Errors conference: executive summary.
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Emergency Medicine↗
Biomedical subjects
C Vincent
Publications and source records attributed to C Vincent.
Cochlear fossa enhancement at MR evaluation of vestibular Schwannoma: correlation with success at hearing-preservation surgery.
PURPOSE: To describe a sign in magnetic resonance (MR) imaging that could reflect the state of the cochlear nerve before hearing-preservation surgery in small vestibular schwannomas. MATERIALS AND METHODS: Thirty-one patients with serviceable hearing underwent 1.5-T MR imaging before hearing-preservation surgery. The presence of cochlear fossa enhancement on T1-weighted spin-echo images obtained after the administration of contrast material was compared with the results of hearing-preservation surgery. RESULTS: Cochlear fossa enhancement was present in 13 patients, and all of them had total hearing loss after surgery. There was no cochlear fossa enhancement in 18 patients; 15 maintained serviceable hearing after surgery, and three had postoperative hearing loss with no serviceable hearing (sensitivity, 81%; specificity, 100%). CONCLUSION: Cochlear fossa enhancement on T1-weighted spin-echo images seems to be a reliable sign for analyzing the state of the cochlear nerve. The absence of cochlear fossa enhancement could become an additional criterion for selecting the surgical approach in vestibular schwannomas.
Adult↗
[Utilization of lifting equipment and slings in occupational therapy].
The occupational therapist is frequently involved in the allocation process of lifting devices for clients with severe physical disabilities who are living in the community. The aim of this paper is to introduce a conceptual framework to help therapists prescribe lifting devices, including the slings. First, factors influencing the decision to prescribe such an aid are analysed based on the concepts of the Canadian Model of Occupational Performance (Canadian Association of Occupational Therapists, 1997). When working with clients toward maximizing their transfer skills, occupational therapists will take into account different aspects such as the characteristics of the client, the environment and the equipment, as well as the time allocated to complete the activity. Secondly, the notion of the work situation outlined by an organization specializing in work safety measures is used as a guide for transfer evaluation. From this viewpoint, the introduction of the lifting device occurs along a continuum of progressive loss of independence and is determined by degrees of personal independence, human assistance as well as technical assistance required to perform transfers. Finally, advantages and disadvantages of using lifting devices in a home setting are presented as a conclusion to the study.
Persons with Disabilities↗
Circadian activity of Lygus lineolaris (Hemiptera: Miridae) and effectiveness of sampling techniques in strawberry fields.
Mobility and distribution of adult tarnished plant bug, Lygus lineolaris (Palisot de Beauvois), was studied on a day-neutral strawberry cultivar ('Selva') in 1991 and 1992 at L'Acadie, Quebec, Canada. On cage-covered plants, individuals were located mainly on reproductive parts. Study of the flight activity with sticky posts revealed that most captures were obtained < 1 m from ground level and that the time of the day at which the maximum counts occur varied among seasons. Three pest-sampling methods (white sticky trap, tapping of flower clusters, and D-Vac) were evaluated over continuous 24-h periods. Maximum captures of adults with white sticky traps were made at midday (1000-1400 hours), whereas the two other methods proved more effective at the beginning (0600-0800 hours) or the end of the day (2000-2200 hours) or during night time. For nymphs, maximum catches were obtained during the day with tapping and D-Vac; white sticky traps were ineffective. Because the D-Vac captures individuals present on all parts of the plant, these counts were used to monitor the effectiveness of the two other sampling techniques. The data suggest that tapping flower clusters throughout the day is a very effective sampling method to estimate nymphal tarnished plant bug populations in strawberries. However, sampling of populations with a high proportion of adults should take into account the bias caused by their flight activity, and sampling should be conducted early in the morning or at the end of the day.
Animals↗
[Prosthetic rehabilitation of unilateral anakusis. Study with stereoaudiometry].
We studied the clinical and stereoaudiometric results in two patients with unilateral anakusis who were rehabilitated with a bone-transmission prosthesis (B.A.H.A.) on the deaf side. Clinically, both patients improved considerably, recovering their capacity to communicate, particularly in a noisy environment. Sound localization tests demonstrated that the sound source was not precisely localized in space. Inversely, the spatial discrimination tests and the multidirectional tests showed an important improvement in comprehension of speech, particularly in the dead space of the defective hemifield. This recovery was certainly related to improved perception of high frequencies via intracranial transmission enabled by the prosthesis.
Audiometry↗
Perinatally acquired human immunodeficiency virus infection in infants: updated guidelines for prevention, diagnosis, and initiation of treatment.
