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Gender differences in autoantibodies to oxidative DNA base damage in cigarette smokers.

Oxidative DNA damage and antibodies to that damage have been implicated in lung, breast, and colorectal cancer. In this observational validation study, the relationship between anti-5-hydroxymethyl-2'-deoxyuridine (HMdU) autoantibody (aAb) and plasma micronutrients was assessed in 140 heavy smokers by ELISA. Anti-HMdU aAbs were 50% higher in women after adjustment for cigarettes/day (CPD; P = 0.002), although men smoked more and had higher plasma cotinine levels. The women reported taking more vitamin C (P < 0.005) and had higher plasma levels of alpha-carotene and beta-carotene (P < 0.001) and cryptoxanthin (P < 0.01) than men. Neither CPD nor cotinine was associated with aAb titers. Anti-HMdU aAbs were associated inversely with alpha-tocopherol (P = 0.10), retinol (P = 0.06), and age (P = 0.04) in women but not in men. In contrast to the men, women 50 years of age (P = 0.05). Given the same duration of exposure, women had higher anti-HMdU aAbs and also reached peak levels at a lower cumulative smoking exposure (30 years) compared with male smokers (40 years). Subjects smoked an average of 28.9 +/- 0.81 CPD and initiated smoking at 17.2 +/- 0.33 (SE) years of age. Therefore, smokers who reported smoking for 30 years were typically <50 years old. Women <or=50 years in the younger age group that smoked 21-30 years had significantly higher levels of aAbs than did men of the same age and smoking history (P = 0.012). Gender difference in aAbs was also evident in 29 persons who gave serial samples before and after quitting smoking (P < 0.028). In women, aAbs remained elevated for 14 months after smoking cessation but decreased significantly by 20.5 months (P < 0.032) by paired t tests. In men, aAbs increased with time since quitting smoking but not significantly. The finding of significantly elevated aAbs to oxidized DNA in females <or=50 compared with male smokers of the same age and exposure suggests a possible interaction with hormones (e.g., estrogens) and may explain a heightened risk of smoking-induced lung cancer in women compared with men.

Adult↗

[Clinical diagnosis of Colles fracture combined with dorsal subluxation of radial carpal joints].

OBJECTIVE: To study the criteria for evaluating Colles fracture combined with dorsal radiocarpal subluxation (DRS). METHOD: Fifty cases of Colles fracture combined with DRS, 100 cases of simple Colles fracture without DRS, and 100 normal wrist joint controls were included. We analysed central point displacement and perpendicular line ratio on the lateral view X-ray. For comminuted and severely displaced fracture, central point displacement (CPD) was not adopted because of difficulties in identifying the central point of the articular surface. Perpendicular line ratio (PLR) was suggested. RESULT: Prominent difference was seen in the CPDs and the PLRs between the Colles fracture combined with DRS group and the simple Colles fracture and the normal control group (P < 0.01). Prominent relevance between the CPD and the PLR was also found (P < 0.05). CONCLUSION: Central point displacement and perpendicular line ratio can be regarded as the diagnostic criteria for Colles fracture combined with DRS. PLR is especially valuable when the central point is hard to be identified in very comminuted and severely displaced fractures. DRS is suggested when CPD is more than 2.5 mm and PLR is less than 0.76.

Adolescent↗

Changes in peritoneal coagulation and fibrinolysis after discontinuation of chronic peritoneal dialysis.

