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Evaluation of a novel dry latex preparation for demonstration of infectious mononucleosis heterophile antibody in comparison with three established tests.

A new, dried antigen-coated latex preparation for the demonstration of infectious mononucleosis (IM) heterophile antibody (Dryspot IM kit; Oxoid, Ltd., Basingstoke, Hampshire, United Kingdom) was compared with the IM kit (a liquid latex reagent from the same source), an immunoassay (ImmunoCard Mono; Meridian Diagnostics), and an absorption test (Monospot; Meridian Diagnostics). The latter was used as a standard for initial statistical comparisons. Discrepancies were resolved by using Epstein-Barr virus serology. Of the 328 routine samples tested, 77 were positive and 222 were negative by all IM heterophile antibody-based kits. Twenty-nine samples gave discrepant results. Following resolution of discrepant results, the sensitivity and specificity values for the IM Dryspot kit were 87.0 and 98.7%, those for the Oxoid liquid latex IM kit were 83.0 and 99.6%, and those for the ImmunoCard Mono immunoassay were 85.0 and 100.0%, respectively. The evaluation shows that the Dryspot kit, which is uniquely straightforward to use and may be stored at room temperature, is comparable in performance to other rapid heterophile tests for the confirmation of IM.

Antibodies, Heterophile↗

Comparison of polyvinyl alcohol fixative with three less hazardous fixatives for detection and identification of intestinal parasites.

Polyvinyl alcohol (PVA) containing the fixative mercuric chloride is considered the "gold standard" for the fixation of ova and parasites in the preparation of permanently stained smears of stool specimens. However, mercuric chloride is potentially hazardous to laboratory personnel and presents disposal problems. We compared three new alternative, nontoxic fixatives with PVA, analyzing ease of sample preparation and quality of smears. Sixty-eight fresh stool specimens were divided into aliquots and placed in each of four different fixatives: PARASAFE (PS) (Scientific Devices Laboratory, Inc., Des Plaines, Ill.), ECOFIX (EC) (Meridian Diagnostics, Inc., Cincinnati, Ohio), Proto-Fix (PF) (Alpha-Tec Systems, Inc., Vancouver, Wash.), and low-viscosity PVA fixative (PVA) (Meridian). Specimens were processed and stained according to each manufacturer's directions. Parasites were found in 31 of 68 slide preparations with PVA, 31 with PF, 30 with EC, and 30 with PS. Blastocystis hominis and Iodamoeba bütschlii were preserved in a readily identifiable state by all methods of fixation. However, some parasites were more easily identified with some of the fixatives because of differences in parasite distortion. For example, Entamoeba histolytica (Entamoeba dispar) was detected in 13 stools fixed with PF, 7 with PVA, and 6 with EC but none with PS. Likewise, Chilomastix mesnili was identified in 13 specimens fixed with PF, 8 with EC, and 5 with PVA but only 1 with PS, while Entamoeba coli was seen much less frequently with PS than with the other three fixatives. A dirty background was observed in 41% of specimens prepared with PS, whereas background quality was acceptable with other fixatives. Sample preparation was most rapid with PS, although the EC method involved the fewest steps. In conclusion, PVA and PF produced the least parasite distortion, while PS proved unsatisfactory for the identification of E. histolytica, E. coli, and C. mesnili. Both PF and EC appear to be acceptable, environmentally safe substitutes for PVA.

Animals↗

Commercial assay for detection of Giardia lamblia and Cryptosporidium parvum antigens in human fecal specimens by rapid solid-phase qualitative immunochromatography.