Perinatally acquired human immunodeficiency virus (HIV) infection can be prevented through education and, for women with HIV and their babies, administration of chemoprophylaxis during the perinatal period. When perinatally acquired HIV infection occurs, early intervention can promote the quality and duration of the infant's life. This report updates and consolidates current recommendations related to the prevention of perinatally acquired HIV infection, as well as recommendations for the management of perinatally exposed and infected infants through the first year of life.
Adult↗
Combination therapy with efavirenz, nelfinavir, and nucleoside reverse-transcriptase inhibitors in children infected with human immunodeficiency virus type 1. Pediatric AIDS Clinical Trials Group 382 Team.
BACKGROUND: Consistent long-term viral suppression has been difficult to achieve in children with human immunodeficiency virus type 1 (HIV-1) infection. We tested the safety and antiviral efficacy of a novel combination consisting of efavirenz, nelfinavir, and one or more nucleoside reverse-transcriptase inhibitors in 57 children previously treated with only nucleoside reverse-transcriptase inhibitors. METHODS: The children were monitored for 48 weeks after the initiation of therapy. We assessed plasma concentrations of efavirenz and nelfinavir, plasma HIV-1 RNA levels, and lymphocyte subpopulations. RESULTS: At base line, the 57 HIV-1-infected children (age range, 3.8 to 16.8 years) had a median of 699 CD4 cells per cubic millimeter and 10,000 copies of HIV-1 RNA per milliliter of plasma. The most common treatment-related effects of at least moderate severity were rash (in 30 percent of children), diarrhea (in 18 percent), neutropenia (in 12 percent), and biochemical abnormalities (in 12 percent). Serious side effects were uncommon. The mean values for the area under the curve for efavirenz and nelfinavir corresponded to expected values. In an intention-to-treat analysis, 76 percent of children had plasma HIV-1 RNA levels of less than 400 copies per milliliter after 48 weeks of therapy and 63 percent had levels of less than 50 copies per milliliter. A high plasma HIV-1 RNA level at base line significantly decreased the likelihood that plasma levels of HIV-1 RNA would become undetectable during treatment. CONCLUSIONS: In HIV-1-infected children who were previously treated with nucleoside reverse-transcriptase inhibitors, the combination of efavirenz, nelfinavir, and nucleoside reverse-transcriptase inhibitors was generally well tolerated and had a potent and sustained antiviral effect.
Adolescent↗
Control of organ asymmetry in flowers of Antirrhinum.
Organ asymmetry is thought to have evolved many times independently in plants. In Antirrhinum, asymmetry of the flower and its component organs requires cyc and dich gene activity. We show that, like cyc, the dich gene encodes a product belonging to the TCP family of DNA-binding proteins that is first expressed in the dorsal domain of early floral meristems. However, whereas cyc continues to be expressed throughout dorsal regions, expression of dich eventually becomes restricted to the most dorsal half of each dorsal petal. This correlates with the effects of dich mutations and ectopic cyc expression on petal shape, providing an indication that plant organ asymmetry can reflect subdomains of gene activity. Taken together, the results indicate that plant organ asymmetry can arise through a series of steps during which early asymmetry in the developing meristem is progressively built upon.
Amino Acid Sequence↗
An epigenetic mutation responsible for natural variation in floral symmetry.
Although there have been many molecular studies of morphological mutants generated in the laboratory, it is unclear how these are related to mutants in natural populations, where the constraints of natural selection and breeding structure are quite different. Here we characterize a naturally occurring mutant of Linaria vulgaris, originally described more than 250 years ago by Linnaeus, in which the fundamental symmetry of the flower is changed from bilateral to radial. We show that the mutant carries a defect in Lcyc, a homologue of the cycloidea gene which controls dorsoventral asymmetry in Antirrhinum. The Lcyc gene is extensively methylated and transcriptionally silent in the mutant. This modification is heritable and co-segregates with the mutant phenotype. Occasionally the mutant reverts phenotypically during somatic development, correlating with demethylation of Lcyc and restoration of gene expression. It is surprising that the first natural morphological mutant to be characterized should trace to methylation, given the rarity of this mutational mechanism in the laboratory. This indicates that epigenetic mutations may play a more significant role in evolution than has hitherto been suspected.
Amino Acid Sequence↗
On the binding of ATP to the autophosphorylating protein, Ptk, of the bacterium Acinetobacter johnsonii.
