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Family involvement in perioperative nursing of adult patients undergoing emergency surgery.

The purpose of this study was to describe how adult patients undergoing emergency surgery experience family centredness in perioperative nursing practice. The central aim was to generate knowledge to be used while developing the practice, education and management of perioperative nursing. Data were collected using a questionnaire with emergency surgical patients in five regional hospitals in Southern Finland. The number of distributed questionnaires was 132. The response rate was 85% (n = 112). The results were mainly described as frequencies and percentages. The open-ended sections of the answers were analysed using qualitative content analysis. The findings from the open-ended questions were used for deepening and complementing the quantitative description of the results. In the preoperative phase, ascertaining the family situation and informing the family member chosen by the patient were not achieved systematically. Family situation was also rarely examined in the intraoperative and postoperative phases, although it is central to coping after surgery, especially in home care. The results support the view of earlier research about the importance of individuality of patients and their families during the perioperative care process and hence enhance the endeavour to develop nursing based on families' real needs.

Adaptation, Psychological↗

Parathyroid hormone-(1-34) enhances aggrecan synthesis via an insulin-like growth factor-I pathway.

During endochondral bone formation, the growth plate chondrocytes proliferate, become hypertrophic, lose the cartilage phenotype, undergo mineralization, and provide a scaffold upon which subsequent longitudinal bone growth occurs. Parathyroid hormone (PTH), a calcium-regulating hormone, and parathyroid hormone-related peptide (PTHrP), which shares several properties with PTH, have profound effects on skeletal growth and new bone formation. In order to define further the mechanism by which PTH/PTHrP promotes the cartilage phenotype, chondrocytes isolated from the rib cages of developing rat embryos were evaluated for the biosynthesis of aggrecan. Cells treated with PTH-(1-34) for a 4-h period followed by a 20-h recovery period showed a significant increase in cartilage proteoglycan (aggrecan) synthesis in a dose-dependent manner. Only N-terminally intact PTH and PTHrP were effective in stimulating aggrecan synthesis. Addition of a neutralizing antibody to insulin-like growth factor-I (IGF-I) during PTH treatment resulted in the inhibition of PTH-stimulated aggrecan synthesis, whereas the addition of a neutralizing antibody to insulin-like growth factor-binding protein-2 (IGFBP-2) resulted in an increase in synthesis in both the control and PTH-treated cells. In addition, PTH treatment resulted in an increase in the mRNA for aggrecan, a reduction in IGFBP-3 mRNA, and no discernible changes in IGF-I mRNA levels, which was complemented by quantitative changes in IGFBP-3 and free IGF-I levels. The reciprocal relationship in the expression of aggrecan and IGFBP was further confirmed in chondrocytes from various gestational stages during normal development. Collectively, our results indicate that the effect of PTH may be mediated at least in part through the regulation of the IGF/IGFBP axis, by a decrease in the level of IGFBP-3, and an increase in free IGF-I levels. It is likely that the local increase in IGF-I may lead to an increase in cartilage type proteoglycan synthesis and maintenance of the cartilage phenotype. The consequence of the prolonged maintenance may be to halt mineralization while a new scaffolding is created.

Aggrecans↗

Qualitative research methods in palliative medicine and palliative oncology--an introduction.

Qualitative research methods can be used as a complement to quantitative methods in palliative research. Possible applications are 1) for the induction of hypotheses, 2) for the development of quality-of-life instruments, 3) for the exploration of complex phenomena and personal experiences, 4) for studying attitudes, 5) for the observation of interactions and 6) for validation of quantitative results. Depending on the context and the research question, different qualitative methods such as hermeneutics, phenomenology, grounded theory or phenomenography might be used. The assumptions, the main steps and the methods are briefly described, with some examples from palliative situations.

Humans↗

Antibody studies in rabbit encephalomyelitis induced by a water-soluble protein fraction of rabbit cord.

A water-soluble protein fraction of nervous tissue was prepared by extraction of rabbit spinal cord with sodium citrate at pH 4.3. Characterization by nitrogen content and paper electrophoresis showed it to be a mixture of basic proteins. This extract demonstrated encephalitogenic activity when injected into rabbits. The most suitable technique for the measurement of serum antibody to the rabbit cord antigen proved to be the precipitation of antigen-antibody complexes by 40 per cent saturated ammonium sulfate. Antibody could not be demonstrated by the techniques of complement fixation, quantitative precipitation, and Ouchterlony plates. The early appearance of circulating antibody occurred almost exclusively in rabbits that subsequently developed EAE. Specificity of the antibodies for nervous tissue was demonstrated by appropriate blocking and adsorption experiments.

