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Biomedical subjects

J Duchateau

Publications and source records attributed to J Duchateau.

At least 73 records · Page 4Linked to original sources
PubMed1994

Anaphylatoxin C5a production during short-term submaximal dynamic exercise in man.

We studied the effects of short-term submaximal exercise on the plasma levels of myeloperoxidase ([MPO]) and C5a anaphylatoxin ([C5a]), taken as specific markers of polymorphonuclear neutrophil (PMN) and complement activation, respectively. Eleven young, healthy male volunteers were subjected to a constant-load concentric exercise on a cycle ergometer (20 min at 80% maximal oxygen uptake). Mean resting MPO and C5a concentrations were 437 +/- 113 and 0.47 +/- 0.21 ng/ml, respectively. During exercise, [MPO] and [C5a] increased significantly (p < 0.001) towards respective peak values of 649 +/- 131 and 1.3 +/- 0.6 ng/ml. A rapid decrease of both [MPO] and [C5a] was observed during recovery. The similar time course of [MPO] and [C5a] changes and the highly significant relationship between these two variables (r = 0.651; p < 0.001) argues for the possible involvement of the complement anaphylatoxin C5a in the process of PMN degranulation. During exercise, the number of circulating PMN increased (+80%; p < 0.001) and remained practically unchanged up to 20 minutes of recovery. As [MPO] and PMN count were not significantly related (r = 0.2; p < 0.1), we concluded that the activation of PMN was independent of their mobilization.

Adult↗
PubMed1994

Biological risk factors for fatal protein energy malnutrition in hospitalized children in Zaire.

Biological markers were used in an attempt to predict mortality in children admitted to the hospital in Kivu, Zaire, for protein energy malnutrition. Data for 39 children who died (16.4%) showed significantly lower levels of albumin (1.61 vs. 2.53 g/dl; p < 0.001), transferrin (82.1 vs. 167.7 mg/dl; p < 0.001), and transthyretin (6.49 vs. 9.87 mg/dl; p < 0.001), but not or retinol-binding protein, than for the 199 survivors. Since albumin and transferrin were correlated, a Cox model was used to see whether albumin or transferrin has a significant predictive value independent of transthyretin. The relative risk predicted by each indicator was of the same order of magnitude, approximately 4. We conclude that specific biological markers help to discriminate among hospitalized subjects at risk and to identify those in need of more intensive nutritional support to prevent early death.

Biomarkers↗
PubMed1994

Twitch analysis as an approach to motor unit activation during electrical stimulation.

The mechanical twitch in response to increasing electrical stimulus intensity, delivered both over the motor point and motor nerve, was recorded in the first dorsal interosseous (FDI) and the adductor pollicis (AP), and only over the motor point in the soleus (Sol), lateral (LG), and medial (MG) gastrocnemius muscles of human subjects. The relationship between intensity of electrical stimulation (ES) and twitch torque showed a positive linear regression in all muscles. In the FDI and AP the relationship was not significantly different when ES was applied at the motor point or over the motor nerve. At small intensities of activation, ES induced larger twitch torques in the MG and LG, which contain a roughly equal proportion of slow and fast motor units (MUs) compared to the Sol, which is composed mainly of slow type fibres. Moreover, the relationship between ES intensity and twitch time-to-peak is best fitted in all muscles by a power curve that shows a greater twitch time-to-peak range in its initial part for muscles containing a larger proportion of fast MUs (LG, MG) than for muscles mainly composed of slow MUs (Sol). In conclusion, these results induced by ES at the motor point and/or over the motor nerve confirm the concept of a reversed sequence of MU activation, as compared to voluntary contractions, and document this viewpoint in muscles of different function and composition. The reversed sequence of MU activation is more clearly evident during motor point ES.

Adult↗
PubMed1994

Complement, leukocytes, and leukocyte elastase in full-term neonates undergoing cardiac operation.

