The prevalence of retinopathy in men with Type 2 diabetes and obstructive sleep apnoea.

AIMS: To clarify the relationship between obstructive sleep apnoea (OSA) and diabetic retinopathy. RESEARCH DESIGN AND METHODS: A cohort of 240 men from primary and secondary care previously participated in a study on the prevalence of OSA in Type 2 diabetes and provided anthropometric information, details of their diabetes, had glycated haemoglobin (HbA1c) measured and overnight oximetry performed. They were re-contacted for permission to review their routine screening clinical retinal photographs, which were then scored by a trained grader, providing detailed retinopathy, maculopathy and photocoagulation scores. RESULTS: One hundred and eighteen men both consented and had retinal photographs available to review. Of these, 24% had OSA, with mean+/-sd 4% oxygen saturation (SaO2) dips/h of 20.9+/-16.6 vs. 2.8+/-2.1 in the non-OSA group. As expected, the OSA group had a significantly higher mean body mass index of 31.9+/-5.2 vs. 28.5+/-5.1 kg/m2 and neck size 44.5+/-3.6 vs. 41.9+/-2.5 cm, but the two groups did not differ significantly in age, diabetes duration, diabetes treatment, HbA1c, smoking history or proportion with known hypertension. Retinopathy and maculopathy scores were significantly worse in the OSA group (P<0.0001). Multiple regression analysis showed only OSA (R2=0.19, P<0.0001) and HbA1c (R2=0.04, P=0.03) to be significant independent predictors of retinopathy. OSA was the only independent significant predictor of the total microaneurysm score (R2=0.21, P=0.004), a detailed retinopathy subclassification. OSA was the only independent significant predictor of maculopathy (R2=0.3, P<0.001). CONCLUSION: In men with Type 2 diabetes, there is a strong association between retinopathy and OSA, independent of conventional retinopathy risk factors.

Unexpected cardiovascular collapse from massive air embolism during endoscopic retrograde cholangiopancreatography.

A 72 year-old woman with cholangiocarcinoma presented for endoscopic retrograde cholangio pancreatography (ERCP) for diagnostic intraductal endoscopy under GETA. During the technically difficult procedure the patient became suddenly hypoxic, hypotensive, bradycardic, and progressed to PEA code (ETCO2 5 mmHg). ACLS was initiated. Transesophageal echo demonstrated massive right heart air accumulation; abdominal X-Ray showed air filled bile ducts. Central access was obtained, a pulmonary artery catheter floated, and 30 ml of air aspirated from the RV. Within 5 minutes pulses returned; the patient was transferred to the ICU. MRI revealed two watershed infarcts in the right frontal lobe. The patient fully recovered and returned a month later for an uneventful ERCP.

Asian bull elephants: Flehmen-like responses to extractable components in female elephant estrous urine.

Flehmen-like responses (urine tests) are one of the characteristic behavioral reactions of male Asian elephants (Elephants maximus) to cow elephants in estrus. Components of the urine of estrous cow elephants were extracted with organic solvents and partially purified by chromatography and shown to evoke Flehmen-like responses when they were presented to adult bulls.

Adipsin and complement factor D activity: an immune-related defect in obesity.

Adipsin is a serine protease that is secreted by adipocytes into the bloodstream; it is deficient in several animal models of obesity, representing a striking example of defective gene expression in this disorder. Recombinant mouse adipsin was purified and its biochemical and enzymatic properties were studied in order to elucidate the function of this protein. Activated adipsin has little or no proteolytic activity toward most substrates but has the same activity as human complement factor D, cleaving complement factor B when it is complexed with activated complement component C3. Like authentic factor D, adipsin can activate the alternative pathway of complement, resulting in red blood cell lysis. Decreased (58 to 80 percent) complement factor D activity, relative to lean controls, was observed as a common feature of several experimental models of obesity, including the ob/ob, db/db, and monosodium glutamate (MSG)-injected mouse and the fa/fa rat. These results suggest that adipsin and the alternative pathway of complement may play an unexpected but important role in the regulation of systemic energy balance in vivo.

Health related quality of life of patients with refractory angina before and one year after enrolment onto a refractory angina program.