OBJECTIVES: To study changes in peritoneal function after transfer from chronic peritoneal dialysis (CPD) to hemodialysis (HD), especially the effects on peritoneal coagulation, fibrinolytic markers, and mesothelium. DESIGN: Prospective observational study. SETTING: A tertiary-care university hospital. PATIENTS: Nine patients who transferred from CPD to HD were enrolled in the study after giving fully informed consent. METHODS: After transfer to HD, the peritoneal cavity was lavaged with low glucose PD solution once per day through PD catheters left in place. Thrombin-antithrombin III complex (TAT) was measured serially as a marker of peritoneal coagulation. As fibrinolytic markers, fibrinogen/fibrin degradation products (FDP) and plasmin-alpha2-antiplasmin complex (PIC) were assessed. Cancer antigen 125 (CA125) was measured as a marker of mesothelial cell mass. RESULTS: Levels of peritoneal TAT and FDP were much higher than plasma levels, indicating high local fibrin turnover. Transfer to HD induced a significant fall in mean peritoneal TAT, from 115.8 +/- 52.1 to 60.7 +/- 21.8 ng/mL, p < 0.05. Except for 1 patient with a 20-fold increase, mean peritoneal FDP decreased significantly, from 43.6 +/- 11.1 to 19.6 +/- 3.5 microg/mL, p < 0.05. Mean peritoneal PIC increased significantly, from 1.9 +/- 0.4 to 3.9 +/- 0.6 microg/mL, p < 0.05. Peritoneal CA125 increased from 156.4 +/- 57.3 to 1426.2 +/- 389.4 U/mL, p < 0.05. CONCLUSIONS: Peritoneal fibrin turnover was accelerated on CPD and stabilized after transfer to HD. Transfer to HD also induced mesothelial regeneration.

Adult↗

A bicyclic monoterpene diol and UVB stimulate BRCA1 phosphorylation in human keratinocytes.

BRCA1 (breast cancer-associated gene 1) is a tumor suppressor gene that plays a role in DNA repair when phosphorylated. Many DNA-damaging agents including UVC and hydrogen peroxide have been shown to induce phosphorylation of BRCA1. Results of this study now show that both UVB and a bicyclic monoterpene diol (BMT diol) result in phosphorylation of BRCA1. This phosphorylation was maximal 2 h after treatment with either agent and declined to basal levels by 24 h. Inhibitor studies revealed that both UVB and the BMT diol phosphorylate BRCA1 through the FK506-binding protein-FKBP rapamycin-associated binding protein pathway, but the BMT diol also led to phosphorylation of BRCA1 through casein kinase II. This suggests that the signaling pathways for UVB and the BMT diol may diverge. Results of this study also show that the BMT diol stimulates the repair of UVB-induced cyclobutane pyrimidine dimers (CPD). Inhibitors of BMT diol-induced BRCA1 phosphorylation blocked the BMT diol-stimulated repair of CPD. This indicates that the BMT diol induces the phosphorylation of BRCA1, which, in turn, leads to an increase in repair of UVB-induced CPD. Therefore, this BMT diol may be useful for ameliorating the damaging effects of UVB.

BRCA1 Protein↗

Relationship between cardiovascular functions and ionic hypocalcemia induced by citrate infusion in anhepatic swines: CaCl2 therapy in severe ionic hypocalcemia.

Baseline and serial values of serum [Ca++], [K+], [Na+], arterial blood gas tensions, acid-base status, temperature and hemodynamic functions were measured during infusion of citrate-phosphate-dextrose (CPD) solution (0.35 ml.kg-1 x min-1) in anhepatic pigs of three randomized groups. Thirteen pigs (group I) continued to receive intravenous infusion of CPD solution until cardiac arrest. When mean arterial pressure (MAP) decreased to about 50 mmHg (group II, n = 7), or 40 mmHg (group III, n = 7) infusion of CPD solution was discontinued, and pigs received CaCl2 (20 mg/kg) intravenously. Serial (1, 4, 8, and 12 min after CaCl2 administration) values of all the above variables and serum citrate at baseline and lowest [Ca++] were measured. After hepatectomy and venovenous bypass, cardiac output (CO) decreased 30%. When ionic hypocalcemia was above 0.7 mM, there was no significant change of cardiovascular functions. When [Ca++] was between 0.34-0.7 mM, there were linear relationships between [Ca++] and CO, systemic vascular resistance (SVR) and MAP, respectively. When [Ca++] was below 0.34 mM, cardiovascular functions decreased abruptly, and the pigs died at [Ca++] of 0.26 +/- 0.06 mM. When [Ca++] decreased to 0.36 +/- 0.06 mM and MAP to 50 +/- 4 mmHg, most hemodynamic functions could be reversed by calcium therapy. However, when [Ca++] decreased to 0.33 +/- 0.05 mM and MAP to 40 +/- 2 mmHg, hemodynamic functions could not be reversed by calcium therapy alone.

Animals↗

Scanning electron microscopy of the mammalian organ of Corti: assessment of preparative procedures.

