Comparison of analytical and predictive methods for water, protein, fat, sugar, and gross energy in marine mammal milk.

Mammalian milks may differ greatly in composition from cow milk, and these differences may affect the performance of analytical methods. High-fat, high-protein milks with a preponderance of oligosaccharides, such as those produced by many marine mammals, present a particular challenge. We compared the performance of several methods against reference procedures using Weddell seal (Leptonychotes weddellii) milk of highly varied composition (by reference methods: 27-63% water, 24-62% fat, 8-12% crude protein, 0.5-1.8% sugar). A microdrying step preparatory to carbon-hydrogen-nitrogen (CHN) gas analysis slightly underestimated water content and had a higher repeatability relative standard deviation (RSDr) than did reference oven drying at 100°C. Compared with a reference macro-Kjeldahl protein procedure, the CHN (or Dumas) combustion method had a somewhat higher RSDr (1.56 vs. 0.60%) but correlation between methods was high (0.992), means were not different (CHN: 17.2±0.46% dry matter basis; Kjeldahl 17.3±0.49% dry matter basis), there were no significant proportional or constant errors, and predictive performance was high. A carbon stoichiometric procedure based on CHN analysis failed to adequately predict fat (reference: Röse-Gottlieb method) or total sugar (reference: phenol-sulfuric acid method). Gross energy content, calculated from energetic factors and results from reference methods for fat, protein, and total sugar, accurately predicted gross energy as measured by bomb calorimetry. We conclude that the CHN (Dumas) combustion method and calculation of gross energy are acceptable analytical approaches for marine mammal milk, but fat and sugar require separate analysis by appropriate analytic methods and cannot be adequately estimated by carbon stoichiometry. Some other alternative methods-low-temperature drying for water determination; Bradford, Lowry, and biuret methods for protein; the Folch and the Bligh and Dyer methods for fat; and enzymatic and reducing sugar methods for total sugar-appear likely to produce substantial error in marine mammal milks. It is important that alternative analytical methods be properly validated against a reference method before being used, especially for mammalian milks that differ greatly from cow milk in analyte characteristics and concentrations.

Prioritisation in haemophilia A: a qualitative study of stakeholder attitudes and preferences.

To learn more about prioritisation in the health care system, we performed an exploratory qualitative study on haemophilia A. The aim was to generate haemophilia disease-specific criteria and to learn more about reasoning in the decision-making process. The 40 participants (patients, relatives, physicians, nurses) were asked in semi-structured interviews about their experiences regarding the German health care system in general and the management of haemophilia A. The 4 stakeholder groups agreed that treatment in haemophilia A was very good; there were complaints about increased bureaucracy. Arguments originated in personal past experiences (patients, relatives) and in the professional background (healthcare professionals). Decision-making criteria ranking high were the maintenance of mobility, social responsibility and the prospect of a long working life span. Criteria with lower ranking were a high social professional status and age. There was ambivalence as to whether savings in the healthcare system in general were necessary or inacceptable. Prophylactic factor administration was rejected when high-risk sports were practiced regularly. Decision-making among actual individuals was rejected as 'immoral'. Patient representatives should be included in the political decision-making process. In conclusion, solidarity in the German health insurance is a highly esteemed principle, but was not well comprehended. The findings demonstrate the variety of individual attitudes with strong context affinity to the disease and the background of the stakeholder groups. The challenge will be to find ways of prioritising in an accountable and transparent way to maintain an excellent health care service for the individual haemophilia patient while also serving the public good.

Inhibitor-immunology-study. Evaluation of inhibitor development in haemophilia B.