The ImmunoCard STAT! Cryptosporidium/Giardia rapid assay (Meridian Bioscience, Inc.) is a solid-phase qualitative immunochromatographic assay that detects and distinguishes between Giardia lamblia and Cryptosporidium parvum in aqueous extracts of human fecal specimens (fresh, frozen, unfixed, or fixed in 5 or 10% formalin or sodium acetate-acetic acid-formalin). By using specific antibodies, antigens specific for these organisms are isolated and immobilized on a substrate. After the addition of appropriate reagents, a positive test is detected visually by the presence of a gray-black color bar (regardless of the intensity) next to the organism name printed on the test device. A control is included in the device. Steps include tube preparation (buffer, patient specimen, conjugates A and B), testing (addition of sample onto the test device), and visual reading (total time, 12 min). Test performance was evaluated with known positive and negative stool specimens (170 specimens positive for Giardia and 231 specimens negative for Giardia) (85 specimens positive for Cryptosporidium and 316 specimens negative for Cryptosporidium); they were tested with trichrome, iron-hematoxylin, or modified acid-fast stains or the Meridian Bioscience, Inc., Giardia/Cryptosporidium Merifluor combination reagent; specimens with discrepant results were retested by using the Merifluor combination reagent. On the basis of the results of the reference methods, the sensitivities, specificities, and positive and negative predictive values were as follows: for G. lamblia, 93.5, 100, 100, and 95.5%, respectively; for C. parvum, 98.8, 100, 100, and 99.7%, respectively. False-negative results for G. lamblia were obtained with specimens with low parasite numbers (n = 7) or specimens containing trophozoites only (n = 3); one specimen with a false-negative result contained numerous cysts. The one specimen false negative for C. parvum was confirmed to be positive by immunofluorescence. No cross-reactivity was seen with 10 different protozoa (152 challenges), nine different helminths (35 challenges), or human cells (4 challenges) found in fecal specimens. This rapid test system may be very beneficial in the absence of trained microscopists; however, for patients who remain symptomatic after a negative result, the ova and parasite examination and special stains for other coccidia and the microsporidia should always remain options.

Animals↗

Evaluation of three commercial assays for detection of Giardia and Cryptosporidium organisms in fecal specimens.

There is an increasing demand for diagnostic testing for Giardia intestinalis (G. lamblia) and Cryptosporidium parvum, with a priority being placed on obtaining diagnostic results in an efficient and timely manner. Several commercial companies have developed rapid diagnostic tests that are simple to perform and can be completed in less time than traditional methods for detecting Giardia and Cryptosporidium: We compared one of these rapid tests, the ImmunoCard STAT! (Meridian Bioscience, Inc.) lateral-flow immunoassay, with the MERIFLUOR direct fluorescent-antibody (DFA) test, the ProSpecT EZ microplate assay for Giardia and the ProSpecT microplate assay for Cryptosporidium, and modified Kinyoun's acid-fast stained smears for the detection of Cryptosporidium using 246 specimens. The MERIFLUOR DFA (Meridian Bioscience, Inc.) test detected the largest number of cases (32 Giardia and 37 Cryptosporidium) infections and was used to calculate the sensitivity and specificity of the other tests. For Giardia, the sensitivities of the ImmunoCard STAT! and the ProSpecT Giardia EZ microplate assay (Alexon-Trend, Inc.) were 81 and 91%, respectively. For detection of Cryptosporidium, the sensitivities of the ImmunoCard STAT!, the ProSpecT Cryptosporidium microplate assay (Alexon-Trend, Inc.), and modified Kinyoun's acid-fast stained smears were 68, 70, and 78%, respectively. Test specificities were equal to or greater than 99%. Specimens with very small numbers of organisms were not detected by the ImmunoCard STAT!, the ProSpecT microplate assay or modified Kinyoun's acid-fast stained smears.

Animals↗

The integration of acupuncture within medicine in the UK--the British Medical Acupuncture Society's 25th anniversary.

