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PubMed2000

Next-generation pulse oximetry. Focusing on Masimo's signal extraction technology.

Pulse oximeters are used to determine trends in patients' blood oxygen saturation and to warn of dangerous saturation levels. But conventional pulse oximetry has some inherent limitations. For example, it has difficulty monitoring patients who are moving or who have poor perfusion; it is also subject to interference from certain visible and infrared light sources. Over the past several years, a number of companies have developed advanced signal-processing techniques that allow pulse oximeters to overcome many of these limitations. We refer to such new technologies as next-generation pulse oximetry. In this Evaluation, we focus on the first next-generation technology to have reached the market: Masimo Corporation's Signal Extraction Technology (SET). We designed our study of Masimo SET to address the main question that needs to be asked of any next-generation technology: How well does it compare to conventional pulse oximetry? Specifically, how well does it perform when a patient is moving or being moved, when a patient is poorly perfused, or when certain types of light strike the sensor while it is attached to or detached from the patient? We also examined one type of sensor used with this product, comparing it to conventional tape-on sensors for comfort and durability. Several other next-generation pulse-oximeter products have become available since we began this study. We are currently evaluating these products and will publish our findings in the near future. A list of the products, including a brief description of each, is included in this article. Pulse oximeters are used to determine trends in patients' blood oxygen saturation and to warn against dangerous saturation levels. These monitors are often vital in helping to ensure patient safety, especially for critically ill patients, pediatric patients, and neonates. But conventional pulse oximetry has some inherent limitations--most significantly, it has difficulty monitoring patients who are moving or who have poor perfusion. Although gradual improvements have been made to the technology, only recently has it advanced to the point where it has really begun to overcome these limitations. A number of manufacturers have developed advanced signal-processing algorithms that allow pulse oximeters to "read through" motion and conditions of poor perfusion. The first of these "next-generation" pulse-oximeter technologies that reached the market was Masimo Corporation's Signal Extraction Technology (SET). We tested that product in this Evaluation. In this Overview, we'll tell you about conventional pulse oximetry and its shortfalls, next-generation technology and how it's designed to improve on the old methods, and how we approached our Evaluation of Masimo SET.

Adult↗
PubMedDate not supplied

Generation of cytotoxic effector lymphocytes by MLTC using tumor cells genetically modified to secrete interleukin-2.

The in vitro generation of effector lymphocytes cytotoxic to cancer cells, was investigated with a mixed lymphocyte-tumor culture (MLTC) system using genetically modified human cancer cells, followed by stimulation with the interleukin (IL)-2 plus immobilized anti-CD3 antibody (IL-2/CD3) system. A gastric cancer cell line, GC022588 (HLA-A2, 24, B35, 55, C1,3), was retrovirally transduced with the human interleukin (IL)-2 gene (GC/IL-2) or the neomycin-resistance gene (GC/Neo). The secretion of biologically active IL-2 was detectable in GC/IL-2 cells but not in GC/Neo or parental GC022588 cells. The cytotoxic activity against the parental GC022588 cells of peripheral blood mononuclear cells (PBMC) was greater among PBMC activated with MLTC using GC/IL-2 than among those activated with MLTC using GC/Neo or without MLTC. The IL-2/CD3 stimulation could efficiently expand the effector lymphocytes without any reduction of the cytotoxic activity generated. The cytotoxic activity generated by this system was reproducible in several HLA-A2- or A24-positive donors. The effector lymphocytes could kill the other adenocarcinoma cells expressing HLA-A2 or A24. The phenotypes of the effector lymphocytes generated with the system were 40% CD4+ and 70% CD8+. Both phenotypes may have been responsible for the cytotoxicity. The removal of adherent cells from PBMC before the MLTC did not affect the generation of cytotoxicity, whereas neutralization of tumor-derived IL-2 with a specific antibody during the MLTC significantly inhibited the generation of cytotoxicity. These results suggest that IL-2 gene-transduction augments the immunogenicity of the tumor cells that efficiently stimulate lymphocytes to be cytotoxic, and that the IL-2/CD3 system may be practical for the expansion of effector lymphocytes for use in adoptive immunotherapy for cancer. The mechanism by which IL-2 gene-modified tumor cells stimulate immune reactivity was discussed.