In 13 neonates undergoing cardiac operations for congenital cardiac defects, complement, leukocytes, and leukocyte elastase were studied during and after cardiopulmonary bypass. All but two neonates received prostaglandin E1 before the operation. The C3d/C3 ratio rose significantly during cardiopulmonary bypass from 0.86 +/- 0.55 to 1.40 +/- 0.56 (mean +/- standard deviation; p < 0.0001). Abnormally elevated C5a levels (18.6 +/- 7.3 micrograms/L) were measured at the end of cardiopulmonary bypass. C4 was not overtly consumed during the procedure. Leukocytes fell from a preoperative value of 10.06 +/- 3.15 x 10(9)/L to 3.21 +/- 0.64 x 10(9)/L after beginning of cardiopulmonary bypass (p < 0.0001) and rose at the end of the procedure from 2.33 +/- 0.67 x 10(9)/L to 7.19 +/- 1.84 x 10(9)/L, after protamine administration (p < 0.0001). Neutrophils fell from a preoperative value of 5.14 +/- 1.18 x 10(9)/L to 1.46 +/- 0.35 x 10(9)/L after beginning of cardiopulmonary bypass and rose at the end of extracorporeal circulation from 1.00 +/- 0.31 x 10(9)/L to 4.10 +/- 1.18 x 10(9)/L, after protamine administration (p < 0.005). Elastase release occurred in all neonates during cardiopulmonary bypass and averaged 331.5 +/- 175.7 micrograms/L. Complement activation and leukocyte stimulation did not correlate with postoperative complications or outcome. This study demonstrates complement activation and leukocyte stimulation in neonates undergoing cardiac operation.

Alprostadil↗
PubMed1993

A different profile of epitopic dominance in the immunoglobulin G response to bovine betalactoglobulin in lung cancer.

BACKGROUND: The authors previously documented a quantitative defect in the immunoglobulin G (IgG) response toward bovine betalactoglobulin (BLG), the major cow's milk antigen, and antigen p1 of the house dust mite, Dermatophagoides pteronyssinus (Der p1), in patients with lung cancer. In the Der p1 model, the authors documented at the IgG level an epitope specificity that differed between patients with lung cancer (preferential specificity for cryptic epitopes) and healthy control subjects and patients with mite allergy. The current study investigated whether this varying specificity might be extended to the IgG response toward BLG. METHODS: The authors compared the IgG binding to native BLG (nBLG) and its products of pepsin hydrolysis (dBLG) in a solid-phase enzyme-linked immunosorbent assay (ELISA) using peroxidase-conjugated protein A in 120 patients with lung cancer, 52 patients with chronic obstructive pulmonary disease (COPD) who were closely matched for age, sex, and smoking habits with the patients with cancer, and 120 healthy control subjects (blood donors). RESULTS: Expressing the ratio between optical densities observed for dBLG and nBLG, respectively, the authors documented two groups: patient with lung cancer with higher levels of binding on dBLG (mean ratio +/- SD, 1.66 +/- 0.26) and healthy control subjects and patients with COPD with similar levels of retention for dBLG and nBLG (mean ratios +/- SD, 1.00 +/- 0.10 and 1.01 +/- 0.07, respectively). Influence of population characteristics could be excluded. The histologic type of cancer and its extent had no influence on the defined ratio. CONCLUSION: These results suggest a preferential recognition of epitopes unmasked by pepsin hydrolysis (cryptic epitopes?) by lung cancer IgG, contrasting with the preferential specificity of IgG from healthy control subjects and patients with COPD for structural epitopes unaffected by the proteolysis. These findings are similar to those observed previously with Der p1 and indicate a varying, and possibly specific, profile of epitopic dominance in the IgG response to antigens naturally presented at the mucosal level in patients with lung carcinoma, a model of mucosal cancer.

Adult↗
PubMed1993

Antibody affinity disturbance in the immunoglobulin immune response to mucosal antigenic stimulation in lung cancer. The Betalactoglobulin Model.

