Hepatitis C virus liver disease in women infected with contaminated anti-D immunoglobulin

The just-in-time (JIT) model originated in the manufacturing industry as a way to manage parts inventories process so that specific components could be made available at the appropriate times (that is, "just in time"). This JIT model can be applied to the management of clinical information inventories, so that clinicians can have more immediate access to the most current and relevant information at the time they most need it--when making clinical care decisions. The authors discuss traditional modes of managing clinical information, and then describe how a new, JIT model may be developed and implemented. They describe three modes of clinician-information interactions that a JIT model might employ, the scope of information that may be made available in a JIT model (global information or local, case-specific information), and the challenges posed by the implementation of such an information-access model. Finally, they discuss how JIT information access may change how physicians practice medicine, various ways JIT information may be delivered, and concerns about the trustworthiness of electronically published and accessed information resources.     

Characterisation of urea-denatured states of an immunoglobulin superfamily domain by heteronuclear NMR

The structural and dynamic properties of an immunoglobulin superfamily domain (IgSF), Ig 18', have been characterised by NMR at 285 K, in the presence of 4.2 M and 6.0 M urea, respectively. Analysis of chemical shift deviations, 3JHNHalpha coupling constants, sequential NOE pattern, and 15N relaxation data reveals that although the two urea-denatured states are highly disordered, some local turn-like residual structures do exist. Moreover, some distinct differences between the properties of the two denatured states are observed. In 4.2 M urea-denatured Ig 18', regions 80-83 and 86-92 adopt turn-like conformations, furthermore, region 84-93 is involved in slow exchange processes that occur on a micro- to millisecond time-scale. In the 6.0 M urea-denatured state, these turn-like conformations are less occupied, and chemical exchange processes in region 84-93 are largely reduced. In contrast, region 32-36 has persistent turn-like structures in both urea-denatured states. Some correlation between the spectral density function at 0 frequency, Jeff(0), for the urea-denatured states and the secondary structure elements of the folded state have been observed. Except for the terminal regions, residues corresponding to beta-strands have higher Jeff(0) values compared to residues corresponding to loops. The characterisation and comparison of the two urea-denatured states highlight residues that possess properties that may be crucial for the initiation of folding of this domain.     

Dwindling supplies of anti-D

We report on two patients with truncal rigidity and agoraphobia. The fear of crossing open places had been judged as psychogenic in both cases. The detection of positive GAD-antibodies led to our final diagnosis. Treatment with liquorphoresis and clonazepam or diazepam alone resulted in a prompt amelioration of the rigidity and, to a lesser extent, of the agoraphobia as well. The stiff-man syndrome has neurological and psychological aspects and shows one more facet of the syndrome of agoraphobia first described by Westphal.     

Effects of a colostrum replacement product derived from serum on immunoglobulin G absorption by calves

Calves are born hypogammaglobulinemic and rely on immunoglobulin (Ig) from colostrum to obtain passive immunity. Previous research has indicated that colostrum supplements derived from milk are less effective than is maternal colostrum in providing adequate IgG to neonatal calves. Our objective was to determine the absorption of IgG by newborn calves fed a USDA food-grade colostrum supplement derived from bovine serum or fed pooled maternal colostrum. Holstein calves (n = 20; 10 bulls) were removed from the dam within 1 h of birth and were housed in individual stalls for the 24-h study. Calves were fed 2 L of colostrum or colostrum replacer at 1.5 and 13.5 h (+/- 0.1 h). Calves were blocked by colostrum pool, and replacer was fed to provide equal intakes of IgG within blocks. Jugular blood was collected at 1 and 24 h (+/- 0.1 h) for analysis of IgG by radial immunodiffusion. At 24 h, calves were injected with 1.5 ml of Evans blue dye to estimate plasma volume. Mean plasma IgG at 24 h of age was 7.3 +/- 0.4 g/L and was affected by an interaction of block and treatment. Apparent efficiency of IgG absorption of 24 h was reduced when 750 g of the colostrum replacement product were fed but was increased when 266 g of colostrum replacement product were fed. Mean plasma volume was unaffected by treatment and was 3.5 +/- 0.2 L or 9.1% of BW. These data indicate that efficiency of IgG absorption from the colostrum replacement product may be affected by amount of material fed. Proteins other than IgG in the colostrum replacement product might have reduced the efficiency of IgG absorption.     