OBJECTIVE: This study was designed to assess the impact of a refractory angina programme on the health related quality of life for patients with chronic refractory angina (CRA) one year following enrolment. DESIGN: A one year prospective audit. SETTING: Specialist refractory angina clinic at a tertiary cardiac referral centre. PATIENTS: 69 consecutive refractory angina patients referred to a regional refractory angina centre from 1/03/2001 to 1/09/2002. INTERVENTIONS: Pain treatment algorithm in accordance with the recommendations of the national refractory angina guideline committee. MAIN OUTCOME MEASURES: Improvements in quality of life indices were assessed using Seattle angina questionnaire (SAQ), and short form-12 (SF-12) with changes in mood determined using the hospital anxiety and depression (HAD) questionnaire. RESULTS: All dimensions of the SF-12 and SAQ were superior at one year with significant improvement seen with the mental component of SF-12 (p = 0.023), and four of the five SAQ domains, angina stability (p = 0.028), angina frequency (p=0.02), treatment satisfaction (p=0.001) and quality of life (p < 0.001). All the significant changes within the SAQ domains were large enough to be considered clinically relevant. At one year the anxiety and depression domains were significantly improved from baseline (p = 0.015, 0.018) with clinical anxiety levels falling significantly from 55% to 40%, a relative reduction of 28% (p = 0.008). CONCLUSIONS: Implementation of the national refractory angina guidelines in a prospective study of 69 consecutive CRA patients significantly improved health related quality of life status at one year.

The preparation of an ovine monoclonal antibody to progesterone.

Peripheral blood mononuclear cells were collected from a sheep immunized against progesterone-11 alpha-hemisuccinate-ovalbumin. Following fusion with NS1 mouse myeloma or heteromyeloma cells, a large number of hybrid colonies was established. These were screened for the production of sheep antibodies to progesterone. Twenty-four cell lines were cloned and one was stabilized. This cell line, O/MP.1A9.D7B2, produced a high-affinity ovine immunoglobulin G1 (dissociation constant 4.8 pmol/l) with a high degree of specificity for progesterone. The antibody was substituted into a competitive enzyme-linked immunosorbent assay for the measurement of progesterone in bovine milk, originally established using an ovine polyclonal antibody, and the results were compared. The monoclonal antibody produced an assay with a lower limit of detection and a greater degree of discrimination than the polyclonal antiserum.

Preparation of ribonucleic acid probes specific for Bacteroides fragilis.

Nucleic acid probes promise to be very useful in the detection of infectious agents. Several RNA probes have been developed by random cloning of chromosomal DNA for the detection of Bacteroides fragilis. Four such probes prepared by transcription of inserts of 400 bp, 800 bp, 2.4 kbp, and 6 kbp all hybridized to denatured B. fragilis DNA on nitrocellulose, but did not bind to DNA from a variety of other Bacteroides spp. or from selected aerobic strains. Each probe readily detected five clinical isolates of B. fragilis and did not react with 11 clinical isolates representing four other species in the "B. fragilis group".

Comparison of susceptibility results of anaerobic organisms determined by agar dilution method and Sceptor Anaerobe MIC/ID Micro Broth Dilution Panels.

A commercial broth microdilution system (Sceptor Anaerobe MIC/ID, BBL) for susceptibility testing of anaerobic bacteria was compared to a reference agar dilution system. Of the 172 organisms tested, only 7% failed to grow sufficiently for testing in the Sceptor system. In 1,590 antibiotic/organism combinations, 86.7% of the Sceptor results were identical or within one doubling dilution of the reference system. In 91.9% of the cases, interpretation of the results was same in both systems. Two hundred and twelve MIC values, however, differ by greater than or equal to 2 log2 dilution from the reference system. Due to this reduced correlation in the actual MIC values with the reference results, further studies are warranted before the Sceptor system can be recommended for routine use.

Comparison of RapID-ANA and Minitek with a conventional method for biochemical identification of anaerobes.