BACKGROUND: This study is a continuation of a recent study, in which a defect in the immunoglobulin G (IgG) response to some natural antigens (bovine betalactoglobulin [BLG] from cow's milk and antigen p1 from the house dust mite Dermatophagoïdes pteronyssinus), usually presented at the mucosal level, was documented in lung cancer patients. The present study further characterizes this difference in terms of antibody relative functional affinity in the BLG model. METHODS: Relative functional affinity was evaluated by solid-phase enzyme-linked immunosorbent assay in terms of the relationship between specific IgG retention, assessed with peroxidase-labeled protein A, and serial dilutions of IgG fractions isolated from 24 sera from lung cancer patients and 24 sera from healthy control subjects matched for their anti-BLG IgG antibody titers. The procedure was performed in the presence and absence of low concentrations of diethylamine, which was expected to prevent low-affinity antigen-antibody binding without affecting the binding of high-affinity antibodies. Anti-BLG IgG antibody affinity also was evaluated in 25 patients with early-stage lung cancer, before and after (5 +/- 1 week) complete surgical excision of the tumor. RESULTS: Results, expressed as the slope of the binding curves and their leftward shift induced by diethylamine, showed different antibody populations between the two groups. Control sera showed a heterogeneous population of anti-BLG IgG antibodies, including antibodies of higher (steeper slope) and lower (more gradual slope) functional affinity. Cancer sera exhibited a less heterogeneous population of anti-BLG IgG antibodies, mostly with lower functional affinity. No change was observed in anti-BLG IgG antibody affinity in the 25 lung cancer patients tested 5 +/- 1 week after complete surgical excision of the tumor. CONCLUSIONS: These results document a persistent qualitative immunologic disturbance in patients with lung cancer, regardless of the type and extent of tumor. The potential relationship between this observation and the development of lung cancer, however, is presently unknown.

Adult↗
PubMed1993

Behaviour of short and long latency reflexes in fatigued human muscles.

1. The human abductor pollicis brevis (APB) and first dorsal interosseus (FDI) were fatigued by sustained maximal voluntary contractions and, in the case of the APB also by electrically induced (30 Hz) contractions, until the loss of force reached 50% of control. The short latency or Hoffmann reflex (H reflex) and the long latency reflex (LLR) were evoked during weak voluntary contractions by the electrical stimulation of the median nerve at the wrist in control, during and after the fatigue experiments. 2. As compared to control, the normalized H reflex amplitude in the two fatigue modalities was found to have decreased by 30% without any significant change in the LLR. This finding and the observation that the LLR was enhanced by 46% in simultaneous recordings, in which the APB remained at rest during FDI fatigue, could be explained by a stronger descending fatigue-induced central drive which spreads to neighbouring non-fatigued muscles. 3. A comparison of the H reflex and the LLR behaviour during fatigue indicates that motoneurone activation threshold is not affected but that changes in peripheral drive are present, which possibly induce presynaptic inhibition of Ia afferents and/or inhibition of interneurones in the oligosynaptic pathways. Our observation of a rather slow time course for the H reflex decrease during fatigue supports the point of view that these inhibitions are activated by metabolic and/or chemical changes in the fatigued muscle. 4. It is concluded from the results of this study that muscle fatigue induces an enhanced descending supraspinal drive which compensates for a loss of excitation from the peripheral afferents on motoneurones.

Adult↗
PubMed1993

Complement activation during cardiopulmonary bypass in infants and children. Relation to postoperative multiple system organ failure.

Twenty-nine children 3 months to 17 years of age undergoing operations for congenital heart disease were included in this prospective study. Complement activation, activation of the plasma contact system, leukocytes, leukocyte elastase release, and C-reactive protein were studied during and after cardiopulmonary bypass for the first postoperative week and related to multiple system organ failure occurring in eight (27.5%) of the 29 children. During cardiopulmonary bypass complement activation via the alternative pathway as indicated by significant conversion of C3 (expressed by C3d/C3) and abnormally high C5a values at the end of cardiopulmonary bypass without consumption of C4 was shown in all children. At the end of cardiopulmonary bypass, C3 conversion was significantly higher in the eight patients with multiple system organ failure than in the others (p < 0.05), whereas no difference in C5a level was shown. All children had a significant increase in leukocyte count directly after protamine administration (p < 0.0001) and elastase release during cardiopulmonary bypass that was significantly higher in patients with multiple system organ failure than in those without (p < 0.05). Consumption of prekallikrein as an indicator of activation of the Hageman system was not detectable during cardiopulmonary bypass in any child. After cardiopulmonary bypass, in patients without multiple system organ failure, C3d/C3 decreased and reached preoperative values within the first postoperative week, whereas, in patients with multiple system organ failure, C3d/C3 increased further, reaching a maximal value on the third postoperative day. In comparison with patients without multiple system organ failure, patients with multiple system organ failure showed a severe decrease of C4 (with minimal values on the third postoperative day), suggesting consumption by activation of the classic pathway of the complement system or a hepatic synthesis deficiency. Prekallikrein values were also significantly lower in patients with multiple system organ failure than in the others, with a maximal difference on the third postoperative day (p < 0.005). C-reactive protein was significantly lower in patients with multiple system organ failure than in the others for the first 2 postoperative days (p < 0.05), probably because of severe hepatic failure in patients with multiple system organ failure. This study demonstrates that, in children, cardiopulmonary bypass induces complement activation principally via the alternative pathway. It suggests a relationship between complement activation and multiple system organ failure observed in the postoperative period. Furthermore, it points out the role of multiple system organ failure itself on the C3 conversion and on the synthesis of the markers of the inflammatory response in children after heart operations.