Different fixation, drying and coating procedures have been applied in preparation of the organ of Corti for scanning electron microscopy (SEM), and structural features of the apical surface of the tissue in unfixed, freeze-fractured preparations used in assessing their effects on morphology. Fixation with glutaraldehyde alone or osmium tetroxide alone causes artefacts that are substantially avoided when tissue is doubly fixed in glutaraldehyde followed by osmium. Significant improvements in preservation are also obtained when tissue is additionally processed through thiocarbohydrazide-osmium (TOTO) processing. In addition to providing a conducting coat, it stabilises the tissue against deformations that might otherwise occur during drying, and reduces the extent of tissue shrinkage. Freeze-drying of TOTO processed tissue produces less tissue distortion than critical point drying (CPD) but is not so easy to apply routinely. The distortions of structure in TOTO-processed CPD tissue are not significant and this may be the preferred procedure for routine use, but air drying from hexamethyldisilazane is a useful alternative, producing results as good as those from CPD samples if TOTO processing is applied beforehand. One particular advantage of freeze-drying, though, is that after freezing, brittle fracture through the tissue can occur making examination of intracellular structure by SEM relatively easy. However, again, TOTO processing prior to freezing is of value as this appears to prevent the formation of large ice-crystal during freezing. Examination of isolated outer hair cells by SEM shows that isolation procedures do not cause significant damage to the stereociliary bundles.

Animals↗

The BDI and the SF36: which tool to use to screen for depression?

Recent studies have suggested a relationship between depression--as assessed by the Beck Depression Inventory (BDI)--and mortality in end-stage renal disease (ESRD) patients. A recent study from the Dialysis Outcomes and Practice Patterns Study (DOPPS) indicated an association between mortality in a large cohort of hemodialysis patients and the patients' responses in the preceding 4 weeks to two questions on the Kidney Disease Quality of Life, Short Form (KDQOL-SF36): "Have you felt downhearted and blue?" and "Have you felt so down in the dumps that nothing could cheer you?" A BDI score > or = 11 and a score < or = 3 for the two questions on the SF36 were considered to suggest the presence of depressive symptoms; both scores have been associated with increased mortality in hemodialysis patients. We aimed to examine the relationship of the two SF36 questions with depressive symptoms as assessed by the BDI. All patients on chronic peritoneal dialysis (CPD) therapy and daily hemodialysis therapy in our units between June 2000 and January 2002 were asked to complete a BDI and an SF36. We recorded 135 tests in 80 CPD patients, and 76 tests in 17 daily hemodialysis patients. Correlation coefficients (r2 values) of the responses to the two questions on the SF36 and the BDI scores demonstrated a significant relationship between the scores. The r2 values for the CPD patients' two SF36 responses and the BDI scores were -0.622 and -0.506; the r2 values for the daily hemodialysis patients were -0.363 and -0.317. The sensitivity and specificity for each SF36 response to be < or = 3 when the BDI was > or = 11 were 82.4% and 68.6% for the "downhearted and blue" question and 65% and 67% for the "down in the dumps" question. Whether the two questions on the SF36 that suggest depression can replace the BDI as a screening tool requires further study. Furthermore, it is unclear if the two questions on the SF36 are predictive of mortality because of their association with clinical depression or because of other issues.

Depression↗

Outcome in children on chronic peritoneal dialysis.

In this retrospective study, we evaluated the causative factors, outcomes, and complications of therapy in 35 patients (16 girls, 19 boys) started on chronic peritoneal dialysis (CPD) between 1997 and 2002. Average age at initiation of CPD was 9.3 +/- 4.4 years. All patients started on continuous ambulatory peritoneal dialysis (CAPD). Nine patients switched to ambulatory peritoneal dialysis (APD) during the follow-up period. The most common cause leading to end-stage renal disease (ESRD) in the patients was reflux nephropathy (22.9%). The major complication during therapy was peritonitis, with 41 episodes seen in 17 patients (1 episode per 18 patient-months). Of the children on APD, 7 developed 17 episodes of peritonitis (1 episode per 8.3 patient-months); of the children on CAPD, 10 developed 24 peritonitis attacks (1 episode per 24.9 patient-months). The other complications were inguinal hernia in 3 patients, subcutaneous leak in 4 patients, dialysate leak in 2 patients, pericardial effusion in 1 patient, umbilical hernia in 1 patient, hydrothorax in 1 patient, and cuff protrusion in 3 patients. During the follow-up period, 4 patients died owing to sepsis or cardiopulmonary complications. Only 1 patient was transferred to hemodialysis (owing to persistent Candida peritonitis). We think that CPD therapy is a good choice of treatment modality in the management of children with ESRD.