UNLABELLED: The development of inhibitors in haemophilia B is one of the most important complications of replacement therapy, affecting mortality and morbidity. Inhibitor development is based on complex immunological factors, and to date, only little is known about its underlying mechanisms. Here, we present first results of the haemophilia B group of our Inhibitor-Immunology study. PATIENTS, METHODS: So far we have analysed 15 patients with haemophilia B. Four of them developed a high titre inhibitor; the remaining 11 had no inhibitor. We evaluated 9 SNPs in 8 genes (CD40, CTLA-4 , IL-1ß, IL-10, TLR2 , TLR4, TLR9, TNF-α). We compared the distribution of these alleles between inhibitor and non-inhibitor haemophilia B patients and between haemophilia B patients and a normal male control population. HLA typing was performed in all patients. Results, discussion: There appears to be a trend towards a skewed distribution of TLR 9, IL-10 and CTLA4 alleles in haemophilia B patients. Due to the limited number these differences are, however, not statistically significant. The t-test of all patients with inhibitor versus without inhibitor was significant for HLA-A*03 and DPB1*0401 and borderline for DRB1*0201.

Inhibitor-Immunology-Study. Different HLA-types seem to be involved in the inhibitor development in haemophilia A.

UNLABELLED: The development of inhibitors is one of the most important complications of replacement therapy in haemophilia, affecting mortality and morbidity. Inhibitor development is based on complex immunological factors. Cytokines and their receptors, T-cell receptors, and the Major Histocompatibility Complex may play important roles in the development of inhibitors. Earlier studies showed non significant associations between HLA class and inhibitor development. Later studies found an increased risk of inhibitor development if there was a combination between certain factor VIII mutations and HLA antigens. We performed HLA typing in 50 patients with haemophilia A in an effort to find associations with inhibitor development. RESULTS: 25 patients had developed an inhibitor (11 low titre, 14 high titre), and 25 never had. In logistic regression analysis, HLA-A 34, DRB1 0405, DRB1 1301 seemed to be involved in inhibitor development and HLA-A 30, B 13, B15, B 57, Cw 12, DQB1 0303, DPB1 0201 protection against inhibitor development. In our patients, the HLA-associations with inhibitor development were different from those in previous publications.

Diagnostic workup of patients with acquired von Willebrand syndrome: a retrospective single-centre cohort study.

BACKGROUND: Diagnosis of acquired von Willebrand syndrome (AVWS) remains challenging. Diagnostic algorithms suggest the use of factor VIII (FVIII:C), von Willebrand factor antigen (VWF:Ag), ristocetin cofactor (VWF:RCo), and collagen-binding capacity (VWF:CB), but the sensitivity of these and other laboratory tests for the diagnosis of AVWS is unknown. OBJECTIVES: To analyze the capacity of laboratory tests, including point-of-care testing (POCT), for the identification of patients with AVWS. PATIENTS/METHODS: Thirty-five consecutive patients were enrolled with AVWS diagnosed because of a history of recent onset of bleeding, a negative family history of von Willebrand disease, and abnormal plasma VWF multimers. RESULTS: According to our inclusion criteria, all patients had bleeding symptoms, and the VWF high molecular weight multimers were either decreased or absent. Regarding POCT, PFA-100 was inconclusive, due to anemia or thrombocytopenia, in 29%; the sensitivity was 80% in the remaining patients. The sensitivity of VWF:Ag (23%), VWF:RCo/Ag ratio < 0.7 (26%), VWF:CB/Ag ratio < 0.7 (46%), anti-VWF antibodies (15%) and VWF propeptide/Ag ratio (22%) was too low to rule out the disease. A combination of VWF:Ag < 50 IU dL(-1), VWF:RCo/Ag ratio < 0.7 and VWF:CB/Ag ratio < 0.8 yielded a sensitivity of 86%. Patients diagnosed only because of abnormal VWF multimers showed similar clinical characteristics as other patients. CONCLUSIONS: Early diagnosis of AVWS is difficult, due to lack of sensitivity of the tests used. A substantial number of patients present with normal or increased test results, emphasizing the importance of multimer analysis in all patients with suspected AVWS.

Quantification and facilitated comparison of von Willebrand factor multimer patterns by densitometry.