Adolescent↗
PubMed1993

Atopic dermatitis: role of food and house dust mite allergens.

OBJECTIVE: The aim of this study was to evaluate the humoral immune response to cow milk (CM) protein, soya protein, and house dust mites in a group of 64 CM-fed infants, who had atopic dermatitis as the sole atopic manifestation, by measuring not only IgE but also specific IgG antibodies (Ab) against bovine beta-lactoglobulin, soya flour aqueous extracts, and Der P1 antigens. METHODS: A CM-free diet (Nan HA, Nestle) was given to these 64 CM-fed infants and the sensitivity to CM proteins was established by a positive challenge test with the offending food in improved infants. The serum was obtained just before the start of the CM-free diet, at the first consultation. The patients were classified into two groups according to their clinical response to the hypoallergenic formula. RESULTS: Thirty-one infants (group 1) improved dramatically (positive challenge test), and 33 (group 2) did not improve with the exclusion diet but did improve after eviction of dust-producing items in the environment. The two groups were different in terms of their total IgE immunoglobulin concentration (higher in group 1, P < .05) and concentration of specific IgE Ab against CM protein (more frequent in group 1, P < .01). The IgG Ab concentrations against beta-lactoglobulin, the major CM antigen (P < 10-4), and against soya protein (P < .01) were significantly more elevated in the group improved by the diet, with a threshold above which the response to the exclusion diet could be predicted as positive. On the contrary, the level of specific IgG Ab against house dust mites was four times higher in group 2 than in group 1. Twenty-nine of the 33 infants of group 2 improved after eviction of dust-producing items in the environment. CONCLUSIONS: It is proposed that specific IgG Ab concentrations against beta-lactoglobulin, soya protein, and Der P1 antigen be determined in infants and children suffering from atopic dermatitis as a means of predicting the response to an exclusion diet, and a possible role of house dust mites in the pathogenicity of the disease is suggested.

Animals↗
PubMed1993

Influence of hypoallergenic milk formula on the incidence of early allergic manifestations in infants predisposed to atopic diseases.

One hundred twenty-two infants at risk of atopy on the basis of IgE screening at birth and family history of atopy were studied. The occurrence of atopic manifestations was analyzed in relation to their diets during the first 3 months of age. Only the infants receiving hypoallergenic milk were protected effectively; all other regimens (humanized cow milk, hypoallergenic milk or humanized cow milk + supplements) increased the frequency of allergic symptoms (P < .07). After a 1-year follow-up, the infants fed strictly on hypoallergenic milk during their 3 first months presented allergic symptoms less frequently than other infants (P < .007).

Animals↗
PubMed1992

Abnormal humoral immune response to mucosal antigenic stimulation in patients with lung cancer.

