Evaluation of the time resolved fluorescence immunoassay (TRFIA) for the detection of varicella zoster virus (VZV) antibodies following vaccination of healthcare workers.

Determination of varicella zoster virus (VZV) immunity in healthcare workers without a history of chickenpox is important for identifying those in need of vOka vaccination. Post immunisation, healthcare workers in the UK who work with high risk patients are tested for seroconversion. To assess the performance of the time-resolved fluorescence immunoassay (TRFIA) for the detection of antibody in vaccinated as well as unvaccinated individuals, a cut-off was first calculated. VZV-IgG specific avidity and titres six weeks after the first dose of vaccine were used to identify subjects with pre-existing immunity among a cohort of 110 healthcare workers. Those with high avidity (≥ 60%) were considered to have previous immunity to VZV and those with low or equivocal avidity (<60%) were considered naive. The former had antibody levels ≥ 400 mIU/mL and latter had levels < 400 mIU/mL. Comparison of the baseline values of the naive and immune groups allowed the estimation of a TRFIA cut-off value of > 130 mIU/mL which best discriminated between the two groups and this was confirmed by ROC analysis. Using this value, the sensitivity and specificity of TRFIA cut-off were 90% (95% CI 79-96), and 78% (95% CI 61-90) respectively in this population. A subset of samples tested by the gold standard Fluorescence Antibody to Membrane Antigen (FAMA) test showed 84% (54/64) agreement with TRFIA.

Changes in the practice of percutaneous coronary intervention: a comparison of enrollment waves in the National Heart, Lung, and Blood Institute (NHLBI) Dynamic Registry.

The National Heart, Lung, and Blood Institute Dynamic Registry includes 15 clinical sites in wave 1, and 16 sites in wave 2 as well as a data-coordinating center. The first wave of enrollment began in July 1997 and was completed in February 1998. The second wave began in February 1999 and ended in June 1999. There were a total of 2,526 patients in wave 1 and 2,109 patients in wave 2. Comprehensive pre-, intra-, and postprocedure (in-hospital) data were analyzed for changes between recruitment waves. Patients in wave 2 were more frequently nonwhite (p < or = 0.001), hypertensive by history (p < or = 0.001), had more significant noncardiac comorbidity (p < or = 0.01), and had more frequently undergone prior percutaneous coronary intervention (p < 0.05). Patients in wave 2 underwent percutaneous coronary intervention in a setting of acute coronary syndromes more frequently than wave 1 patients (p < or = 0.001). However, most interventions in both waves were performed on 1 vessel, irrespective of the extent of disease. Attempted lesions in wave 2 were longer (p < or = 0.001), less frequently totally occluded (p < or = 0.001), and more frequently in vessels with a prior stent (p < or = 0.01). Using the American Heart Association/American College of Cardiology lesion classification scheme, attempted lesions in wave 2 were less complex than those in wave 1 (p < or = 0.001). Stent use increased significantly from wave 1 (67%) to wave 2 (79%, p < or = 0.001) as did the use of platelet glycoprotein IIb/IIIa antagonists (wave 1, 24%; wave 2, 32%: p < 0.001). Procedural outcomes (angiographic success without major in-hospital adverse events) were excellent in both waves 1 (94.6%) and 2 (95.6%) and were not significantly different. However, the frequency of significant procedural coronary dissection and in- and out-of-laboratory abrupt closure were significantly less in wave 2 (p < or = 0.001) Discharge medications were more likely to include angiotensin-converting enzyme inhibitors, beta-adrenergic blocking agents, and hypolipidemic treatment in wave 2 than in wave 1 (p < or = 0.001). These data indicate a continuing aggressive approach to patient care over the time interval analyzed. Although overall procedural outcomes are excellent, procedural safety has been further enhanced. There is also a growing awareness of the importance of secondary prevention among interventional cardiologists.

Percutaneous coronary intervention in the current era compared with 1985-1986: the National Heart, Lung, and Blood Institute Registries.

BACKGROUND: Although refinements have occurred in coronary angioplasty over the past decade, little is known about whether these changes have affected outcomes. METHODS AND RESULTS: Baseline features and in-hospital and 1-year outcomes of 1559 consecutive patients in the 1997-1998 Dynamic Registry who were having first coronary intervention were compared with 2431 patients in the 1985-1986 National Heart, Lung, and Blood Institute Registry. Compared with patients in the 1985-1986 Registry, Dynamic Registry patients were older (mean age, 62 versus 58 years; P:<0.001) and more often female (32.1% versus 25.5%; P:<0.001). In the Dynamic Registry, procedures were more often performed for acute myocardial infarction (22.9% versus 9.9%; P:<0.001) and treated lesions were more severe (84.5% versus 82.5% diameter reduction; P:<0.001), thrombotic (22.1% versus 11.3%; P:<0.001) or calcified (29.5% versus 10.8%; P:<0.001). Stents were used in 70.5% of Dynamic Registry patients, whereas 1985-1986 patients received balloon angioplasty alone. Procedural success was higher in the Dynamic Registry (92.0% versus 81.8%; P:<0.001) and the rate of in-hospital death, myocardial infarction, and emergency coronary bypass surgery combined was lower (4.9% versus 7.9%; P:=0.001) than in the 1985-1986 Registry. The 1-year rate for CABG was lower in the Dynamic Registry (6.9% versus 12.6%; P:<0.001). CONCLUSIONS: Although Dynamic Registry patients had more unstable and complex coronary disease than those in the 1985-1986 Registry, their rate of procedural success was higher whereas rates of complications and subsequent CABG were lower. Results of percutaneous coronary intervention have improved substantially over the past decade.