The analysis of von Willebrand factor (vWF) multimers is an important laboratory tool for distinguishing among the numerous subtypes of von Willebrand disease (vWD). Comparability and reproducibility of this method are insufficient; standardization and external references are pending. Interlaboratory comparison of results therefore may be difficult. We applied densitometry to obtain a reproducible quantification of vWF multimer patterns in healthy donors, patients with vWD variants, and factor VIII/vWF concentrates to improve the reproducibility and comparability of vWF multimer analysis. Multimers were separated and visualized luminographically on x-ray films. Films were scanned and evaluated by densitometry. The variation inherent in vWF multimer analysis and the range of the normal could be quantified. In vWD variants and factor VIII/vWF concentrates, densitometry could quantify and visualize alterations of vWF multimer patterns and facilitate their comparison. Densitometry permits a precise quantitative comparison of sample patterns to a reference plasma. It could be a valuable tool offering reproducible quantification and additional visualization of normal and pathologic vWF multimer patterns, facilitating their comparison and contributing to a standardization of vWF multimer analysis.

Microscopic anatomy of the eye of the deep-diving Antarctic Weddell seal (Leptonychotes weddellii).

The microscopic anatomy of the eye of the Weddell seal was studied with various light and electron microscopic methods with a view to correlating morphological findings with the biology of this seal which is adapted to the extremes of the Antarctic environment and to extreme diving excursions into the lightless depths of the sea. In the retina an area centralis was found but no fovea centralis. The densely packed photoreceptors consist exclusively of highly differentiated rods, which in primates detect light at low intensity but have rather poor image discrimination. The ganglion cells are relatively scarce, suggesting a high degree of convergence of the light-sensitive cells on the ganglion cells. The pigment epithelium is almost devoid of pigment granules. The extensive tapetum lucidum is about 400-500 microm thick and is composed of about 30 layers of specialized cells. The cornea is 650 (center) to 800-900 (periphery) microm thick. Its structure and glycosaminoglycan histochemistry correspond to that of other mammals. The iridocorneal angle is unusually deep and pervaded by an elaborate trabecular meshwork, which together with a complex canal of Schlemm can be correlated with the ability to absorb large amounts of fluid. The ciliary muscle and its antagonist, the membrane of Bruch, are poorly developed, suggesting relatively poor abilities of accommodation. The combination of a well-developed tapetum lucidum, an unpigmented pigment epithelium, well-developed rods, and a high number of rods converging on only few ganglion cells is obviously an adaptation to an extreme light sensitivity, enabling the animals to make use of the little light available in the deep sea.

Application of on-site solid-phase microextraction in aquatic dissipation studies of profoxydim in rice.

The application of a manual operated solid-phase microextraction (SPME)-HPLC interface is discussed for the analysis of thermally labile analytes in aqueous matrices. The technique has been applied on-site at a flooded rice field to demonstrate its potential for real time extraction of the herbicide profoxydim. Thus, compounds which would otherwise easily degrade in the aqueous matrices within hours or days could be determined more accurately. The fibers were shipped back to the laboratory with express delivery where the target analyte was desorbed from the fiber and determined by HPLC-UV analysis. The SPME method was characterized by significant ruggedness where conventional techniques such as liquid-liquid extraction and solid-phase extraction require additional shipping and handling costs and time-consuming multiple sample preparation steps. In general, any delay in shipping the aqueous samples to the laboratory has the potential for sample degradation and a loss in accuracy when using non on-site extraction techniques. Fifty microm Carbowax-templated resin coatings were most suitable for coupling SPME to HPLC in order to achieve a high sensitivity for polar analytes. The SPME technique was characterized by a good sensitivity and a precision less than 10% RSD. The SPME-LC-UV method was linear over at least three orders of magnitude while achieving a limit of detection in the lower microg/l range. The on-site SPME method has shown significantly increased accuracy. Profoxydim was determined at concentrations of ca. 180 microg/l 3 h after an application on a flooded bare soil field.

Prevalence of a 23bp insertion in exon 3 of the endothelial cell protein C receptor gene in venous thrombophilia.