Characterisation of functionally graded and VC/steel surface alloyed composites produced using powder metallurgy

Abstract

In this study, low carbon steel specimens with surface alloyed composites were produced by means of powder metallurgy. Vanadium carbide, graphite (1·2 wt-%) and Fe were used for the surface alloyed composite, while Fe and graphite (0·2 wt-%) were used for the low carbon steel side. The powder mixtures were compacted together in the same mould. On the surface alloyed side the vanadium carbide content was changed from 5 to 25 wt-%. Microstructural investigations including EDX and X-ray, hardness measurement and abrasive wear tests were performed. The results showed that V₈C₇ formed in the alloyed surface and carbon diffusion from the alloyed surface to the parent metal created a functionally graded material. The hardness values decreased towards the parent metal. Wear resistance increased as the vanadium carbide increased in the surface alloyed composite. Thus, a functionally graded steel having a surface composite that is resistant to abrasive wear can be obtained via the powder metallurgy route.     

Stimulating effect of xanthene dyes on immunoglobulin produced in vitro by rat spleen lymphocytes

The effects of food additives on immunoglobulin produced in rat splenic lymphocytes were examined. The xanthene dye, Rose Bengal, enhanced IgE production, while inhibiting the production of IgG and IgM, at 50 microM. Among the xanthene dyes, Rose Bengal having 4 iodine and 4 chlorine atoms exerted the highest Ig production-regulating activity in splenocytes, and dihalogenated fluorescein, a diiodo compound, exerted similar activity, while the dichloro and dibromo compounds did not. These results suggest that halogen atoms, especially the iodine atom, in xanthene dyes play an important role in regulation of Ig production.     

An audit of anti-D sensitisation in Yorkshire

We present herein the case of a 59-year-old man in whom a Dumon stent, inserted as treatment for stenosis of the left main bronchus, caused a left bronchopericardial fistula. The patient initially presented with severe dyspnea caused by main bronchial stenosis of unknown origin for which a Dumon stent was inserted at a local hospital. The Dumon stent migrated to the endobronchus through the stenosis of the left main bronchus a few days later, and his dyspnea remained unresolved. He was subsequently referred to our department 6 months later, where a left pneumonectomy under supportive cardiopulmonary bypass through the femoral artery and vein was performed, and a postoperative pathological diagnosis of bronchial leiomyosarcoma was made. For this rare group of malignant tumors, early diagnosis permits complete surgical resection of the mass and offers the best prognosis. Excision of the tumor should be performed under cardiopulmonary bypass through the femoral vessels when a risk of sudden rupture of the pulmonary artery or vein exists for any reason.     

The use of anti-D to improve post-transfusion platelet response: a randomized trial

Patients undergoing induction chemotherapy for acute leukaemia often become refractory to platelet transfusions. Increased clearance of transfused platelets due to alloimmune destruction has been identified as one of the primary mechanisms contributing to this refractory state. We performed a double-blind randomized trial to determine whether the administration of anti-D to Rh-positive individuals could prevent the refractory state and improve post-transfusion platelet response. Rh-positive patients with acute leukaemia undergoing induction chemotherapy and requiring platelet transfusions were allocated to weekly intravenous anti-D (20 micrograms/kg) or placebo. Platelets and red cell concentrates were administered according to standardized transfusion guidelines. Outcome measures included platelet transfusion utilization, red cell utilization, platelet recovery 18-24 h post-infusion, and the percentage of patients refractory to platelet transfusion. There were 43 patients studied: 21 received anti-D and 22 saline placebo. The mean number of platelet concentrates required per day of observation was 0.59 (SD 0.22) in the anti-D group and 0.61 (SD 0.22) in the placebo group, P = 0.86. No difference was detected between groups in terms of platelet recovery post-infusion, refractoriness to platelet transfusion or frequency of infection (P = 0.97). Red cell concentrate utilization was significantly increased in the anti-D group compared to the placebo group, 0.58 units per day versus 0.37 units per day respectively, P = 0.005. We conclude that the use of anti-D did not improve post-transfusion platelet response in Rh positive patients with acute leukaemia, but did result in an increased need for red cell transfusion.     