The autophosphorylating protein, Ptk, of the bacterium Acinetobacter johnsonii was overproduced, purified to homogeneity and assayed for ATP binding by using the nucleotide analog 5'-p-fluorosulfonylbenzoyl adenosine. The ATP binding site of this bacterial autophosphorylating protein was found to be different from that generally used by eukaryotic protein kinases. It consists of two amino acid sequences that closely resemble the Walker motifs A and B. This observation was confirmed by site-directed mutagenesis experiments which showed, in addition, that the ATP molecule bound to these motifs is effectively employed by the bacterial protein to autophosphorylate on tyrosine. It is concluded that even though the overall autophosphorylation reaction is similar in eukaryotic and prokaryotic proteins, the mechanism involved is likely different.
Acinetobacter↗
The epitopes targeted by the rheumatoid arthritis-associated antifilaggrin autoantibodies are posttranslationally generated on various sites of (pro)filaggrin by deimination of arginine residues.
Antifilaggrin autoantibodies (AFA) are a population of IgG autoantibodies associated to rheumatoid arthritis (RA), which includes the so-called "antikeratin" Abs and antiperinuclear factor. AFA are the most specific serological markers of RA. We previously showed that they recognize human epidermal filaggrin and other profilaggrin-related proteins of various epithelial tissues. Here, we report further characterization of the protein Ags and epitopes targeted by AFA. All the Ags that exhibit numerous neutral/ acidic isoelectric variants were immunochemically demonstrated to be deiminated proteins. In vitro deimination of a recombinant human filaggrin by a peptidylarginine deiminase generated AFA epitopes on the protein. Moreover, two of three filaggrin-derived synthetic peptides with a citrulline in the central position were specifically and widely recognized by AFA affinity-purified from a series of RA sera. These results indicate that citrulline residues are constitutive of the AFA epitopes, but only in the context of specific amino acid sequences of filaggrin. In competition experiments, the two peptides abolished the AFA reactivity of RA sera, showing that they present major AFA epitopes. These data should help in the identification of a putative deiminated AFA-inducing or cross-reactive articular autoantigen and provide new insights into the pathogenesis of RA. They could also open the way toward specific immunosuppressive and/or preventive therapy of RA.
Amino Acid Sequence↗
The monoclonal antibody DCGM4 recognizes Langerin, a protein specific of Langerhans cells, and is rapidly internalized from the cell surface.
We generated monoclonal antibody (mAb) DCGM4 by immunization with human dendritic cells (DC) from CD34+ progenitors cultured with granulocyte-macrophage colony-stimulating factor and TNF-alpha. mAb DCGM4 was selected for its reactivity with a cell surface epitope present only on a subset of DC. Reactivity was strongly enhanced by the Langerhans cell (LC) differentiation factor TGF-beta and down-regulated by CD40 ligation. mAb DCGM4 selectively stained LC, hence we propose that the antigen be termed Langerin. mAb DCGM4 also stained intracytoplasmically, but neither colocalized with MHC class II nor with lysosomal LAMP-1 markers. Notably, mAb DCGM4 was rapidly internalized at 37 degrees C, but did not gain access to MHC class II compartments. Finally, Langerin was immunoprecipitated as a 40-kDa protein with a pI of 5.2 - 5.5. mAb DCGM4 will be useful to further characterize Langerin, an LC-restricted molecule involved in routing of cell surface material in immature DC.
Antibodies, Monoclonal↗
Evaluation of alpha-fetoprotein assay in ascitic fluid for the diagnosis of hepatocellular carcinoma.
Ascites and hepatocellular carcinoma are frequently associated. We evaluated the usefulness of alpha-fetoprotein assay in ascitic fluid versus the serum assay, for the diagnosis of hepatocellular carcinoma, in 125 patients with peritoneal effusions (31 patients with hepatocellular carcinoma, 14 with extra-hepatic malignancies and 80 with a benign effusion). Albumin and total protein were also assayed and cytological analysis of the ascitic fluid performed. Alpha-fetoprotein appeared to be lower in ascitic fluid than in serum. For a diagnostic specificity of 95%, the thresholds were 18.9 microg/l in serum and 4 microg/l in ascitic fluid and the diagnostic sensitivity of alpha-fetoprotein was identical in serum and ascitic fluid (67.7%). Various ratios between alpha-fetoprotein and albumin or total protein did not enhance the diagnostic performance. Thus alpha-fetoprotein concentration in ascitic fluid reflected the serum concentration and proved to be of similar value for the diagnosis of hepatocellular carcinoma, providing that the appropriate thresholds are considered.
Adult↗
Anorectal pain and irritation: anal fissure, levator syndrome, proctalgia fugax, and pruritus ani.