Animals↗

Assessment of carotid plaque composition in hypertensive patients by ultrasonic tissue characterization: a validation study.

OBJECTIVE: Ultrasonic tissue characterization of epi-aortic vessels may be useful to define the composition of atherosclerotic plaques. Videodensitometry provides a histogram representing the frequency distribution of gray levels corresponding to different compositions of the carotid wall. However, lack of standardization limits the clinical application of this technique. In the present study, the echoreflectivity (ER) pattern of atherosclerotic plaques in vivo was compared with their histological pattern after surgical removal, and the reproducibility of measurement was tested. DESIGN AND METHODS: We studied 19 hypertensive patients with a carotid artery stenosis >or= 70%, eligible for carotid thromboendarterectomy (TEA). Before TEA, all patients underwent standard high-resolution B-mode carotid ultrasound. ER parameters (mean gray level, broad band, skewness, and kurtosis) were obtained in a region of interest selected along the whole plaque, between the intima-blood and the media-adventitia interfaces. The plaques removed during TEA were examined by a histologist and classified into three groups on the basis of fibrous tissue (FT) content: lipidic (FT < 20%), fibrolipidic (20 50%). Discriminant function analysis was used to evaluate classification efficacy of different histological groups based on ER parameters. RESULTS: Histologically, five lesions were classified as lipidic, six as fibrolipidic and eight as fibrous. Analysis of variance showed significant between group differences in all ER parameters. The combined use of all ER parameters provided correct classification of plaques in 94.73% of cases (P < 0.0001), improving the classification made using single parameters. Intra-observer and inter-observer variabilities (Bland-Altman method) of mean gray level measurements were small. CONCLUSIONS: Videodensitometry can discriminate between tissue composition of carotid lesions and complement the quantitative assessment of intima-media thickness by additionally providing a well-reproducible semiquantitative evaluation of vascular wall constituents.

Aged↗

Semi-quantitative analysis of immunoglobulins and complement fractions 3 and 4 in the jejunal mucosa in coeliac disease and in food allergy in childhood. Immunohistochemical study by light and electron microscopy.

Immunoglobulins A, M, G and E and complement fractions 3 and 4 in jejunal biopsy specimens of 14 children were stained by the peroxidase-labelled antibody technique and studied in light and electron microscopy. In addition, cryostat sections were stained with FITC-conjugated anti-C3,-C4 and -IgE sera. Five patients had coeliac disease, three intestinal cow's milk or rye allergy, three eczema due to food allergy, and in three patients, who served as controls, intestinal and immunological diseases were excluded. This study showed that increased amounts of IgA and IgM both in coeliac disease and in food allergy are produced by the plasma cells in the lamina propria of the jejunum and are secreted into the gut through the epithelial cells in a similar manner as in the morphologically normal intestine. The amount of IgG produced locally or derived from serum, was increased in coeliac disease. IgE-producing cells were rare in all patients. No deposits of complement were seen in the basement membranes or epithelial cells.

Animals↗

The parenting experiences of mothers with dissociative disorders.

This article presents a qualitative analysis of the experience of parenting of mothers with dissociative disorders. This analysis was performed to complement the quantitative analysis of problems of mothers with dissociative disorders that Benjamin, Benjamin, and Rind (1996) presented previously. They found that the functioning of these mothers, as well as their subjective experience of mothering, was poorer than that of either clinical or nonclinical control mothers. Our goal was to provide a clearer, richer picture of their problems in parenting. Using the mothers' own words, we describe how the five symptom areas of dissociation (amnesia, depersonalization, derealization, identity confusion, and identity alteration) impeded their parenting efforts. We conclude with a discussion of the necessity of addressing parenting in the treatment of client-mothers with dissociative disorders.

Adaptation, Psychological↗

Antibody to HSV-2 induced tumor specific antigens in serums from patients with cervical carcinoma.

Antibody distinct from that involved in neutralization and directed to an antigen (AG-4) induced in HEp-2 cells by infection with herpesvirus type 2 was identified in serums from patients with cervical carcinoma by means of a quantitative micro complement fixation test. The presence of antibody to AG-4 correlates well with the extent of the tumor; antibody is virtually absent in matched control women and in women with therapy and without recurrent neoplasia. Reactivity is not observed with control antigen consisting of a cell extract prepared from uninfected HEp-2 cells. The possible prognostic significance of this antibody and its implications are discussed.