Two micromethods for the identification of anaerobes, one requiring growth (Minitek) and one nongrowth dependent (RapID-ANA), were compared with a conventional identification culture system. For 222 clinical isolates, RapID-ANA agreed with PRAS in 187 (84%) and Minitek agreed for only 170 strains (76%). Both systems identified common isolates well, but encountered some difficulty in identifying less common clostridia and Gram-negative bacilli. Although adequate for most strains, the results from both systems should be interpreted with caution, particularly for less frequently isolated species.

Effect of routine use of a multiplex PCR for detection of vanA- and vanB- mediated enterococcal resistance on accuracy, costs and earlier reporting.

A multiplex PCR (MPCR) for detection of vanA-and vanB-mediated resistance to vancomycin was optimized and adapted for use in the routine microbiology laboratory. Consecutive specimens (1196) submitted for vancomycin resistant Enterococci (VRE) surveillance were processed by clinical technologists on Bile Esculin Azide Agar containing 6 mg/L vancomycin (BEAA/Vanco6) plates and 466 showing black colony growth were processed by conventional biochemical testing (CBT) and by MPCR. CBT identified 208 VRE positives. MPCR detected 205 of the CBT- positives plus an additional 10. Analysis of the discordant specimens determined that 5 CBT- negative/MPCR-positive specimens also contained Enterococci with vanC resistance, 3 CBT-positive/MPCR-negative specimens were true positives, and 5 CBT-negative/MPCR-positive specimens occurred due to technical error. The sensitivity and specificity of MPCR were 98.4% and 96.1%. MPCR identifications of VRE were achieved approximately 48 h earlier than CBT and at 60% of the costs.

The production and application of non-rodent monoclonal antibodies in veterinary science.

The requirement for monoclonal antibodies derived from species other than rats and mice is becoming increasingly realised in veterinary, as well as human, medicine. This paper reviews current knowledge of the production of inter-species hybridomas (heterohybridomas) by the fusion of rodent myeloma cell lines with lymphocytes from species of veterinary importance. To date a number of monoclonal immunoglobulins derived from sheep, cattle, pig, rabbit, mink and primate species have been produced to a variety of different bacterial, viral and nematode pathogens as well as to blood group and MHC determinants and to hormones. The technique opens up a number of possibilities for the future; some of these applications are discussed in relation to the antibodies produced thus far.

A bovine monoclonal antibody to oestrone/oestradiol prepared by a (murine x bovine) xbovine interspecies fusion.

A heterohybridoma was produced by the fusion of sensitized peripheral blood lymphocytes (PBLs) with a previously derived heteromyeloma, generated by the fusion of bovine PBLs with murine myeloma cells. The sensitized bovine PBLs were collected from a steer immunized with an oestradiol-ovalbumin conjugate. The cell lines resulting from the fusion were screened for the production of bovine antibodies to oestradiol. A stable heterohybridoma was isolated which secreted a bovine IgG1 to oestrone/oestradiol. The use of sensitized PBLs together with heteromyeloma fusion partners has proved to be a reliable and simple way of producing monoclonal antibodies against specific haptens.

Preparation of a bovine monoclonal antibody to testosterone by interspecies fusion.

This communication reports the first successful attempt to produce a hybridoma cell line secreting bovine immunoglobulin to a small hapten, starting with peripheral blood lymphocytes, rather than spleen or lymph node cells. A heteromyeloma line, sensitive to selective media, was made by fusing NS1/1-Ag4-1 mouse myeloma cells with bovine peripheral blood lymphocytes. This cell line was then fused with blood lymphocytes from a steer immunised with a testosterone immunogen. Cell cultures were screened using an ELISA specific for bovine antibodies to testosterone. Following repeated cloning, a cell line was established which secretes moderate levels of a specific, high affinity antibody to testosterone. This particular cell line has significant potential for veterinary application and the successful fusion demonstrates the possibilities of heteromyelomas for the development of non-murine monoclonal antibodies.

Veterinary sources of nonrodent monoclonal antibodies: interspecific and intraspecific hybridomas.