Adenocarcinoma↗
PubMed2000

Healthcare risk waste in Saudi Arabia. Rate of generation.

OBJECTIVE: To assess the amount of healthcare risk waste generated by health establishments in Saudi Arabia METHODS: A healthcare waste management questionnaire was applied in 27 hospitals, and 16 primary health centres and clinics. The total quantity of healthcare risk waste collected in 24 hours in each of these establishments was weighed. Calculations were carried out to get hospitals rate of healthcare risk waste generation and primary healthcare centres risk waste generation. The total national estimate of healthcare risk waste production in kilograms/year for the whole health establishments in the Kingdom was then calculated. RESULTS: The mean hospital healthcare risk waste rate of generation was 1.13+/-0.96 kg/bed/day. The mean primary healthcare centres and clinics healthcare risk waste rate of generation was 0.08+/-0.08 kg/visitor/day. The estimated mean amount of all healthcare risk waste generated in the Kingdom of Saudi Arabia is 25,207 tons/year. CONCLUSION: Healthcare establishments in Saudi Arabia produce healthcare risk waste. Much care is given by the responsible authorities for the management of that type of waste. A program is being established to formulate standards for healthcare waste management

Ambulatory Care Facilities↗
PubMed2002

Inhibition of thrombin generation in plasma by fibrin formation (Antithrombin I).

The adsorption of thrombin to fibrin during clotting defines "Antithrombin I" activity. We confirmed that thrombin generation in afibrinogenemic or in Reptilase defibrinated normal plasma was higher than in normal plasma. Repletion of these fibrinogen-deficient plasmas with fibrinogen 1 (gamma A/gamma A), whose fibrin has two "low affinity" non-substrate thrombin binding sites, resulted in moderately reduced thrombin generation by 29-37%. Repletion with fibrinogen 2 (gamma'/gamma A), which in addition to low affinity thrombin-binding sites in fibrin, has a "high affinity" non-substrate thrombin binding site in the carboxy-terminal region of its gamma' chain, was even more effective and reduced thrombin generation by 57-67%. Adding peptides that compete for thrombin binding to fibrin [S-Hir53-64 (hirugen) or gamma'414-427] caused a transient delay in the onset of otherwise robust thrombin generation, indicating that fibrin formation is necessary for full expression of Antithrombin I activity. Considered together, 1) the increased thrombin generation in afibrinogenemic or fibrinogen-depleted normal plasma that is mitigated by fibrinogen replacement; 2) evidence that prothrombin activation is increased in afibrinogenemia and normalized by fibrinogen replacement; 3) the severe thrombophilia that is associated with defective thrombin-binding in dysfibrinogenemias Naples I and New York I, and 4) the association of afibrinogenemia or hypofibrinogenemia with venous or arterial thromboembolism, indicate that Antithrombin I (fibrin) modulates thromboembolic potential by inhibiting thrombin generation in blood.

Afibrinogenemia↗
PubMed2002

Suppressive Effects of Edible Thai Plants on Superoxide and Nitric Oxide Generation.

We screened ethanol extracts from a total of 134 species of edible Thai plants for their suppressive effects on superoxide (O2(-)) generation using a xanthine (XA)-xanthine oxidase (XOD) assay system. When the extracts were tested at a concentration of 500 &mgr;/g/ml, 28.4% significantly suppressed O2(-) generation. Of these active extracts, it was found that in 17.9% of cases the action was due to XOD inhibition, in 1.5% due to O2(-) scavenging activity, and in 9% due to both XOD inhibition and O2(-) scavenging. In addition, some plant extracts (25 species) which had been known to possibly possess anti-tumor promoting activity were tested for O2(-) and NO generation in cellular systems. In this test, 13 species exhibited strong inhibitory activity toward both O2(-) and NO generation. From the fruit pods of Oroxylum indicum (Bignoniaceae), a traditional vegetable in Thailand, two flavones, oroxylin A and chrysin, and a triterpene carboxylic acid, ursolic acid (UA), were identified as inhibitors of O2(-) generation in XA/XOD system. These compounds also showed marked inhibitory effects on the tumor promoter 12-O-tetradecanoylphorbol-13-acetate (TPA)-induced O2(-) generation in dimethylsulfoxide (DMSO)-differentiated HL-60 cells. Our results suggest that, as we have reported earlier, edible Thai plants are promising sources of antioxidants with chemopreventive potential.