Adult↗

Serological specificity of acid-soluble antigens of Bacterionema matruchottii.

Sibal, Louis R. (University of Illinois College of Medicine, Chicago), Arthur V. Kroeger, Dan Kumarich, and Esther Meyer. Serological specificity of acid-soluble antigens of Bacterionema matruchottii. J. Bacteriol. 83:811-818. 1962.-The serological specificity of acid-soluble antigens extracted from the oral, filamentous organism, Bacterionema matruchottii, was demonstrated by the microprecipitin reaction. There was no evidence of cross-reaction with antisera prepared against Leptotrichia buccalis, Actinomyces, or Lactobacillus species, and these results were confirmed by quantitative complement-fixation tests with selected antisera. Since all of the B. matruchottii isolates studied possess antigens in common, it was concluded that the microprecipitin reaction offers a useful aid in the differentiation of this genus from other filamentous organisms. The results do not provide definitive evidence regarding the taxonomic relationship of B. matruchottii to any genus tested, and tend to support the recent proposal for establishment of a new genus, Bacterionema. Preliminary data obtained with the indirect fluorescent antibody technique appear to indicate that the antigens of the intact bacterial cell are as specific as the acid-soluble extracts.

Actinomyces↗

Immunological studies on dermatophytes. I. Serological reactivities of neutral polysaccharides with rabbit antiserum to Microsporum quinckeanum.

Antiserum produced in the rabbit to autoclaved mycelial suspensions of Microsporum quinckeanum reacted with three neutral polysaccharides isolated from each of five species of dermatophytes, M. quinckeanum, Trichophyton granulosum, T. interdigitale, T. rubrum, and T. schönleinii. The serological reactivities of these polysaccharides, grouped as galactomannans I, galactomannans II, and glucans, were compared by qualitative precipitation analyses in gel and quantitative complement-fixation analyses. Significant differences were found among the glucans and galactomannans II but not among the galactomannans I of these species.

Complement Fixation Tests↗

Immunological studies on dermatophytes. II.

The contribution of terminal galactofuranose residues to the antigenic specificity and to cross-reactivity of galactomannans isolated from five species of dermatophytes, Microsporum quinckeanum, Trichophyton granulosum, T. interdigitale, T. rubrum, and T. schoenleinii, was investigated. Galactofuranose units were removed from galactomannans I and galactomannans II by mild acid hydrolysis. The resulting mannans were tested for serological reactivity with rabbit antiserum to M. quinckeanum by qualitative precipitation in gel and by quantitative complement-fixation analyses. Our results showed that, with this antiserum, the galactofuranose residues contributed greatly to the antigenic specificity and to cross-reactivity of the galactomannans II, but these residues were less significant as antigenic determinants in the galactomannans I. We have shown that mannans isolated from three Candida species reacted with rabbit antiserum to M. quinckeanum.

Antigens↗

Comparison of an enzyme-linked immunosorbent assay for quantitation of rotavirus antibodies with complement fixation in an epidemiological survey.

The development of a micro-scale enzyme-linked immunosorbent assay (ELISA) with horseradish peroxidase as the marker enzyme for the detection and measurement of human rotavirus antibodies is described. A semipurified preparation of the serologically related simian agent, SA-11 virus, was used as the antigen. Test sera were reacted with antigen-sensitized wells in disposable poly-vinyl microplates. Any attached antibody was detected by the addition of peroxidase-labeled anti-species immunoglobulin (conjugate) followed by assay of the enzyme reaction with its substrate, hydrogen peroxide plus 5-aminosalicylic acid. This micro-ELISA was compared with complement fixation in a seroepidemiological study of the age prevalence of rotavirus antibody in Aboriginal and European populations living in the same outback area in Australia. The ELISA (results read with the naked eye) proved to be approximately 16 times more sensitive than complement fixation. Of Aborigines, 71% had rotavirus complement-fixing antibody, as compared to 45% of Europeans. By ELISA 100% of both populations had rotavirus antibodies. Mean antibody titers in the different age groups were higher in Aborigines than in Europeans. Antibody levels rose steeply throughout the first 20 years of life, remained high during the next 20 years, then increased again at least up to the age of 60 years. The micro-ELISA was practical, simple to perform, and more suitable than complement fixation for large seroepidemiological rotavirus studies. It also has potential for serodiagnosis of the disease, both in the laboratory and in the field.