Previous studies have suggested an inverse relationship between atopy and cancer of mucosal surfaces. Atopy is classically assessed by detecting specific immunoglobulin E (IgE) antibodies against inhalant allergens. However, Platts-Mills recently proposed that atopy is the ability of an organism to recognize and to respond to limited doses of allergens presented at the mucosal level by producing not only IgE, but also immunoglobulin A and immunoglobulin G (IgG) antibodies. The authors compared the prevalence of atopy in 103 patients with lung cancer (a model of mucosal cancer), 51 patients with chronic obstructive pulmonary disease matched for age, sex, and smoking habits with patients with lung cancer, and 102 healthy control subjects. The authors investigated whether the IgG response to antigens presented at the mucosal level, exacerbated in atopic subjects, might inversely be decreased in patients with lung cancer. Serum IgE antibodies against five common inhalant allergens (Dermatophagoides pteronyssinus [Der p1], Aspergillus fumigatus, grass pollen, and cat and dog danders) were detected through a radioallergosorbent test assay. Serum IgG antibodies against allergens naturally presented at the mucosal level (respiratory mucosa with Der p1 and digestive mucosa with betalactoglobulin [BLG] and soya proteins [SP]) were measured through a solid phase enzyme-linked immunosorbent assay test. Atopic status was assessed in 19 patients (18.4%) with lung cancer, 9 patients (17.6%) with chronic obstructive pulmonary disease (COPD), and 18 healthy control subjects (17.6%). Distributions of specific IgG levels were represented on frequency histograms after natural logarithmic transformation and showed reduced levels of anti-Der p1 and anti-BLG IgG in the cancer population compared with the control populations but similar levels of anti-SP IgG. Influence of sex, age, smoking habits, histologic type of cancer, and its extent could be excluded. The authors' results show no difference in the prevalence of atopy between the three groups. They document a selective, rather than general, defect in the immune response initiated at the mucosal level in patients with lung cancer, the most frequent mucosal cancer in man.

Administration, Inhalation↗
PubMed1992

Effects of fatigue on the stretch reflex in a human muscle.

The effects of fatigue on the electromyographic (EMG) reflex activities were compared during sustained voluntary contractions and contractions evoked by electrical stimulation (30 Hz) in the human first dorsal interosseus (FDI). Short latency (SL), medium latency (ML) and long latency (LL) reflex responses to a ramp-and-hold stretch of the muscle were recorded and analysed in 27 healthy subjects of both sexes. The amplitude of the reflex components was normalized as function of the amplitude of the surface action potential (SAP) recorded in response to the supramaximal stimulation of the motor nerve. The results indicate that for a similar reduction of force, SL and ML are significantly reduced after fatigue induced by voluntary contractions but they are not when the fatigue test is performed by electrical stimulation at the motor point. In voluntary fatigue experiments, the LL component showed no significant decrease below control values, but an enhancement was observed during electrically evoked contraction. This enhancement remained above control values for at least 15 min during the recovery period, whereas SL and ML decreases returned to control within 5 min after the fatigue tests. The electrical stimulation applied to the skin overlying the FDI at an intensity lower than the motor threshold did not affect SL and ML, but enhanced LL for about 15 min. On the contrary, the anaesthesia of the skin overlying the FDI induced a decrease in LL without significant change of SL and ML. It is concluded that muscle reflex fatigue is present during sustained voluntary contractions and decreases SL and ML responses to quick stretches.(ABSTRACT TRUNCATED AT 250 WORDS)

Electric Stimulation↗
PubMed1992

Inflammatory response to acute inhalation of endotoxin in asthmatic patients.

Inhalation of 20 micrograms endotoxins (from the membrane of Gram-negative bacteria) has been reported to induce a bronchial obstructive response in asthmatic subjects. The aim of the present study was to evaluate in asthmatic patients the possibility of an inflammatory response to inhaled endotoxins. Eight patients with mild asthma were submitted to bronchial challenge tests, in a single-blind trial, on Day 1 with control solution and on Day 7 with 20 micrograms endotoxin of Escherichia coli (026:B6). Local inflammatory response was indirectly evaluated by the degree of bronchial hyperresponsiveness (BHR) expressed as PD20 FEV1 histamine (the dose of histamine inducing a 20% decrease in FEV1) at 0, 6, 24, and 48 h and 7 days. Systemic inflammation was investigated by sequential blood determinations of total (and differential) white cells, complement anaphylatoxin C5a, interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-alpha), and C-reactive protein (CRP). A significant (p < 0.01) bronchial obstructive response was demonstrable 45 min after lipopolysaccharide (LPS) inhalation, lasting 5 h. Comparing the level of BHR after control inhalation, a significant (p < 0.05) increase in BHR was shown 6 h after LPS, partially normalized at 24 and 48 h. A short peak in TNF-alpha at 60 min (p < 0.05) and an increase in total white blood cells (p < 0.01) and neutrophil polymorphonuclear neutrophils at 360 min (p < 0.05) and of CRP at 24 and 48 h (p < 0.05 and p < 0.01) were significant. The other blood parameters did not change significantly.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Inhalation↗
PubMed1992

Neuromuscular electrical stimulation and voluntary exercise.