Journal Article↗
PubMed1992

Long-term generation of colony-forming cells in liquid culture of CD34+ cord blood cells in the presence of recombinant human stem cell factor.

Human cord blood was used as a source of progenitor and stem cells to evaluate the effect of recombinant human stem-cell factor (SCF) on colony formation and the generation of colony-forming cells (CFC) under highly defined, serum-deprived conditions. SCF interacted with a number of hematopoietic growth factors to stimulate colony growth and was particularly effective in stimulating the formation of mixed-cell colonies from CD34+ soybean agglutinin negative (SBA-) cells. In suspension culture of CD34+, SBA- cells, SCF alone was unable to maintain cell numbers or CFC but, in combination with interleukin-3 (IL-3), increased input numbers of cells by 10-fold and increased CFC of all kinds by nearly 20-fold. This included erythroid burst-forming cells (BFU-E), granulocyte/macrophage (GM) CFC, and mixed-cell CFC. In contrast, CD34- SBA- cells neither gave rise to CFC nor were maintained by combinations of growth factors including SCF. SCF interacted with erythropoietin (Epo) and granulocyte colony-stimulating factor (G-CSF) to maintain large numbers of cells as well as to generate a twofold to threefold increase in CFC in the case of Epo, and a 10-fold increase in CFC in the case of G-CSF. With Epo, the predominant CFC generated were BFU-E and erythroid CFC and many of the cells in suspension were erythroblasts. In contrast, SCF plus G-CSF resulted in large numbers of granulocytes at various stages of maturation and the CFC generated were almost exclusively granulocytic-CFC. IL-1 and IL-6, alone or in combination with SCF, showed little or no ability to increase cell numbers or generate CFC. In summary, SCF interacts with a variety of hematopoietic growth factors to promote colony formation, particularly mixed-cell colony formation, and also, in suspension culture, SCF interacts with IL-3, G-CSF, and Epo to generate large numbers of differentiated cells as well as a variety of CFC for up to 1 month.

Antigens, CD↗
PubMed2004

Effect of stobadine on opsonized zymosan stimulated generation of reactive oxygen species in human blood cells.

To predict more precisely the effect of stobadine, a pyridoindole antioxidant agent, in the whole organism, we studied its effect on opsonized zymosan-stimulated free radical generation in whole blood, on superoxide generation in the mixture of PMNL : platelets (1:50), as well as on superoxide generation and myeloperoxidase release in isolated PMNL. Without stimulation, stobadine had no effect on reactive oxygen species (ROS) generation and myeloperoxidase release. Stobadine in a concentration of 10 or 100 micromol/l significantly decreased luminol-enhanced chemiluminescence in opsonized zymosan-stimulated whole blood. In concentrations of 10 and 100 micromol/l, it reduced myeloperoxidase release from isolated neutrophils. Stobadine significantly decreased superoxide generation in isolated neutrophils in 100 micromol/l concentration. Its effect was much less pronounced in the mixture of neutrophils and platelets in the ratio close to physiological conditions (1:50). Our results suggest that stobadine might exert a beneficial effect in diseases or states where superfluous ROS generation could be deleterious.

Adult↗
PubMed2004

Second-generation HIV surveillance: better data for decision-making.