Melanin content and downregulation of glutathione S-transferase contribute to the action of L-buthionine-S-sulfoximine on human melanoma.

L-buthionine-S,R-sulfoximine (L-S,R-BSO) was enriched for the active L-buthionine-S-sulfoximine (L-S-BSO) diastereomer. Comparative analysis was performed to determine if this enriched form possessed an increased capacity to deplete glutathione (GSH), and to inhibit the proliferation of tumor cell lines and fresh human tumor samples. Increased activity was observed for the enriched preparation of L-S-BSO in direct proportion to its increased L-S-diastereomeric percentage. Significant antitumor activity towards melanoma, breast and ovarian carcinoma specimens was noted, with the greatest activity directed against malignant melanoma. The activity of BSO on melanoma specimens was found to be correlated with their melanin content, suggesting that free radicals generated during melanin synthesis may become cytotoxic after GSH-dependent scavenging has been eliminated by BSO treatment. The antimelanoma activity of melphalan and BCNU were found to be significantly enhanced in combination with L-S-BSO. With respect to the mechanism of L-S-BSO synergy with alkylators, L-S-BSO treatment of M14 and ZAZ human melanoma cell lines resulted in decreased GSH levels and glutathione S-transferase (GST) activity. Western and Northern blot analyses indicated that GST-mu was the predominant isozyme downregulated after L-S-BSO treatment. Both M14 and ZAZ cell lines selected for resistance to L-S-BSO also showed decreased levels of GST-mu expression. However, in drug free media GST enzyme activity returned to pre-treatment levels without altering the BSO-resistance status of the cell lines. We conclude that L-S-BSO may be an active agent in the treatment of melanoma, and that it may enhance alkylator activity on melanoma through depletion of GSH and down-regulation of GST expression. Purified L-S-BSO should be explored clinically as an active agent for the treatment of melanoma.

Selective and synergistic activity of L-S,R-buthionine sulfoximine on malignant melanoma is accompanied by decreased expression of glutathione-S-transferase.

L-buthionine-S,R-sulfoximine (BSO) selectivley inhibits glutathione (GSH) synthesis. Malignant melanoma may be uniquely dependent on GSH and its linked enzymes, glutathione S-transferase (GST) and GSH-peroxidase, for metabolism of reactive orthoquinones and peroxides produced during melanin synthesis. We compared the in vitro effects of BSO on melanoma cell lines and fresh melanoma specimens (n = 118) with breast and ovarian cell lines and solid tumors (n = 244). IC50 values (microM) for BSO on melanoma, breast and ovarian tumor specimens were 1.9, 8.6, and 29, respectively. The IC90 for melanoma was 25.5 microM, a level 20-fold lower than steady state levels achieved clinically. The sensitivity of individual specimens of melanoma correlated with their melanin content (r = 0.63). BSO synergistically enhanced BCNU activity against melanoma cell lines and human tumors. We followed GSH levels, GST enzyme activity, GST isoenzyme profiles and mRNA levels after BSO. BSO (50 microM) treatment for 48 hr resulted in a 95% decrease in ZAZ and M14 melanoma cell line GSH levels, and a 60% decrease in GST enzyme activity. GST-mu protein and mRNA levels were significantly reduced in both cell lines. GST-pi expression was unaffected. These data suggest that BSO action on melanoma may be related to GSH depletion, diminishing the capacity to scavenge toxic metabolites produced during melanin synthesis. We report here for the first time that BSO enhancement of alkylator action may be related in part to down regulation of GST. BSO may be a clinically useful adjunct in the treatment of malignant melanoma.

Pacemaker-lead puncture of the tricuspid valve. Successful diagnosis and treatment.

During insertion, a transvenous pacing lead pierced the tricuspid valve in a 66-year-old man, causing progressive tricuspid insufficiency and congestive heart failure. The defect remained undiagnosed for ten years and was then repaired. To our knowledge, this is the first case in which this problem has been successfully treated rather than being diagnosed at autopsy.

Double valve replacement and coronary artery bypass in a patient with chronic osteomyelitis.

Implantation of a prosthetic heart valve is generally contra-indicated in the presence of infection. A 68-year-old man with chronic osteomyelitis underwent successful double valve replacement, combined with coronary artery bypass, after his draining osteomyelitic fistula was controlled with antibiotics. During the 39 months since surgery, he has shown no sign of paravalvular leakage or infectious complications.

Fistula between the left anterior descending coronary artery and the pulmonary artery causing angina in two middle-aged patients.