BACKGROUND: The endothelial cell protein C receptor (EPCR) enhances protein C activation by the thrombin-thrombomodulin complex. As evidence is accumulating that EPCR is an important component of the protein C anticoagulant pathway, polymorphisms in the EPCR gene might be candidate risk factors predisposing to venous thromboembolism (VTE). Recently, a 23bp insertion in exon 3 of the EPCR gene has been identified, which duplicates the preceding 23 bases and results in a STOP codon downstream from the insertion point. However, the clinical significance of this mutation in VTE remains to be clarified. METHODS AND RESULTS: In this study we evaluated the EPCR 23bp insertion in 889 patients with documented VTE and in 500 healthy controls. The prevalence of the EPCR insertion among patients was 0.1%, which was not significantly different compared to controls (0.6%, p = 0.1). CONCLUSIONS: Our findings showed that the EPCR 23bp insertion is very rare in both patients with VTE and the general population and failed to support an association between the EPCR 23bp insertion and an increased risk of VTE.

Increased lipoprotein (a) levels as an independent risk factor for venous thromboembolism.

Elevation of serum lipoprotein (a) (Lp[a]) is a known risk factor predisposing to cardiovascular and cerebrovascular disease. However, little is known about the role of increased Lp(a) in venous thromboembolism (VTE). This study evaluated the role of Lp(a) among a panel of established hereditary thrombogenic defects in patients with VTE. A total of 685 consecutive patients with at least one episode of VTE and 266 sex- and age-matched healthy controls were screened with regard to activated protein C resistance, protein C, protein S, and antithrombin deficiency, elevated serum levels of Lp(a), and the factor V G1691A, MTHFR C677T, and prothrombin G20210A mutations. Elevated Lp(a) levels above 30 mg/dL were found in 20% of all patients, as compared to 7% among healthy controls (P <.001, odds ratio [OR] 3.2, 95% confidence interval [CI], 1.9-5.3). The coexistence of FV G1691A and elevated Lp(a) was significantly more prevalent among patients with VTE than in the control group (7% versus 0.8%; P <.001, OR 9.8, 95% CI, 2.4-40.7). No other established prothrombotic risk factor was found to be significantly combined with increased Lp(a). These data suggest that Lp(a) concentrations greater than 30 mg/dL are a frequent and independent risk factor for VTE. Furthermore, elevated Lp(a) levels might contribute to the penetrance of thromboembolic disease in subjects being affected by other prothrombotic defects, such as FV G1691A mutation.

Automated in-tube solid-phase microextraction-high-performance liquid chromatography for carbamate pesticide analysis.

In-tube solid-phase microextraction (SPME) is an automated version of SPME that can be easily coupled to a conventional HPLC autosampler for on-line sample preparation, separation and quantitation. It has been termed "in-tube" SPME because the extraction phase is coated inside a section of fused-silica tubing rather than coated on the surface of a fused-silica rod as in the conventional syringe-like SPME device. The new in-tube SPME technique has been demonstrated as a very efficient extraction method for the analysis of polar and thermally labile analytes. The in-tube SPME-HPLC method used with the FAMOS autosampler from LC Packings was developed for detecting polar carbamate pesticides in clean water samples. The main parameters relating to the extraction and desorption processes of in-tube SPME (selection of coatings, aspirate/dispense steps, selection of the desorption solvents, and the efficiency of desorption solvent, etc.) were investigated. The method was evaluated according to the reproducibility, linear range and limit of detection. This method is simple, effective, reproducible and sensitive. The relative standard deviation for all the carbamates investigated was between 1.7 and 5.3%. The method showed good linearity between 5 and 10000 microg/l with correlation coefficients between 0.9824 and 0.9995. For the carbamates studied, the limits of detection observed are lower than or similar to that of US Environmental Protection Agency or National Pesticide Survey methods. Detection of carbaryl present in clean water samples at 1 microg/l is possible.

Determination of pesticides in aqueous samples by solid-phase microextraction in-line coupled to gas chromatography-mass spectrometry.