Adolescent↗

Differences in smoking and quitting experiences by levels of smoking among African Americans.

BACKGROUND: Despite smoking fewer cigarettes per day than their White counterparts, African Americans have higher tobacco-related morbidity and mortality. Since most tobacco control efforts have focused on heavy smokers, little is known about smoking and quitting experiences of African-American occasional and light smokers. METHODS: We conducted a survey of 484 African-American smokers, which included: 104 occasional (smoked in < or = 25 of last 30 days), 176 light [smoked 1-10 cigarettes per day (cpd)], 69 moderate (11-19 cpd), and 135 heavy (> or = 20 cpd) attending an inner-city clinic. The survey assessed their sociodemographic characteristics, smoking characteristics, and cessation experiences. RESULTS: Compared with moderate and heavy smokers, occasional and light smokers were, on average, younger, more likely to be female, and more likely to initiate regular smoking at an older age. Forty percent of occasional smokers used other tobacco products compared to 23.3%, 24.6%, and 27.4% for light, moderate, and heavy smokers, respectively. Motivation and confidence to quit were higher among occasional and light smokers. Interest in participating in a formal cessation program was equally high in all 4 groups (mean ranged from 7.6-8.0 on a scale of 1-10). The use of pharmacotherapy for smoking cessation was similar, and generally low, among all 4 groups. CONCLUSIONS: High levels of motivation for smoking cessation exist among African-American occasional and light smokers. The interest of these lighter smokers in smoking cessation represents a window of opportunity to design programs for a group that has been excluded from most cessation interventions.

Adult↗

Serum levels of prostate-specific antigen and vitamin D in peritoneal dialysis patients.

Measuring the free:total ratio of prostate-specific antigen (f/t-PSA) can improve the specificity of single-serum PSA values, distinguishing between benign prostatic hyperplasia (BPH) and prostatic carcinoma (PCa) in men over the age of 50. Additionally, clinical trials have shown that dihydroxyvitamin D3 can slow the rate of PSA rise in PCa patients. However, little is known regarding the applicability of those findings in men undergoing chronic peritoneal dialysis (CPD). In the present study, we investigated the prevalence of increased serum PSA levels among CPD patients and correlated those values with serum levels of vitamin D [25-hydroxyvitamin D3 and 1,25-dihydroxyvitamin D3]. We undertook a cross-sectional study of 71 male CPD patients without a known history of prostate cancer from 24 centers in Canada, Greece, and Turkey. All of the patients were more than 50 years of age. In these patients, we measured serum concentrations of PSA, free PSA (f-PSA), total PSA (t-PSA), prostate alkaline phosphatase (PAP), 25-hydroxyvitamin D3, 1,25-dihydroxyvitamin D3, and intact parathyroid hormone (iPTH). We recorded serum PSA levels < 4 ng/mL in 62 patients (87.3%, group A) and levels > 4 ng/mL in 9 patients (12.7%, group B). The f/t-PSA ratio was < 0.25 in 16 patients (22.5%). Group B patients were older than those in group A (median: 73 years vs. 65 years, p < 0.01) and had a lower body weight (median: 66.5 kg vs. 76.7 kg, p < 0.05). We observed no statistically significant difference between the two groups for serum 1,25-dihydroxyvitamin D3 (median: 9.8 ng/mL vs. 10.1 ng/mL) or 25-hydroxyvitamin D3 (8 ng/mL vs. 8.2 ng/mL) levels. Also, we observed no correlation between vitamin D levels and f/t-PSA, but iPTH levels were significantly higher in group A (200.5 pg/mL vs. 61.2 pg/mL, p < 0.04). Also, serum PAP levels correlated significantly with PSA (r = 0.49, p = 0.01) and with f-PSA (r = 0.56, p = 0.000). Our results showed no clear relationship between vitamin D and serum levels of PSA or-of f/t-PSA in PD patients. However, further studies are needed to better define the uses of these PSA markers in PD patients because, in such patients, other relevant factors might be implicated in their predictive value.