This paper seeks to outline the key elements of the expanded surveillance efforts recommended by the second-generation HIV surveillance approach. Second-generation systems focus on improving and expanding existing surveillance methods and combine them in ways that have the greatest explanatory power. The main elements of this approach include: considering biological surveillance - HIV, AIDS, sexually transmitted infections (STIs) - and behavioural surveillance as integral components, targeting surveillance efforts at segments of the population where most new infections are concentrated - which might differ depending on the stage and type of the epidemic - and providing the rationale for the optimal use of data generated for monitoring the HIV epidemic and evaluating national AIDS control programmes. The paper emphasizes improvements in existing surveillance methodologies and discusses in detail crucial issues such as the validity of HIV prevalence data measured in pregnant women and linking HIV surveillance and behavioural data collection. In addition, a strategic partnership between second-generation surveillance and AIDS programme evaluation is proposed that stresses the complementary roles of these data collection activities in determining the effectiveness of prevention and care programmes and explaining the epidemiological trend data collected by sentinel serosurveillance systems. In conclusion, second-generation HIV surveillance systems provide a comprehensive, cost-effective and appropriate response to the information needs of AIDS control programmes. The implementation of such systems, including a better use of the data generated by the system, will ensure that national programmes are in the best possible position to respond to the challenges of the epidemic.

Behavioral Risk Factor Surveillance System↗
PubMed2004

Pregnancy outcome of Mexican-American women: the effect of generational residence in the United States.

OBJECTIVE: To determine whether duration of generational residence in the United States is associated with the pregnancy outcome of Mexican Americans. DESIGN: This is a population-based study. METHODS: Stratified analyses were performed on a data set of 1989-1991 Illinois computerized vital records of Mexican-American infants. RESULTS: First generation (N=2,203) and second or higher (N=4,192) US-born Mexican-American women had infant low birth-weight rates of 7.5% and 6.1%, respectively, compared to 5.1% for Mexican-born women (N=39,050); relative risk=1.4 (1.2-1.7) and 1.2 (1.1-1.4), respectively. Among women with one or more high-risk sociodemographic characteristics (age less than 20 years, educational attainment less than 12 years, unmarried, high parity, or inadequate prenatal care), first generation (N=1,624) and second or higher generation (N=2,874) US-born Mexican-American women had infant low birth-weight rates of 8.3% and 6.5%, respectively, vs 5.2% for Mexican-born women (N=33,625); relative risk = 1.6 (95% confidence interval [CI], 1.3-1.9) and 1.2 (95% CI, 1.0-1.4), respectively. Among women with the lowest sociodemographic risk profile, infant low birthweight rates did not vary between the subgroups. CONCLUSIONS: For second or higher generation US-born Mexican-American women, the rate of infant low birth weight does not exceed that of first generation US-born women; it actually approximates that of Mexican-born women across a broad range of sociodemographic characteristics.

Adult↗
PubMed2004

Anti-tissue factor pathway inhibitor activity in subjects with antiphospholipid syndrome is associated with increased thrombin generation.

BACKGROUND AND OBJECTIVES: Immunoglobulin G (IgG) fractions from subjects with antiphospholipid syndrome (aPS) have previously been demonstrated to have inhibitory activity against tissue factor pathway inhibitor (TFPI). This may contribute to the development of a prothrombotic state by impaired regulation of the tissue factor (TF) pathway. This study investigated the effect that IgG fractions from aPS subjects containing anti-TFPI activity have on in vitro TF-induced thrombin generation. DESIGN AND METHODS: TFPI and anti-TFPI activities were determined in normal controls (n=29) and aPS subjects (n=57). TFPI activity was determined using an amidolytic assay based on the generation of factor Xa. Anti-TFPI activity was determined after incubating IgG isolated from a control or subject plasma with pooled normal plasma, using the TFPI activity assay. The influence of IgG fractions from controls (n=10) and subjects (n=23) on TF-induced in vitro thrombin generation was determined using a chromogenic assay of thrombin activity. RESULTS: TFPI activity in controls (1.13+/-0.25 U/mL) was significantly lower than in subjects (1.30+/-0.42 U/mL) (p < 0.05). Anti-TFPI activity was significantly higher in subjects than controls (p = 0.0001). TF-induced thrombin generation was positively associated with anti-TFPI activity (r = 0.356; p > 0.05), with increased levels of each demonstrated in 5 subjects. INTERPRETATION AND CONCLUSIONS: Anti-TFPI activity was confirmed in 65% of aPS subjects. IgG fractions demonstrated a variable ability to interfere with TFPI function and TF-induced thrombin generation. Cross-reacting antiphospholipid antibodies and/or other entities may interfere with TFPI function, resulting in a net increase in thrombin generation and an increased thrombotic risk.