A multiresidue method was developed for the determination of nitrogen- and phosphorous-containing pesticides (amines, anilides, phosphorothioates, and triazines) by solid-phase microextraction (SPME) in-line coupled to gas chromatography-mass spectrometry (GC/MS). The 85-µm polyacrylate fiber was first dipped into the aqueous sample for a given time and then directly introduced into the heated injector of the gas chromatography-mass spectrometer, where the analytes are thermally desorbed. The method was evaluated with respect to the limit of detection, linearity, and precision. The limit of detection [selected ion monitoring (SIM) mode] depends on the compound and varies from 5 to 90 ng/L. The method is linear over at least 3 orders of magnitude with coefficients of correlation usually ≥0.996. In general, the coefficient of variation (precision) is <10%. The partitioning of the analyte between the aqueous phase and the polymeric phase depends on the hydrophobicity of the compound as expressed by the octanol-water partitioning coefficient P ow. The addition of sodium chloride has a strong effect on the extraction efficiency. This effect increases with decreasing hydrophobicity (increasing polarity) of the compound.The triazines atrazine, simazine, and terbuthylazine were first identified and quantified in water samples from the effluent of sewage plants by SPME-gas chromatography-nitrogen-phosphorus detection (GC/NPD). For such a complex matrix GC/NPD is not sufficiently selective for an unambiguous identification at low levels (<1 ppb) of pesticides. Selectivity may be enhanced by using SMPE-GC/MS in the SIM mode with three characteristic ions for each pesticide. This method allows an unequivocal identification and quantification at low levels of pesticides in environmental samples.At a target limit of detection below 100 ng/L, SPME-GC/MS represents a very simple, fast, selective, and solvent-free multimethod for the extraction and determination of these nitrogen- and phosphorous-containing pesticides from aqueous samples.

Recombinant human interferon (IFN) alpha-2b in chronic myelogenous leukaemia: dose dependency of response and frequency of neutralizing anti-interferon antibodies.

Twenty-seven patients with Philadelphia chromosome positive chronic myelogenous leukaemia in the chronic phase were treated with low doses of recombinant interferon (IFN) alpha-2b. Ten patients entered a complete and six a partial haematologic remission with a median duration of 5.8 and 9.1 months respectively. Five minor cytogenetic responses were observed. These results are inferior compared to other studies with higher interferon-doses. Fever was an acute side effect after injection of IFN, limb pains and fatigue occurred protractedly. Haematologic side effects, nonspecific EEG changes, weight loss, and development of pulmonary infiltrates were observed in later periods of the treatment. Eight patients developed neutralizing anti-IFN antibodies after 4.2-20.4 months (median 12.8 months). Anti-IFN antibodies were associated with relapse or refractoriness to IFN treatment: five out of nine patients with rising WBC after initial fall had antibodies, while four did not. Two out of four patients with primary non-response had IFN-antibodies. These results may indicate a serious problem in the long-term treatment of CML with recombinant interferon.

Treatment of acute myelocytic leukemia with a daunorubicin-cytarabine-6 thioguanine regimen without maintenance therapy.

The present study reports on the treatment of 44 patients with AML. 17 patients were male, 27 female. Mean age was 50.1 years. Treatment-regimen consisted of induction-therapy with daunorubicin 45 mg/m2 i.v. d 1-3, cytarabine 100 mg/m2 X 24 h continuous intravenous infusion (c.i.v.i.) d 1-7, 6 thioguanine 100 mg/m2 twice orally d 1-7. There were only two consolidation therapies with daunorubicin and cytarabine and no maintenance therapy. 30 patients (68%) achieved CR, 1 patient (2%) PR, 3 were non-responders (7%). There were 10 (23%) early deaths during or following induction therapy. Median disease-free survival was 6 months, median overall survival 7.5 months. We conclude, that the reported induction therapy is efficient though toxic. To improve long term results, consolidation and intensification therapy should be escalated.

Detection of lymphocyte stimulation by flow cytometry: differences in cells from patients with and without neoplasia.

Fluorescence polarization measurements were performed to detect PHA-stimulation of peripheral lymphocytes in an early state. Single cell fluorescence was measured by flow cytometry using an epi-illumination design to avoid the influence of background fluorescence and multiscattering. By these arrangements the accuracy in the determination of P, the degree of polarization, could be improved over the usual cell suspension measurements. Fluorescence polarization measurements were performed on density specified human lymphocytes after incubation with fluorescein diacetate with and without preincubation with phytohemagglutinin (PHA). A group of healthy donors had an average polarization of P = 0.17 before and P = 0.12 after PHA-stimulation, whereas a group of patients with malignant disease showed an average polarization of P = 0.14 before and after PHA-stimulation.