Anal fissures, proctalgia fugax, levator ani syndrome, and pruritus ani are common causes of anorectal pain and irritation. The clinician who obtains a thorough history and performs a complete examination can accurately diagnose these disorders. Ancillary tests seldom are helpful and rarely are necessary. Most patients suffering from these conditions readily respond to conservative therapy provided in the primary care practitioner's office.
Anus Diseases↗
Evaluation of seven tumour markers in pleural fluid for the diagnosis of malignant effusions.
Carcinoembryonic antigen (CEA), carbohydrate antigens 15-3, 19-9 and 72-4 (CA 15-3, CA 19-9 and CA 72-4), cytokeratin 19 fragments (CYFRA 21-1), neuron-specific enolase (NSE) and squamous cell carcinoma antigen (SCC) were evaluated in pleural fluid for the diagnosis of malignant effusions. With a specificity of 99%, determined in a series of 121 benign effusions, the best individual diagnostic sensitivities in the whole series of 215 malignant effusions or in the subgroup of adenocarcinomas were observed with CEA, CA 15-3 and CA 72-4. As expected, a high sensitivity was obtained with SCC in squamous cell carcinomas and with NSE in small-cell lung carcinomas. CYFRA and/or CA 15-3 were frequently increased in mesotheliomas. Discriminant analysis showed that the optimal combination for diagnosis of non-lymphomatous malignant effusions was CEA + CA 15-3 + CYFRA + NSE: sensitivity of 94.4% with an overall specificity of 95%. In malignant effusions with a negative cytology, 83.9% were diagnosed using this association. The association CYFRA + NSE + SCC was able to discriminate adenocarcinomas from small-cell lung cancers. Regarding their sensitivity and their complementarity, CEA, CA 15-3, CYFRA 21-1, NSE and SCC appear to be very useful to improve the diagnosis of malignant pleural effusions.
Adenocarcinoma↗
Bullous pemphigoid associated with chronic B-cell lymphatic leukaemia: the anti-230-kDa autoantibody is not synthesized by leukaemic cells.
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Aged↗
Presence of circulating abnormal CD34+ progenitors in adult Langerhans cell histiocytosis.
Langerhans cell histiocytosis (LCH) is related to the proliferation of cells, which are similar to Langerhans cells (LC) but possess many abnormal characteristics. Lesions are widespread and this fact suggests that LCH cells or their precursors are present in the blood of patients. In five adult patients, we have isolated and cultured CD34+ blood progenitors of dendritic cells. We studied their phenotype by flow cytometry and their functional properties in mixed culture with heterologous lymphocytes and with autologous lymphocytes in the presence of tri-nitro-phenyl antigen (TNP). The amount of CD34+ precursors was dramatically higher than controls but a high mortality occurred during the in vitro differentiation. The phenotype of surviving cells was similar to LC phenotype (CD1a+, CD83+, Lag+) but some of them expressed CD2. These cells were able to induce T cell proliferation in mixed culture. They could not initiate primary response to TNP, except in a patient treated with thalidomide. In our hands, these CD34+ cells may be precursors of LCH cells.
Adult↗
An evaluation of adverse incident reporting.
To examine the reliability of adverse incident-reporting systems we carried out a retrospective review of the mother and baby case notes from a series of 250 deliveries in each of two London obstetric units. Notes were screened for the presence of adverse incidents defined by lists of incidents to be reported in accordance with unit protocols. We assessed the percentage of adverse incidents reported by staff to the maternity risk manager at each unit; the percentage of incidents detected by each risk manager, but not reported; and the percentage of incidents identified only by retrospective case note review. A total of 196 adverse incidents was identified from the 500 deliveries. Staff reported 23% of these and the risk managers identified a further 22%. The remaining 55% of incidents were identified only by retrospective case-note review and not known to the risk manager. Staff reported about half the serious incidents (48%), but comparatively few of the moderately serious (24%) or minor ones (15%). The risk managers identified an additional 16% of serious incidents that staff did not report. Drug errors were analysed separately; only two were known to the risk managers and a further 44 were found by case-note review. Incident-reporting systems may produce much potentially valuable information, but seriously underestimate the true level of reportable incidents. Where one risk manager covers an entire trust, rather than a single unit, reporting rates are likely to be very much lower than in the present study. Greater clarity is needed regarding the definition of reportable incidents (including drug errors). Staff should receive continuing education about the purposes and aims of clinical risk management and incident reporting and consideration should be given to designating specific members of staff with responsibility for reporting.
Communication↗