Adult↗
PubMed2004

[A long-acting second generation anti-psychotic--experience in Israel].

Schizophrenia is a chronic disease characterized by psychotic symptoms as well as negative symptoms such as affective flattening, social withdrawal and occupational dysfunction. Anti-psychotic medications reduce the risk of psychotic exacerbations and hospitalization. Poor compliance is common among patients with schizophrenia. Long-acting medications have such advantages as stabilizing drug levels and improving compliance. Second generation anti-psychotic medications were found to be more effective and tolerable compared to first generation drugs. These medications cause less extra-pyramidal symptoms, and compliance with them was shown to be better. Until recently there were only first generation long-acting anti-psychotics in use. Recently a new second generation long-acting anti-psychotic drug was introduced in Israel. We present our experience with a first schizophrenic patient treated with long-acting Risperidone (Risperdal Consta). The patient was treated in the past with several first generation anti-psychotics and suffered severe extra-pyramidal symptoms. His compliance with treatment was poor. Under treatment with oral Risperidone a considerable improvement was recorded, however compliance remained poor. Under treatment with long-acting Risperidone, Intramuscularly 25 Mg every two week, both positive and negative symptoms improved substantially, as well as compliance with treatment. The results of this case study encourage us to believe that many more patients will benefit from the advantages of both a second-generation anti-psychotic and a long-acting preparation.

Adult↗
PubMed2005

New-generation pulse oximetry in the care of critically ill patients.

OBJECTIVE: To review the published, peer-reviewed studies to date on use of the new-generation pulse oximeters, which are manufactured with algorithms to filter out patients' body motions, and describe the application of new-generation pulse oximetry in clinical practice in critical care. METHODS: MEDLINE was used to locate appropriate articles on pulse oximetry for the years 1995 to 2003. Each article was examined for scientific merit, content, and applicability to clinical practice. RESULTS: A total of 17 relevant articles on the clinical performance of the new-generation pulse oximeters were reviewed, and the data were organized into a table. CONCLUSIONS: The combination of studies done in both clinical and laboratory settings did not provide any strong and convincing evidence that the performance of any single new-generation device was superior to that of any other new-generation device. However, the clinical performance of all the new-generation pulse oximetry devices was better than that of earlier devices.

Adult↗
PubMed2005

In vitro activity, pharmacokinetics, clinical efficacy, safety and pharmacoeconomics of ceftriaxone compared with third and fourth generation cephalosporins: review.

Due to their wide spectrum of activity, good pharmacokinetics, established clinical efficacy and high tolerability, cephalosporins are among the most widely used antibiotics worldwide. The third and fourth generation cephalosporins are predominantly parenteral agents, administered two or three times daily, used in the treatment of a wide range of moderate to severe infections. Ceftriaxone, a third generation cephalosporin, is unique in exhibiting an unusually long elimination half-life that allows for once-daily administration. Among third generation cephalosporins, ceftazidime and cefoperazone are unusual among cephalosporins in possessing activity, albeit moderate, against Pseudomonas aeruginosa. However, both of these agents also exhibit marked loss of activity against Gram-negative organisms producing high levels of Class A or C beta-lactamases. Sulperazone, a 1:1 combination of cefoperazone and the beta-lactamase inhibitor sulbactam, is more resistant to attack by Class A beta-lactamases but remains vulnerable to isolates producing Class C beta-lactamases. Ceftriaxone exhibits the widest antibacterial spectrum of third generation cephalosporins and this is reflected in clinical responses. Cefoperazone and sulperazone exhibit the poorest clinical responses. Although the fourth generation cephalosporins cefpirome and cefepime exhibit enhanced stability to bacterial beta-lactamases and marginally enhanced in vitro antibacterial activity over ceftriaxone, there is no clinical advantage in terms of clinical or bacteriological success. The cephalosporins are well tolerated, with few and generally transient adverse effects; the major exception being haematological abnormalities including blood coagulation disorders associated with cefoperazone. Several pharmacoeconomic studies indicate that the once-daily dosing regimen required for ceftriaxone is the major factor responsible for its cost-effectiveness over third and fourth generation cephalosporins.