Acupuncture was first used in China, probable about 2000 years ago. When acupuncture first arrived in the West in the 17th century, the principles which the Chinese had used to explain its actions were at variance with current scientific knowledge of the body's structure and function. This led to the rejection of acupuncture by the medical profession in the UK, although individual practitioners adopted it with enthusiasm, usually needling the point of maximal tenderness to treat musculoskeletal pain. Acupuncture was more generally accepted in France and Germany, where the pioneering British physician Felix Mann encountered it in the 1950s. He then taught acupuncture to other medical practitioners and organised regular meetings in London, from which the British Medical Acupuncture Society, BMAS, emerged in 1980. The tradition of biannual scientific meetings has continued since then. The Society has many connections with prominent acupuncturists internationally and is a founder member of the International Council of Medical Acupuncture and Related Techniques (ICMART), and has hosted two world congresses. The Society was involved in standardisation of the meridian nomenclature published in 1990. The Society's scientific journal, Acupuncture in Medicine, was founded in 1981 and has gained international recognition, being indexed on several databases. The Society has established regular teaching courses at different levels, which lead to professional qualifications of Certificate and Diploma. The membership is now open to different health professionals, has grown steadily and now stands at nearly 2500. The Society is administered from offices in Cheshire and London. Many individual members have contributed to the Society's characteristic Western 'medical' approach to acupuncture in which needling is seen as a form of neuromuscular stimulation that owes little to traditional meridians or points. The Society has shown a particular interest in acupuncture for myofascial trigger point pain. Members of the Society have contributed to the evidence base of acupuncture with several books, clinical trials and reviews. The Society is optimistic that it will have an increasingly important role in promoting the use and scientific evaluation of acupuncture for the public benefit.

Acupuncture↗

Does visual restitution training change absolute homonymous visual field defects? A fundus controlled study.

AIM: To examine whether visual restitution training (VRT) is able to change absolute homonymous field defect, assessed with fundus controlled microperimetry, in patients with hemianopia. METHODS: 17 patients with stable homonymous visual field defects before and after a 6 month VRT period were investigated with a specialised microperimetric method using a scanning laser ophthalmoscope (SLO). Fixation was controlled by SLO fundus monitoring. The size of the field defect was quantified by calculating the ratio of the number of absolute defects and the number of test points; the training effect E was defined as the difference between these two ratios before and after training. A shift of the entire vertical visual field border by 1 degrees would result in an E value of 0.14. RESULTS: The mean training effect of all right eyes was E = 0.025 (SD 0.052) and all left eyes E = 0.008 (SD 0.034). In one eye, a slight non-homonymous improvement along the horizontal meridian occurred. CONCLUSIONS: In one patient, a slight improvement along the horizontal meridian was found in one eye. In none of the patients was an explicit homonymous change of the absolute field defect border observed after training.

Adult↗

Blind spot size depends on the optic disc topography: a study using SLO controlled scotometry and the Heidelberg retina tomograph.

AIMS: To find out whether the size of the blind spot area, determined by static perimetry, depends on the surface topography of the optic disc and its surrounding area. METHODS: Ten eyes were examined; all had a parapapillary atrophy adjacent to the temporal side of the disc. Microperimetry was performed under direct fundus control using a Rodenstock scanning laser ophthalmoscope. The horizontal meridian of the optic discs was examined in 0.5 degree steps using five stimulus sizes (Goldmann I to V), each with 10 different degrees of brightness. Optic disc topography was measured with the Heidelberg retina tomograph (HRT). RESULTS: Stimuli with a high luminance level (Goldmann IV, 4 dB), presented on the horizontal meridian, were seen up to 0.75 degree centrally (that is, towards the optic disc centre) from the temporal edge of the parapapillary atrophy but up to 1.85 degrees centrally from the nasal optic disc border (p < 0.01). Horizontal HRT section profiles of the optic disc consistently showed prominent nasal disc borders contrasting with a shallow excavation within the temporal parapapillary atrophy. CONCLUSIONS: The size of scotomas depends on the surface topography of the tested area. The prominent nasal part of the optic disc appears less 'blind' than the shallow temporal part, probably because of more intensive light scattering by the prominent nasal part of the disc. These considerations should also apply to other scotomas.

Adult↗

Asymmetries of the retinal nerve fibre layer thickness in normal eyes.