Aged↗

Prediction of claudication pain from clinical measurements obtained at rest.

The ability to predict claudication pain during single-stage (S) and progressive (P) treadmill protocols from clinical measurements obtained at rest was examined. Peripheral hemodynamic measurements from the more severely diseased lower limb and medical history data were obtained from 56 claudicant patients during supine rest immediately preceding S (1.5 mph and 7.5% grade) and P (2 mph, 0% grade with 2% increase every 2 min) treadmill protocols. Distance walked to onset of claudication pain (CPD) and to maximal pain (MPD) during both protocols were recorded. The claudication distances during the S protocol were not correlated with either the peripheral hemodynamic or medical history variables. In contrast, CPD and MPD during the P protocol were predicted (P less than 0.05) by ankle/brachial systolic blood pressure index (ABI) (quadratic relationship), laterality of claudication pain (1 = unilateral, 2 = bilateral), and gender (1 = female, 2 = male) from the following regression equations: CDP (m) = 159.9 - (321.8 x ABI) + (445.6 x ABI2) - (93.5 x laterality) + (99.0 x gender), R = 0.74, R2 = 0.55, adjusted R2 = 0.53, SEE = 110.5, P less than 0.0001; and MPD (m) = 83.1 + (195.0 x ABI) + (174.0 x ABI2) - (76.4 x laterality) + (114.2 x gender), R = 0.76, R2 = 0.58, adjusted R2 = 0.55, SEE = 138.3, P less than 0.0001. It is concluded that the regression equations for the prediction of CPD and MPD may be used to quickly estimate the functional severity of peripheral vascular occlusive disease in clinical settings where treadmill testing is not feasible or is impractical.

Aged↗

Access to continued professional education among health workers in Blantyre, Malawi.

OBJECTIVE: To describe the current status of continued professional development (CPD) of healthcare personnel within the Ministry of Health (MoH) health centres in Blantyre, Malawi. DESIGN: A cross-sectional descriptive study utilizing an interviewer-administered questionnaire. SUBJECTS: Healthcare workers in public health centers in Blantyre District, Malawi. RESULTS: Fifty-seven healthcare workers participated of whom 47 (82.5%) were nurses, 8 (14.0%) were either medical assistants or clinical officers, and one laboratory technician and a dental therapist. At the time of the study, 50(87.7%) were prescribers and 54 (94.7%) had ever issued a prescription for medications. Participation in workshops and seminars within the past 12 months was reported by 54 (94.7%) of the participants and 49 (86.0%) reported that their health facilities had clinical hand-over meetings. All participants indicated desire to receive professional journals for free while only 35 (61.4%) were willing to pay for a journal subscription. Current personal and institutional subscription to a journal was low, at 2 (3.5%) each. About 30% had been trained to conduct research and 23 (40.1%) had ever conducted research with only 3 (5.3%) ever written a journal or newsletter article. 47.4% had access to a working phone at work and only 3 (5.3%) had access to internet facilities at all. Only 21% were satisfied with their own knowledge on health matters. CONCLUSIONS: Healthcare professionals in Blantyre's DHO zone are using mostly clinical hand-over meetings, seminars and workshops for their CPD. There is need to improve access to relevant professional journals. The regulatory or licensing boards for healthcare professional in Malawi should seriously consider mandatory CPD credits for re-registration.

Adult↗

Pregnancy in patients on dialysis--experience at a referral center.