The generation of monoclonal antibodies from species other than rats and mice has developed slowly over the last 20 years. The advent of antibody engineering and realization of the advantages of nonmurine antibodies, in terms of their superior affinities and specificities, and their potential as components of human and veterinary therapeutics has increased their relevance recently. There have been significant advances in the development of myeloma and heteromyeloma fusion partners. This is an opportune moment to consolidate experiences of MAb production across the range of species of veterinary interest and place it into context with other developments in the field of monoclonal antibodies. The background to the development of antibodies from species other than the mouse is discussed. The species and antigens used to date are reviewed, as are the methods and results reported. A suggested protocol is provided for first attempts to exploit the huge potential of this aspect of hybridoma technology and suggestions are made for its further expansion.

Production of an ovine monoclonal antibody to testosterone by an interspecies fusion.

Hybridomas were made between NS1/1-Ag4-1 mouse myeloma cells and peripheral blood lymphocytes from a sheep immunized with a testosterone-protein conjugate. ELISAs were developed to detect ovine IgG and specific ovine anti-testosterone and these were used to screen the colonies. Although the cells fused acceptably only 3% of colonies secreted detectable quantities of antibody. The antibody was secreted at low levels (2.5 ng/ml) but was of high affinity (KD = 7.63 x 10(-12) M/1). One line, O/M 4.22, continued to secrete in culture for four months until the termination of the experiment.

Vertical transmission of hepatitis C virus in New Zealand.

AIMS: To investigate the transmission of hepatitis C virus from viraemic mothers to infants. METHODS: The study group comprised 54 hepatitis C ribonucleic acid (RNA) positive, human immunodeficiency virus (HIV) negative women attending antenatal clinic, their infants when born, 12 previous children and 44 children of 29 additional nonpregnant, viraemic women. During the study period there were 60 live births (1 set of twins, 5 sequential pregnancies). All infants were tested at birth for hepatitis C virus (HCV) RNA. Thirty infants were retested at 6 months or later. Breast milk from 30 mothers was tested for HCV RNA. The 56 other children were tested for antibody to HCV and HCV RNA. RESULTS: Of the 60 infants tested at birth, 30 failed to attend a 6 month or later followup, 2 infants were HCV viraemic by six months of age, 2 infants had one episode of possible HCV RNA positivity followed by loss of detectable HCV RNA and 26 have shown no evidence of HCV infection. Five of the 30 breast milk samples tested were positive for HCV RNA. Four older children of viraemic mothers were HCV RNA positive. CONCLUSIONS: In this study, 2 of 30 (6.6%) of infants born to HIV negative, HCV viraemic mothers acquired HCV infection. Breast milk remains a possible contributory source of infant HCV infection. Management of babies born to HCV viraemic mothers should include retesting of baby for HCV RNA at 3 to 6 months of age.

Sports competition and its influence on self-esteem development.

Competition and its influence upon the adolescent is the primary concern of many recreational agencies. In the past ten years, many youth agencies have de-emphasized competition in their programs because of its negative influence upon self-esteem. There is a need to examine the relationship between competition and self-esteem so that recreational programs can be better designed to utilize competition as a positive factor. A study was undertaken to examine self-esteem in relation to competition in a basketball program. It was found that the coach's assessments of ability and intention of participation are important factors in positive self-esteem development. The social aspects of peer interaction and parent influence also contribute to positive self-esteem. These are minor elements, however, in comparison to the impact of the coach. There needs to be intensive training for coaches on how to develop positive self-esteem and how to deal with the range of participation styles.

Music as a vehicle for life enrichment and expanded content for special audiences.

Music for special audiences has been a neglected part of most programs. The primary problem has been lack of understanding of the advantages of music and where it fits into a curriculum. Another problem has been the lack of skill to execute an effective program. Most musical events have been isolated with little continuity from one activity to another. Another programming difficulty has been where to find resources and how to use them. The purpose of this article is to briefly discuss programming for special audiences. An illustrative exercise has been provided to point out a programming format, especially the sequencing among activities and the resource utilization dimensions.

Beyond the Pedometer: New Tools for Monitoring Activity.

Devices and methods for measuring physical activity are becoming more accurate and economical, and researchers are using them to study topics ranging from the aerobic capacity of children to the job performance of military aircrews.

Is Childhood Obesity Related to TV Addiction? (Part 2 of 2).

Physicians aren't used to thinking of television as an agent of pediatric disease. However, experts increasingly contend that television may indeed play such a role. The disease: obesity.