Congenital coronary artery fistulas usually originate from the right coronary artery. Patients with such fistulas rarely reach middle age without symptoms or complications. In the cases presented here, a congenital fistula between the left anterior descending coronary artery and the pulmonary artery was discovered in a 55-year-old man and a 41-year-old man who were being evaluated for angina. The first patient also had coronary artery disease. Both fistulas were successfully treated with ligation and division.

Simultaneous enzyme immunoassay of two thyroid hormones.

We describe an enzyme immunoassay in which the two thyroid hormones, triiodothyronine and thyroxin, are measured simultaneously in a single tube. The method involves labeling the two with separate enzymes (beta-galactosidase and alkaline phosphatase, respectively), whose catalyzed reactions can easily be distinguished from each other by absorption spectrophotometry, with o-nitrophenyl-beta-galactoside and phenolphthalein monophosphate as substrates. Performance of this dual assay method compares well with that of conventional single-hapten enzyme-labeled assays, and results compare well with those by two single-hapten radioimmunoassays. The dual assay has certain advantages over single-hapten methods: smaller sample volume, lower reagent cost, and shorter overall assay time. As presented here, the use of enzyme labels to measure two (or more) haptens simultaneously represents a significant advance in the use of immunoassay techniques.

Normal postpartum involution of the uterus in the dog.

Ninety-eight reproductive tracts from dogs at different postpartum time periods were used to investigate stages of normal involution. Seventy-eight reproductive tracts were obtained from the field, and 20 obtained surgically for gross and microscopic examination. Plasma progesterone was measured in 22 dogs at various times postpartum. The uterine horns during the first week postpartum were dilated and edematous. The placental sites were 1.5-3 cm in width, rough, granular and covered with mucus and a few blood clots. By the fourth week the placental sites were thick, grayish-tan and nodular with a few blood clots within nodules. The uterine horns during the seventh week were greatly contracted and the placental sites were narrow and light in color. A few nodules were still present on the surface. By the ninth week the uterine horns were uniform in shape and contracted with a narrow lumen. The placental sites appeared as a narrow brown band. Histologically the placental sites during the first week postpartum were covered by an eosinophilic staining necrotic mass and a few intact epithelial cells scattered on the surface as an interrupted single layer. Under the necrotic mass, large eosinophilic staining cells in moderate number were scattered throughout the lamina propria of the placental site. These cells were considered to be decidual cells. By the fourth week the placental sites were covered by a large lobulated mass of collagen fibers. The uterine glands were greatly dilated and degenerate, and mononuclear cell infiltration in the lamina propria was pronounced. By the seventh week, large masses of collagen fibers were detached from the surface, and endometrial glands were normal in size and shape. By the ninth week surface sloughing was completed. However, regeneration and replacement of the endometrial lining from the mouth of the uterine glands continued until the end of the twelfth week when the involution process was completed. The progesterone levels were very low for eight weeks postpartum.

Involution abnormalities in the postpartum uterus of the bitch.

Of 95 reproductive tracts from postpartum bitches, 20 had subinvolution of the placental sites. Grossly, the placental sites were hemorrhagic and about twice the size of normal sites at the same time after parturition. Microscopically, large masses of collagen, hemorrhage and dilated endometrial glands were in the endometrial sites. The myometrium was invaded in many areas by trophoblast-like cells from the endometrium. Variations in the size of placental sites in the same uterus were found in eight cases, and histological variations in the involution process in five. Invasion of the myometrium by trophoblast-like cells four days after parturition was seen in one bitch.

Improved double-antibody enzyme immunoassay for methotrexate.

We report an enzyme immunoassay procedure for methotrexate measurement that takes less than 3 h to perform. beta-D-Galactosidase (EC 3.2.1.23) from Escherichia coli was conjugated to methotrexate by means of the mixed anhydride reaction. Bound and free labeled drug were separated by a preincubated cubic complex of first and second antibody. The enzyme activity of the bound fraction was measured with o-nitrophenyl-beta-D-galactopyranoside as substrate. The standard curve covered the range 1 to 10 micrograms of methotrexate per liter. One microgram of methotrexate per liter inhibited binding of the tracer by 17%. The assay is specific for methotrexate in the presence of folinic acid (citrovorum factor), folic acid, tetrahydrofolic acid, and other methotrexate metabolities. Intra- and inter-assay CVs were less than 5 and 10%, respectively. Results obtained with this enzyme immunoassay method agreed well with those obtained with an established radioimmunoassay method.

Double-antibody enzyme immunoassay for nortriptyline.

beta-D-Galactosidase (EC 3.2.1.23) from Escherichia coli was conjugated to desmethylnortriptyline by means of a bifunctional cross-linking reagent, dimethyl adipimidate, and used in a double-antibody immunoassay for nortriptyline. Eighty percent of the enzyme activity was retained after conjugation; 75% of the enzyme was conjugated to desmethylnortriptyline. In the final immunoassay the enzyme activity of the bound fraction was determined with o-nitrophenyl-beta-D-galactopyranoside as substrate. The sensitivity, precision, and simplicity of the enzyme immunoassay compared favorable with that of a published radioimmunoassay method. Results for nortriptyline in plasma samples correlated well with those determined by either radioimmunoassay or gas-chromatography.