Anti-Bacterial Agents↗
PubMedDate not supplied

A "second generation" of ministry leadership.

Catholic health care leaders differ from others in the field in that "they are expected to serve as Jesus served, teach as Jesus taught, and lead as Jesus led, in order to heal as Jesus healed." The Catholic health ministry today is led largely by laypeople-what might be called the "first generation" of lay leaders. This first generation was privileged in that it was tutored by and worked alongside women and men religious. Those religious are now mostly gone from the ministry, and that first generation of lay leaders will also be retiring in the not too distant future. Leadership will then pass to a "second generation," laypeople who have not worked alongside religious. How is this new generation to learn "to heal as Jesus healed"? Catholic Health East (CHE), Newtown Square, PA, has developed a program explicitly directed at the recruitment and development of second-generation leaders. In its efforts to fill a position, the system first assembles a preferred-candidate profile, based on 15 competencies, including seven core competencies. CHE then employs a recruitment process based on behavioral event interviewing. All involved stakeholders participate in the interviews.

Catholicism↗
PubMedDate not supplied

Characteristics of fresh gander semen and its susceptibility to cryopreservation in six generations derived from geese inseminated with frozen-thawed semen.

The paper summarises seven years experiments designed to determine the effect of continuous insemination with frozen-thawed semen on fresh semen quality and sperm susceptibility to freezing stress in succeeding generations. During course of experiments, semen was collected from 10-12 White Koluda ganders at the age of 8-9 months, then subjected to freezing and used after thawing for insemination of 10 geese in order to obtain the subsequent generation of males. Semen was diluted 1 to 0.5 (v/v) with EK diluent, equilibrated for 15 min at +4 degrees C, mixed with 6 percent (v/v) of dimethyl-formamide (DMF), frozen to temp. -140 degrees C at a rate 60 degree C per min and then transferred into liquid nitrogen container. Semen samples were thawed prior to insemination in a 60 degree C water-bath. It is difficult to conclude whether freezing stress affected the fresh semen quality, since average volume of SQF (index comprising ejaculate volume, sperm concentration and percentage of live normal cells) varied between generations from 19.3 to 56.2. Continuous goose reproduction by insemination with frozen-thawed semen resulted in significant increase (P less than 0.01) in spermatozoa resistance to cryoinjury in every subsequent generation. In the relation to adequate fresh semen the percentage of live morphologically intact spermatozoa which withstood freezing procedure increased from 27.2 in first generation to 74.4 in sixth generation.

Animals↗
PubMed1991

Two roles for CD4 cells in the control of the generation of cytotoxic T lymphocytes.