Neuromuscular electrical stimulation (NMES) has been in practice since the eighteenth century for the treatment of paralysed patients and the prevention and/or restoration of muscle function after injuries, before patients are capable of voluntary exercise training. More recently NMES has been used as a modality of strengthening in healthy subjects and highly trained athletes, but it is not clear whether NMES is a substitute for, or a complement to, voluntary exercise training. Moreover the discussion of the mechanisms which underly the specific effects of NMES appears rather complex at least in part because of the disparity in training protocols, electrical stimulation regimens and testing procedures that are used in the various studies. It appears from this review of the literature that in physical therapy, NMES effectively retards muscle wasting during denervation or immobilisation and optimises recovery of muscle strength during rehabilitation. It is also effective in athletes with injured, painful limbs, since NMES contributes to a shortened rehabilitation time and aids a safe return to competition. In healthy muscles, NMES appears to be a complement to voluntary training because it specifically induces the activity of large motor units which are more difficult to activate during voluntary contraction. However, there is a consensus that the force increases induced by NMES are similar to, but not greater than, those induced by voluntary training. The rationale for the complementarity between NMES and voluntary exercise is that in voluntary contractions motor units are recruited in order, from smaller fatigue resistant (type I) units to larger quickly fatiguable (type II) units, whereas in NMES the sequence appears to be reversed. As a training modality NMES is, in nonextreme situations such as muscle denervation, not a substitute for, but a complement of, voluntary exercise of disused and healthy muscles.

Electric Stimulation↗
PubMed1992

Mechanism of action of maternal serum on the interleukin2 receptor expression.

Neoplastic Jurkat cells were submitted to a PHA stimulation test after a preincubation in maternal or nulliparous serum (10% dilution). The Il2R expression was significantly downregulated among maternal serum treated cells. Retroplacental serum was significantly more inhibitive than peripheral maternal serum (P less than 0.01). The maternal IgG fractions and mostly the retroplacental IgG fraction proved to contain a factor mainly responsible for the Il2R expression inhibitive property. The molecular mechanism of this phenomenon was further studied. It was shown that H7 (acting as a protein kinase inhibitor) could not influence the Il2R modulation. E.G.T.A., a calcium chelator, was not able to interfere with the inhibitive influence of maternal serum. It was suggested that the maternal serum mediated inhibition of the IL2R expression is not influenced by the hydrolysis of membrane bound phosphatidyl inositol. In contrast, pertussis toxin markedly enhanced, in a dose dependent way, the suppressive influence of maternal serum as compared to nulliparous serum. At low concentrations, pertussis toxin lost its stimulating property and retained its ability to ADP ribosylate the alpha subunit of G proteins inducing a release of adenylcyclase mediating cAMP synthesis. This mechanism has been further studied by the addition of dbc AMP or dbc GMP to Jurkat cells preparations stimulated by PHA. dbc AMP, in a dose-related way, induced a downregulation of the IL2R expression of stimulated neoplastic cells preincubated in nulliparous or maternal serum. dbc GMP did not influence the IL2R expression in the same experimental conditions. The maternal serum mediated cells showed the most pronounced IL2R inhibition. Finally, it was shown that the cAMP synthesis by PHA stimulated Jurkat cells was upregulated in a dose dependent way, after a previous cellular incubation in progressive concentrations of maternal serum. In contrast, among nulliparous serum pretreated cells, cAMP synthesis remained significantly lower, after a lectin stimulation, as compared to the cAMP production derived from retroplacental serum treated and stimulated cells. Taken together, these experiments suggest that the maternal serum dependent suppression of the IL2R expression is related to a protein G stimulation followed by an enhanced cAMP synthesis.

Calcium↗
PubMed1992

[Value of serum immunoglobulin assays in early myocardial infarction].

Serum immunoglobulin (Ig) levels were assayed in 672 patients admitted for acute myocardial infarction with onset within 24 hours of hospitalization. Supranormal Ig levels (A > or = 300, G > or = 1,200) or subnormal Ig levels (M < 40 mg/100 ml) were seen in patients with one or several risk factors (diabetes mellitus, alcohol abuse) or a history of previous myocardial infarction. Patients with one or more Ig anomalies were more likely to exhibit unfavorable outcomes, including early death, suggesting that increased viscosity due to aggregation of Ig molecules may occur.

Acute Disease↗