OBJECTIVE: Pregnancy is infrequent in women with end-stage renal disease. The frequency of conception in dialysis patients has been reported as 0.3% to 1.4% in different studies from different countries. In the present study the frequency and outcome of pregnancies from a referral center in Saudi Arabia from January 1992 to December 2003 is reported. METHODS: All females on maintenance hemodialysis (MHD) and chronic peritoneal dialysis (CPD) were reviewed. Files of the patients in childbearing age (less than 50 years) were analyzed for the frequency of pregnancy, mode of dialysis, complications and outcome. Of the 192 females taken for MHD and CPD, 113 were of the childbearing age. Five patients were already on HD when they became pregnant, the period on HD varied from 7-34 (mean = 24) months and in 4 dialysis was initiated during first pregnancy. (Abortion was defined as termination of pregnancy before 22 weeks of gestation. Perinatal mortality was taken as death of a viable fetus after 22 weeks of gestation or within 4 weeks after delivery. Preterm was defined as delivery before 37 weeks of gestation and low birth weight as a baby weighing less than 2500 gm at birth). RESULTS: Twelve pregnancies were noted in 9 patients (7.9%) with a yearly frequency of 0.66%. All pregnancies were noted in patients on MHD and none on CPD. Seven pregnancies (58%) ended in live births and all were preterm deliveries in the range of 27-36 (mean 31.5) weeks. All babies were low birth weight ranging from 1115-2300 (mean 1700) gram. Three deliveries were spontaneous vaginal and 4 underwent lower segment cesarean sections. Two deliveries ended in perinatal mortality. Three pregnancies ended in spontaneous abortions between 10-20 (mean 12) weeks. One woman had 3 pregnancies, the last one ending in antepartum hemorrhage, hysterotomy and hysterectomy for rupture of uterus. Another patient had 2 pregnancies. No congenital abnormalities were noted in any of the live births. CONCLUSION: Pregnancy though uncommon in women on dialysis can occur. Preterm deliveries with low birth weight are usual though live birth rate of 58% was observed. In view of the need for increased frequency of dialysis for successful outcome, planning the pregnancy and high chances of dangerous complications, early diagnosis of pregnancy in a patient on dialysis essential.

Adolescent↗

Allergic dermatitis caused by povidone iodine: an uncommon complication of chronic peritoneal dialysis treatment.

Allergic dermatitis around the catheter exit site, caused by topical antiseptics such as povidone iodine and chlorhexidine gluconate, is an uncommon complication in patients on chronic peritoneal dialysis (CPD). As yet, published reports concerning this rare non catheter-related complication are few. The frequency of this type of dermatitis is not known, because reports of isolated cases constitute the only source of information. Here, we report our clinical experience with 2 patients (2.3%) among the 86 children with end-stage renal disease who underwent CPD treatment at our center during the period between November 1995 and December 2004. These 2 pediatric patients developed allergic contact dermatitis, with extensive patchy and linear erythema around the exit-site area because of administration of povidone iodine solution. The symptoms subsided within a week in both patients after daily topical application of normal saline solution was started. Allergic dermatitis caused by povidone iodine at the site of the catheter exit should be kept in mind as a complication in patients on CPD. Antiseptic solutions should be used cautiously in these patients.

Adolescent↗

Clinical practice guideline for cesarean section due to cephalopelvic disproportion.

OBJECTIVES: To evaluate the effect of the Clinical Practice Guideline (CPG) for cesarean section due to Cephalopelvic Disproportion (CPD) on physician compliance, pregnancy outcomes and cesarean section rate. The study also wants to identify factors associated with physician non-compliance. MATERIAL AND METHOD: 455 medical records of women undergoing a cesarean section due to CPD from January 1, 2002 to December 31, 2003 were reviewed The CPG was implemented on January 1, 2003. The pregnant outcomes of women who delivered from January 1, 2002 to December 31, 2002 were used for comparison. The outcome measurements were physician compliance, pregnancy outcomes and cesarean section rates. Multivariate logistic regression analysis was used to identify factors associated with physician non-compliance. Independent variables included private care, parity, maternal height, Bishop score, maternal age and estimated fetal weight. RESULTS: The compliance rate was 83%. Physician compliance in private practice was lower than in non-private practice (76.6% VS 92.4%). Pregnancy outcomes were not different between the two periods. The cesarean section rates before and after implementation of the CPG were 8.4% and 8.5%, respectively. Private practice, poor Bishop score and estimated fetal weight < or = 3500 g were significant predictors of physician non-compliance. CONCLUSION: The compliance rate was high, but the cesarean section rate due to CPD did not significantly change within a one year period There was no adverse outcome. Physician non-compliance was more common in private practice. Poor Bishop score and high estimated fetal weight were significant predictors.

Adult↗

Enhancement of phagocytosis by Compound 48/80 and its influence upon Ca++-dependent ATP-ase.