AIMS: To investigate the variation in the retinal nerve fibre layer thickness in detail in normal eyes with a scanning laser polarimeter. METHODS: The retinal nerve fibre layer thickness (RNFLT) was measured in 94 normal volunteers with a scanning laser polarimeter. The mean RNFLT around a 10 pixel-wide ellipse located concentrically with the disc of 1.5 disc diameters was calculated for 16 sectors each of 22.5 degrees. The symmetry of the RNFLT distribution with respect to the horizontal midline for individual eyes and to the vertical meridian for the two eyes was examined. RESULTS: The RNFLT was thicker on the inferior side than on the superior side for the temporal four pairs of 22.5 degrees sectors, and the differences were significant in two of the four temporal pairs (p<0.007). The RNFLT was thicker in the superior than in the inferior side for the nasal four pairs of the sectors, and the differences were significant in three of the four nasal pairs (p<0.04). The mean RNFLT was significantly thicker in the right eyes than in the left eyes in the four temporal sectors (p<0.02), and significantly thicker in the left eyes than in the right eyes in the inferior two nasal sectors (p<0.01). CONCLUSIONS: Asymmetries of the RNFLT in normal eyes with respect to the horizontal midline and to the vertical meridian for the two eyes were found. These asymmetries should be considered when retinal nerve fibre layer loss is evaluated during the course of a disease process.

Adolescent↗

Studies of the central neural pathways to the stomach and Zusanli (ST36).

The purpose of this morphological study was to investigate the relation between the meridian, meridian points and viscera using neuroanatomical tracers. The common locations of the spinal cord and brain projecting to the stomach and Zusanli were observed following injection of CTB (cholera toxin B subunit) and pseudorabies viruses (PRV-Ba, Bartha strain and PRV-Ba-Gal, galactosidase insertion) into the stomach and Zusanli (ST36). After 4-5 days of survival following injection into twelve rats, they were perfused, and their spinal cords and brains were frozen sectioned (30 microm). These sections were stained by X-gal histochemical, CTB and PRV-Ba immunohistochemical staining methods, and examined with the light microscope. The results were as follows: Commonly labeled medulla oblongata regions were dorsal motor nucleus of vagus nerve (DMV), nucleus tractus solitarius (NTS) and area postrema (AP) following injection of CTB and PRV-Ba-Gal into stomach and Zusanli, respectively. In the spinal cord, commonly labeled neurons were found in thoracic, lumbar and sacral spinal segments. Densely labeled areas were found in lamina IV, V, VII (intermediolateral nucleus) and X of the spinal cord. In the brain, commonly labeled neurons were found in the Al noradrenalin cells/Cl adrenalin cells/caudoventrolateral reticular nucleus, dorsal motor nucleus of vagus nerve, nucleus tractus solitarius, area postrema, raphe obscurus nucleus, raphe pallidus nucleus, raphe magnus nucleus, gigantocellular nucleus, locus coeruleus, parabrachial nucleus, Kolliker-Fuse nucleus, A5 cell group, central gray matter, paraventricular hypothalamic nucleus, lateral hypothalamic nucleus, retrochiasmatic hypothalamic nucleus, bed nucleus of stria terminalis and amygdaloid nucleus. Thus central autonomic center project both to the stomach and Zusanli. These morphological results suggest that there is a commonality of CNS cell groups in brain controlling stomach (viscera) and Zusanli (limb).

Acupuncture Points↗

Oriental diagnosis in stomach cancer patients.

A new method of performing Oriental diagnosis using Meridian Imbalance Diagram which, consisting of 23 different ratios, has a highly discriminatory significance. Using this method, Oriental and Western diagnosis in the same patients were compared. To do this we compared the Meridian Imbalance Diagrams of 22 patients entering our hospital for surgical operations with those 19 in a healthy control group. Four significantly different ratios became evident. The postoperative reports showed that 10 of the patients were suffering from stomach cancer. The Oriental diagnosis data of this new group were then compared to the data of the control group. This time, 10 ratios were found to be significantly different. This shows the existence of a pattern of Oriental diagnosis corresponding to a specific Western diagnosis.

Differential Threshold↗

Acupuncture points of the sacral plexus.

This is the sixth and final communication in a series describing acupuncture points by anatomic nomenclature. Most acupuncture points on the lateral and posterior surfaces of the lower limb are located along routes of the sacral plexus. These points belong to acupuncture meridians carrying "Yang energy" in the lower limbs. The meridians are traditionally known as the Urinary Bladder on the posterior surface of the lower limb, Gall Bladder on the lateral surface of the lower limb, and Stomach on the anterior surface of the leg and dorsum of the foot.

Acupuncture Therapy↗

Clinical study of objective pulse diagnosis.