Treatment of chronic autoimmune thrombocytopenic purpura with monoclonal anti-D

BACKGROUND: The platelet count increases transiently after treatment with polyclonal anti-D in about 50 percent of D+ patients with autoimmune thrombocytopenic purpura (AITP). The effect is usually attributed to macrophage Fc-receptor blockade by antibody-coated red cells. As polyclonal anti-D is in limited supply, prospective testing was performed on a monoclonal anti-D (MoAb D) in such patients. STUDY DESIGN AND METHODS: Seven D+ patients with chronic AITP received MoAb D intravenously at doses of 47 to 95 microg per kg of body weight. Response was assessed by studying platelet count increment. Hemolysis and red cell-bound MoAb D were measured before and after MoAb D administration. RESULTS: MoAb D red cell binding was demonstrated in all patients at a ratio higher than that observed in AITP patients successfully treated with polyclonal anti-D. However, little or no platelet count increment was observed in six patients, while a transient response was observed in only one (platelet count 97 x 10(9)/L before MoAb D infusion and 163 x 10(9)/L 4 days later). Furthermore, because five patients showed signs of hemolysis and two became anemic, higher doses of MoAb D should be used only with caution in patients with AITP. CONCLUSION: The MoAb D used in this study cannot be proposed as an alternative treatment for patients with AITP.     

The effect of chromatographically pure sample of adenosine 5''-tetraphosphate on sheep and rabbit blood platelets

1. The commercially available trisodium salt of adenosine 5'-tetraphosphate (ATetraP) (Sigma) was found to be contaminated with ATP, ADP and AMP, and therefore unsuitable for use in platelet studies. 2. The more stable barium salt of ATetraP was converted to the ammonium salt and found to be chromatographically homogeneous. This sample was tested for its influence on sheep blood platelets in citrated-rich plasma by the photometric method. 3. The ammonium salt of ATetraP (5-105 mumol.1(-1)) induced platelet aggregation which showed no tendency towards disaggregation. 4. The log dose-response lines for ATetraP and for adenosine diphosphate were parallel. On a molar basis, the tetraphosphate and only 1.5% of the aggregating activity of ADP. 5. The initial rate of aggregation induced by the tetraphosphate was inhibited by adenosine 5'-monophosphate analogues which are selective ADP-antagonists. These compounds also dispersed aggregates produced by ATetraP. 6. Platelets made refractory to ADP were also refractory to ATetraP. 7. Like ADP, ATetraP induced the change in shape of rabbit platelets and in this respect had only 3.4% the activity of ADP. 8. It is concluded that ATetraP per se can induced platelet aggregation and platelet shape change, and appears to exert its effect at the same site on the platelet surface as does ADP.     

Characterisation of a novel lyssavirus isolated from Pteropid bats in Australia

A novel lyssavirus isolated from Pteropid bats in Australia (Australian Bat Lyssavirus, ABLV) has been characterised using gene sequence analyses, electron microscopy and a panel of monoclonal antibodies. Electron microscopic examination of Pteropid bat and mouse brain material as well as virus isolated from tissue culture medium, showed the presence of bullet-shaped rhabdovirus particles and structures characteristic of lyssavirus. Analysis using nucleocapsid (N) specific monoclonal antibodies, showed a strong relationship between this new lyssavirus and serotype 1 rabies. The nucleotide sequence of the prototype strain of ABLV was determined from the initiator methionine codon for the nucleocapsid protein (N protein) to the amino terminus of the polymerase gene (L protein), a distance of 5344 nucleotides. Comparisons of the deduced N, phosphoprotein (P), matrix protein (M), and glycoprotein (G) proteins showed that ABLV was more closely related to serotype 1 classic rabies viruses than to other members of the Lyssavirus genus. The percent relatedness of the ABLV proteins when compared to the cognate proteins of PV (Pasteur vaccine strain) rabies was 92, 75, 87 and 75% for the N, P, M and G proteins, respectively. Phylogenetic studies of N protein sequences showed clearly that ABLV is an unrecognised member of the Lyssavirus genus and represents a new genotype, genotype 7.     

Characterisation of a novel AGE-compound derived from lysine and 3-deoxyglucosone

Dicarbonyl compounds are supposed to be reactive intermediates in the non-enzymatic glycation of proteins. A process that eventually could lead to the development of late diabetic complications. Glyoxal lysine dimer (GOLD) and methylglyoxal lysine dimer (MOLD) have previously been described as such reactive dicarbonyls. Here a new compound 3-deoxyglucosone lysine dimer (DOLD), a cross-link resulting from the reaction between hippuryl-lysine and 3-deoxyglucosone, has been isolated by HPLC and the structure determined by mass spectrometry and NMR.