Adolescent↗

Quantitative influence of antibody and complement coating of red cells on monocyte-mediated cell lysis.

Monocyte-mediated lysis in vitro of human red cells coated with measured amounts of immunoglobulin G (IgG) or complement were studied. 1,000-1,500 molecules of IgG anti-D are necessary to effect measurable lysis, and lysis increases linearly with increasing levels of antibody sensitization. 100 microgram/ml of IgG1 abolished lysis even at maximal levels of anti-D sensitization (15,000 molecules/cell). Two isoimmune IgG anti-A or anti-B antisera were 5 to 10-fold less efficient in promoting phagocytosis or lysis per molecule of IgG bound; however, because of the greater antigen density of A or B, more than 100,000 molecules IgG/cell could be bound, producing equivalent lysis to anti-D-coated cells. Although inhibition by IgG1 was similar at equivalent levels of sensitization with anti-A, anti-B, or anti-D at high levels of coating with anti-A or anti-B (not attainable with anti-D), lysis was not inhibited by IgG1. Cells coated with human complement components alone were not lysed by monocytes; however, complement coating augmented IgG-mediated lysis and reduced the quantity of anti-D necessary to produce lysis to less than 1,000 molecules/cell. After thorough degradation of C3b by serum to C3d, complement augmentation persisted.

ABO Blood-Group System↗

Histochemical localization of estrogen and progesterone receptors: evaluation of a method.

A histochemical method for the detection of estrogen (ER) and progesterone (PR) receptors in human endometrium, using estrogen and progesterone derivatives linked to fluorochrome-labeled bovine serum albumin (E2-BSA-fluorescein isothiocyanate (FITC) and progesterone-BSA-tetramethylrhodamine isothiocyanate (TMRITC], has been evaluated. The fluorochrome-labeled steroids were bound to the cytoplasm--preferably in glandular epithelial cells but to a lesser extent also to stromal cells. The steroid specificity of the observed binding was studied by preincubating the sections with a series of unlabled steroids and nonsteroidal, hormonally active compounds (estradiol-17 beta, diethylstilbestrol, tamoxifen, 5 alpha-dihydrotestosterone and R 1881 for ER and ORG 2058, R 5020, dexamethasone, cortisol and 5 alpha-dihydrotestosterone for PR). The inhibition studies indicated that E2-BSA-FITC and progesterone-BSA-TMRITC bind to ER and PR in human endometrium with a reasonable degree of specificity. The method was reproducible and various procedural steps were tested, showing satisfactory technical stability. The method is applicable to small tissue samples, and is a valuable complement to quantitative biochemical receptor assays, as it localizes the receptors in tissue slices.

Binding Sites↗

A conceptual view of the complement system.

The activities of the complement system encompass cell destruction either directly through the membrane attack complex or indirectly via the effects of inflammation. The effects of complement fragments on immune functioning are just now being elucidated. Recent advances in methodology have allowed recognition of complement deficiencies of both quantitative and structural varieties. Complement activation studies may detect subclinical activation and be useful guideposts for therapeutic intervention. Coupling our new understanding of the mechanisms of complement activation with new technologies to measure this activation may result in the better understanding of the pathology of inflammation and its concurrent immunologic reactions.

Complement Activation↗

Use of synthetic, crystalline, L-alpha-dimyristoyl lecithin in cardiolipin antigens.

Experiments were carried out by the authors to determine whether synthetic, crystalline, L-alpha-dimyristoyl lecithin could replace natural purified lecithins in the preparation of cardiolipin antigens. These experiments were designed specifically to find out whether it was possible to obtain the same serological reactions, qualitatively and quantitatively, with the test antigen as with a reference antigen containing natural lecithin, and whether the test antigen had the same keeping qualities as the reference antigen.The tests used were the quantitative complement-fixation test as modified by Mørch in 1933, and the VDRL slide flocculation test.The results showed that synthetic, crystalline, L-alpha-dimyristoyl lecithin could replace natural lecithin in the preparation of cardiolipin antigens, but that the antigens prepared with the synthetic lecithin were significantly less sensitive than those prepared with an equimolar amount of natural lecithin. The authors consider that further investigation is required before the use of synthetic lecithin is finally adopted.

Cardiolipins↗