The generation of CTL against Qa-1 Ag in C57BL/6 (B6) (Qa-1b) and B6.Tlaa (Qa-1a) congenic strains requires in vivo priming with the Qa-1 alloantigen together with a helper Ag, such as H-Y. The primed precursors obtained from these female mice generate Qa-1-specific CTL activity upon culture in vitro. Although the presence of the H-Y helper Ag is not required for the in vitro sensitization, no response occurs in the absence of CD4 cells. Addition of unprimed B6.Tlaa CD4 cells from Qa-1 incompatible radiation bone marrow chimeras (B6.Tlaa----B6), that are presumably tolerant to Qa-1b, provide helper activity for Qa-1b-specific CTL. This indicates that although CD4 cells are obligatory for the Qa-1 response, they need not be specific for alloantigens on the APC to generate helper activity in in vitro cultures. Addition of unirradiated B6 CD8-depleted spleen cells to CD4-depleted B6.Tlaa anti-B6 cultures in the presence of either B6.Tlaa CD4 cells or rIL-2 prevents the generation of Qa-1 specific CTL. This inhibition is not due to an anti-idiotypic Ts cell since B6.Tlaa----B6 chimeric cells do not suppress an anti-Qa-1b response. Rather, this finding is consistent with that of a veto cell mechanism. To determine whether CD4 cells themselves exhibit veto activity, highly purified CD4 populations were tested for their ability to inhibit the generation of Qa-1-specific CTL. CD4 cells precultured for 2 to 3 days with Con A and rIL-2 specifically inhibit CTL activity whereas resting cells do not, similar to that noted for CD8 veto cells. The relative efficiency of activated CD4 cells is greater than that of resting NK cells but is less than that of activated CD8 or NK cells. Thus, CD4 cells not only provide helper activity for CTL precursors, but also act as veto cells to prevent the generation of CTL activity.

Animals↗
PubMed2006

The effects of tissue factor pathway inhibitor and anti-beta-2-glycoprotein-I IgG on thrombin generation.

BACKGROUND AND OBJECTIVES: Recent evidence suggests that autoantibodies to tissue factor pathway inhibitor (TFPI) and/or antiphospholipid antibodies (aPL) may contribute to upregulation of the tissue factor (TF) pathway of blood coagulation and the development of thrombotic complications in the antiphospholipid syndrome (aPS). The aim of this study was to determine the influence of aPL e.g. anti-beta-2-glycoprotein-I (anti-beta2GPI) and anti-prothrombin, on in vitro TF-induced thrombin generation in the presence and absence of TFPI. DESIGN AND METHODS: IgG fractions were collected from subjects with aPL (n=21) and normal controls (n=36). Anti-TFPI activity was determined after incubation of IgG isolated from control or subject plasma with pooled normal plasma using an amidolytic assay for TFPI. The influence of IgG fractions and purified aPL (anti-beta2GPI and anti-prothrombin) on TF-induced in vitro thrombin generation was determined using a chromogenic assay of thrombin activity. RESULTS: Patients with aPL had significantly elevated thrombin generation (median [interquartile range]) compared to normal controls (112.0 [104.0-124.0]% vs 89.9 [85.7-100.9]%, respectively; p<0.001). Thrombin generation was significantly correlated with anti-TFPI activity in patients with aPL (r(s)=0.452; p=0.039). It was also demonstrated that anti-beta2GPI, but not anti-prothrombin IgG antibodies, significantly enhanced TF-induced thrombin generation in the presence of TFPI, using both purified and patients' samples. INTERPRETATION AND CONCLUSIONS: Our findings support the hypothesis that anti-beta2GPI IgG antibodies accelerate thrombin generation in the presence of TFPI and may contribute to hypercoagulability in patients with aPS.

Adult↗
PubMed2006

[The expectations for the third generation clinical laboratories in Japan].

The author expressed his hopes and expectations for third generation clinical laboratory schemes or systems in Japan. The history of development of the clinical laboratory in Japan can be classified three generations after the Second World War, the first generation (1945-1975), the second generation (1970-2005) and the third generation (2001-). The third generation clinical laboratory can be called "the clinical laboratory for the 21st century". The author advised some suggestions for the clinical laboratory for the 21st century. The main advice of the author is as follows: 1) The necessity of professional physicians of clinical laboratory medicine in hospitals. 2) The necessity of standardization and holding nationwide common reference values of main clinical laboratory tests. 3) The realization of a network of high-grade laboratory tests between all clinical laboratory divisions of the national university hospitals.

Clinical Laboratory Information Systems↗