The recording of the objective pulse diagnosis was performed and the meridian points were selected from this recording. The proper meridian points (five element points) according to the five element theory and the improper points (non-five element points) were stimulated. Pain threshold was elevated by the stimulation of five element points and not raised by non-five element points in a patient who had nasal polypectomy under acupuncture analgesia and also in 6 of 9 healthy volunteers. Naloxone reversal of elevated pain threshold was also observed in volunteers.

Acupuncture Therapy↗

Singular point, organizing center and acupuncture point.

A hypothesis is proposed on the nature of acupuncture point and organizing center, the role of meridian system in growth regulation, and the mechanism of acupuncture. Both organizing centers and acupuncture points have low electric resistance. The low electric resistance is related to the distribution of gap junction and thus intercellular communication. Some acupuncture points may be organizing centers. The meridian system is important in coordination and regulation of morphogenesis. The properties of organizing centers and acupuncture points can be explained in view of singular point. Coupling and oscillation may underlie the mechanism of acupuncture as well as growth regulation.

Acupuncture Points↗

Collective effect of a Chinese formula--a study of xiao-jian-zhong-tang.

Components of a traditional Chinese medicine formula Xiao-Jian-Zhong-Tang were divided into three groups: (1) Radix Paeoniae Lactiflorae, (2) Radix Astragali, and (3) Cinnamon twig, Radix Glycyrrhizae, Fructus jujubae and Saccharum Granorum. Extracts of each group were injected into rats to observe the blood pressure wave spectrum changes at the caudate artery. The whole formula was also extracted and injected into rats to monitor blood pressure wave spectrum changes. Each group has its own effect on the Fourier components of the blood pressure wave. The meridian effects of these herbs are the same as described in the Chinese medical literature, if we consider each meridian in resonance with a specific Fourier component. The whole formula when injected into rats had an effect on the Fourier components of the blood pressure wave similar to the linear combination of individual effect of the three herb groups when used separately. This may be the fundamental idea behind formula construction.

Animals↗

Pulse spectrum analysis of chemical factory workers with abnormal blood test.

Double blind tests to check the correlation between pulse diagnosis and liver function tests were performed. Blood tests including T-Bil, D-Bil, SGOT and SGPT of 70 chemical factory workers were compared with pulse analysis. Special attention was paid to the indicators of liver and lung meridians for pulse diagnosis. It was found that using the criterion (1) C1 > or = 3+ and C1 + C4 > or = 4+ (hyperfunction) and (2) C1 < or = 3-(hypofunction) as abnormal liver meridian (for C1, every 5% above normal give one +, every 5% below normal give one-; for C4 every 10% above normal give one +, every 10% below normal give one -). The correlation or agreement between the blood tests and the pulse diagnosis was very high (noncorrelation chance checked by X2-test, P < 0.001, degree of agreement checked by Kappa test Ka = 0.61 which means a substantial relationship). Suggestions such as more tests, more criteria and precautions for future study are also proposed.

Adult↗

Shape and size of the human diaphragm in vivo.

Serial computerized tomograph (CT) sections at 5-mm intervals of a human diaphragm in relaxed and contracted states were obtained in one subject while he held his breath and lay supine in a CT scanner. All sections for one state were scanned at the same chest wall configuration as monitored by rib cage and abdominal dimensions, using magnetometers. Sections were scanned at relaxed functional residual capacity and after inspiring approximately 1 liter in such a way that rib cage dimensions increased only slightly. Models of the diaphragm dome in the two states were constructed from the sets of serial sections. Diaphragm length and volume displaced were measured, the zone of apposition of diaphragm to rib cage was mapped, and the line of the diaphragm silhouette in anteroposterior and lateral X-rays identified. Coronal and sagittal sections were constructed. In the inspiration studied, the diaphragm movement displaced 680 ml. Meridian lines in sagittal, coronal, and transverse directions over the right hemidiaphragm dome shortened by 6.7-7.2 cm, but over the left dome by only 4.0-4.3 cm. Lines of X-ray silhouettes were close to meridian lines, and estimates of shortening were similar to those made previously from X-rays. The peculiar saddle shape of the muscle may help the hemidiaphragms to operate independently, the fibers of the saddle acting as an anchor for midline directed fibers of the hemidiaphragm domes. The shape of the diaphragm also has implications for the distribution of transdiaphragmatic pressure and for the kind of distortion of the lower rib cage margin that is seen during inspirations at high lung volume.

