chronic, and that soluble antigens are effective in eliminating alloantibodies in children.     

Efficacy and safety of inhaled Salmeterol (Serevent) as maintenance therapy for asthma in Nairobi

An open study to assess the efficacy and safety of 50 micrograms inhaled Salmeterol (Serevent) administered twice daily as maintenance therapy for asthma was undertaken by the Respiratory Diseases Research Unit (RDRU) in Nairobi between August and October, 1992. Salmeterol (Hydroxynaphthoate) is a long acting selective beta-2-agonist. Seventy-three adult patients recruited at Kenyatta National Hospital underwent a two weeks treatment period during which they were assessed over three visits. At Visit 1, eligibility was confirmed, baseline lung function indices measured, the study drug introduced and all the previous medications withdrawn. After treatment for one week (Visit 2) and two weeks (Visit 3), lung function indices were measured again and subjective patients' and physicians' assessments of efficacy documented. Patients with obstructive ventilatory defect (OVD) at baseline had significant improvement in their lung function compared to those without at the end of the treatment period. A significant number of patients reported decreased number of nocturnal awakenings and increased tolerance to physical activity. Cough, headache and itchy throat were adverse events possibly related to the use of Salmeterol. The patients treated with Salmeterol gained improved control of their asthma symptoms. The drug offers a convenient dose schedule and we recommend its use for maintenance therapy for mild to moderate asthma.