A new activity of p-methoxy-phenylethyl-methyl-amine condensed by formaldehyde (Cpd 48/80) has been established: enhancement of phagocytosis. This property seems to be correlated to its ability to activate lysosomes. Enhancement of phagocytosis is discussed in relation to the virus penetration process. Furthermore it was found that Cpd 48/80 and to a smaller degree the dimer inhibit the Ca++-dependent ATP-ase (E. C. 3.6.1.3.) from human red blood cells. The enzyme from bovine myosin is not inhibited by the dimer, but somewhat more by poly-THIQ (7-methoxy-tetrahydroisoquinoline condensed by formaldehyde) than by Cpd 48/80. These properties are discussed in relation to a general hypothesis of virus-induced giant cell formation. Finally it has been shown that the drug does not influence the PHA-stimulation (phytohemagglutinin) of lymphocytes, indicating selectivity of its activity.

Adenosine Triphosphatases↗

Compatibility of packed erythrocytes and Ringer's lactate solution.

Packed erythrocytes are frequently reconstituted with crystalloid during rapid infusion. Dilution of whole blood with calcium containing solutions, such as Ringer's lactate has been cautioned against, citing possible clot formation because of chelation of the citrate anticoagulant. We studied the compatibility of Ringer's lactate solution and citrate phosphate dextrose (CPD)-preserved packed erythrocytes to evaluate the safety of using Ringer's lactate solution as a diluent in the emergency setting. Aliquots of CPD-preserved packed erythrocytes were diluted with either Ringer's lactate or normal saline solutions in ratios between 5:1 to 1:20 (packed erythrocyte to crystalloid), incubated at room temperature or 37 degrees centigrade and examined for clot formation at intervals up to two hours. Although clotting occurred at dilutions of 1:1 (packed erythrocytes to Ringer's lactate solution) and beyond, no clot formation occurred in the clinically relevant dilutions between 5:1 and 2:1. Thirty-two additional units of CPD-preserved packed erythrocytes were diluted to hematocrit values of 35, 45, 55 or 65 per cent and passed through a 170 micron filter. Flow rates of packed erythrocytes diluted with Ringer's lactate and normal saline solutions were compared. There was no difference in flow rates between packed erythrocytes diluted with Ringer's lactate compared with normal saline solutions. Ringer's lactate solution can be safely used as a packed erythrocyte diluent in patients requiring rapid blood transfusions.

Anticoagulants↗

[The development of an antimony electrode with a built-in thermocouple and a temperature-compensated pH meter for the determination of intramyocardial pH during open-heart surgery].

Myocardial acidosis as reflected in pH measured by a glass (G) electrode during ischemic arrest may adversely affect postoperative cardiac function. However, (G) is slow in response and fragile. We report the development of an antimony electrode (Sb) and a pH meter based on our investigation and the results of their clinical application. As a biological material, CPD blood was chosen and subjected to a series of experiments determine its pH by (Sb) and (G). There was a small (within 0.1), but statistically significant difference in pH between (Sb) and (G). To simulate myocardial cooling during operation, CPD blood was cooled and its pH measured by (Sb) and (G). (Sb) showed significantly different behaviour from (G), i,e, the pH tended to fall with the falling temperature, whereas with (G) it tended to rise as had been previously known. The thermodynamic property of (Sb) was checked in appropriate buffer solutions by varying their temperatures. There was an almost linear correlation between EMF by (Sb) and the temperature of the buffer solutions (1 mV/1 degree C, or 0.017 pH/1 degree C). Accordingly, a pH meter incorporating an electronic circuit compensating for the temperature-depending EMF and a (Sb) with a built-in-thermocouple were constructed. Utilizing the new apparatus, CPD blood was again tested and it was proved that the new electrode and the pH meter worked in similar manner to (G). The new apparatus was applied to a series of measurement of intramyocardial pH during open-heart surgery and the results compared with that previously obtained by (G). There were no significant differences either between control pH or rate of its fall in the initial 10 minutes. following aortic cross-clamping and the administration of the cardioplegic solution. It is concluded that although (Sb) is not as accurate as (G), it is a reasonable alternative for the determination of the intramyocardial pH during open-heart surgery.

Cardiac Surgical Procedures↗