Adult↗

Modulation of cardiovascular excitatory responses in rats by transcutaneous magnetic stimulation: role of the spinal cord.

This study investigated the efficacy of magnetic stimulation on the reflex cardiovascular responses induced by gastric distension in anesthetized rats and compared these responses to those influenced by electroacupuncture (EA). Unilateral magnetic stimulation (30% intensity, 2 Hz) at the Jianshi-Neiguan acupoints (pericardial meridian, P 5-6) overlying the median nerve on the forelimb for 24 min significantly decreased the reflex pressor response by 32%. This effect was noticeable by 20 min of magnetic stimulation and continued for 24 min. Median nerve denervation abolished the inhibitory effect of magnetic stimulation, indicating the importance of somatic afferent input. Unilateral EA (0.3-0.5 mA, 2 Hz) at P 5-6 using similar durations of stimulation similarly inhibited the response (35%). The inhibitory effects of EA occurred earlier and were marginally longer (20 min) than magnetic stimulation. Magnetic stimulation at Guangming-Xuanzhong acupoints (gallbladder meridian, GB 37-39) overlying the superficial peroneal nerve on the hindlimb did not attenuate the reflex. Intravenous naloxone immediately after termination of magnetic stimulation reversed inhibition of the cardiovascular reflex, suggesting involvement of the opioid system. Also, intrathecal injection of delta- and kappa-opioid receptors antagonists, ICI174,864 (n=7) and nor-binaltorphimine (n=6) immediately after termination of magnetic stimulation reversed inhibition of the cardiovascular reflex. In contrast, the mu-opioid antagonist CTOP (n=7) failed to alter the cardiovascular reflex. The endogenous neurotransmitters for delta- and kappa-opioid receptors, enkephalins and dynorphin but not beta-endorphin, therefore appear to play significant roles in the spinal cord in mediating magnetic stimulation-induced modulation of cardiovascular reflex responses.

Afferent Pathways↗

Role of corpus callosum in functional organization of cat striate cortex.

The short-term (3-51 days) and long-term (31-42 wk) effects of corpus callosum transection on the receptive-field properties of neurons were assessed at the single-cell, architectural, and topographical levels of organization in the cat striate cortex. Corpus callosum transection decreased the proportion of neurons that could be activated from both eyes. In short-term animals, the reduction in binocularity was restricted to the representation of a vertical strip of visual space extending from the vertical meridian to at least 12 degrees lateral. In the long-term animals, the reduction in binocularity was restricted to the representation of visual space 4 degrees lateral to the vertical meridian. Therefore, the reduction in the representation of 4-12 degrees was only temporary. In both groups, the reduction in binocularity was less in the representation of area centralis than at other retinal locations in the same vertical strip. The region of area 17 affected permanently by the transection receives fibers from the contralateral hemisphere in normal animals. The region affected temporarily by the transection contains callosal cells but does not contain callosal terminals. Binocularity was assessed separately for simple I, simple II, and complex receptive-field types. The reduction in binocularity in the 12 degrees strip in short-term animals and in the 4 degrees strip in long-term animals was accounted for mainly by a reduction in binocularity of simple I and complex cells. As in normal animals, complex cells in callosum-transected cats were always more binocular than the other cell types. An analysis of the effects of corpus callosum transection on different cortical layers showed that a greater proportion of cells in the supragranular layers II and III showed a reduction in binocularity than in the infragranular layers V and VI. The proportion of binocular neurons in layer IV was not significantly different from normal. The major decreases in binocularity occurred in layers II, III, and VI for simple I and simple II cells and in layers II, III, and V for complex cells. The binocularity of simple II cells in layer IV and complex cells in layer VI was not affected. The effects of the transection on the columnar organization of the cortex were assessed by making electrode tracks that passed in the radial or laminar dimensions of the cortex. Reconstructions of the radial tracks showed that cells within one radial column tended to be dominated by the same eye. In adjacent columns, cells tended to be dominated by different eyes.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