Feasibility of osteosynthesis of fractured cadaveric hips following preventive elastomer femoroplasty.

BACKGROUND: In vitro cadaveric studies showed that elastomer femoroplasty prevents displacement of fracture parts after proximal hip fracture allowing for conservative treatment. In the event that secondary displacement does occur, the purpose of this present study was to determine the feasibility of performing osteosynthesis of a fractured hip after preventive treatment with elastomer femoroplasty. METHODS: Ten pairs of human cadaveric femurs were fractured in a simulated fall configuration. From each pair, one femur was randomly selected for elastomer femoroplasty prior to fracture generation and the contralateral femur was used as control. Following hip fracture generation, osteosynthesis was performed in all femurs. The operative time per case, technical difficulties during the procedure, and postoperative energy-to-failure load were recorded. RESULTS: The mean (SD) time to perform osteosynthesis was 20 (6) minutes in the control-group and 19 (5) minutes in the elastomer femoroplasty-group (P=0.69). During osteosynthesis of the fractured hip in the elastomer femoroplasty-group, no difficulties including the need for additional instruments to remove elastomer from the proximal femur were recorded. Postoperative energy-to-failure load was similar in the control-group and the elastomer femoroplasty-group. CONCLUSION: Fixation with routine osteosynthesis of displaced cadaveric hip fractures is not hindered by the presence of previously injected elastomer.

Cyclic loading of fractured cadaveric femurs after elastomer femoroplasty: an in vitro biomechanical study.

BACKGROUND: Elastomer femoroplasty is a novel and experimental approach in the prevention of hip fracture surgery. Previously, we published the results of an in vitro cadaveric experiment in which we showed a significant reduction of fracture displacement in treated femurs. The aim of the present study was to establish the failure loads and inter-fragmentary movement of fractured, elastomer femoroplasty treated femurs during cyclic loading. METHODS: 16 cadaveric femurs were treated with elastomer femoroplasty and fractured in a simulated fall configuration. Each specimen underwent 10 cycles with a preload of 50 N, starting with a peak load of 250 N followed by 10 cycles of 500 N and continued with 500 N increments. The crosshead speed was 2 mm/s. The failure load, the number of completed cycles, and crosshead extensions were recorded. FINDINGS: The mean failure load was 2709 N (SD 1094). The number of completed cycles until failure was 60 (SD 22). The mean translation during maximum loading was 5.25 mm (SD 0.9). At 1500 N (two times the bodyweight of a 75 kg individual) the extension was 3.16 mm. INTERPRETATION: Preventive elastomer femoroplasty leads to the stabilization of the proximal femur after fracture. In a single leg stance configuration, cyclic loading with mean failure loads that well exceed the peak loads during normal gait is feasible.

Elastomer femoroplasty prevents hip fracture displacement In vitro biomechanical study comparing two minimal invasive femoroplasty techniques.

UNLABELLED: The purpose of this study was to test femur strength and the ability to prevent fracture displacement of two minimal invasive Elastomer femoroplasty techniques. METHODS: A total of sixteen fixed human cadaveric femur pairs were used. From each pair one femur was randomly assigned for Elastomer femoroplasty. In these femora we drilled a 3.5mm entrance in the lateral cortex. Cavities for the Elastomer were created by: group A, balloon and group B an excentric drill. All femora were fractured by simulating a fall on the greater trochanter. Neck-shaft-angles on plain anterior posterior radiographs were measured to determine fracture displacement. FINDINGS: There was no significant difference in fracture load between controls and treated femora for group A, 2904N (SD 1091) versus 2803N (SD 627) and group B, 2773N (SD 747) versus 2597N (SD 834). In group A the mean displacement was 35° (SD 14) for the control femora and 3° (SD 2) for the treated femora (P<0.001). In group B the mean displacement was 38° (SD 10) for the controls and 8° (SD 13) for the treated femora (P<0.001). INTERPRETATION: The results of this study show that minimal invasive Elastomer femoroplasty prevents fracture displacement of the proximal femur. We found no significant compromise in load-to-fracture after minimal invasive balloon or excentric drill femoroplasty.

Survival after transfusion in the Netherlands.

BACKGROUND: Cost-effectiveness analyses of blood safety interventions require estimates of the life expectancy after blood product transfusion. These are best derived from survival after blood transfusion, per age group and blood component type. STUDY DESIGN AND METHODS: In the PROTON (PROfiles of TransfusiON recipients) study transfusion recipient data was collected from a hospital sample covering 28% of the total blood use between 1996 and 2006 in the Netherlands. The dataset includes date of transfusion, blood component type transfused and recipient identification details. PROTON data were individually matched to mortality data of the Netherlands. Survival after first transfusion and after any transfusion was calculated, per blood component type and age group. PROTON mortality rates were compared to mortality rates in the general population. The results were used to estimate survival beyond the study period and to estimate life expectancy after transfusion. RESULTS: Of all 2,405,012 blood product transfusions in the PROTON dataset, 92% was matched to the national Dutch Municipal Population Register, which registers all deaths. After 1 year, survival after any transfusion was 65·4%, 70·4% and 53·9% for RBC, FFP and PLT respectively. After 5 years, this was 46·6%, 58·8% and 39·3% for RBC, FFP and PLT, respectively. Ten years after transfusion, mortality rates of recipients are still elevated in comparison with the general population. CONCLUSION: Mortality rates of transfusion recipients are higher than those of the general population, but the increase diminishes over time. The mortality rates found for the Netherlands are lower than those found in comparable studies for other countries.

The PROTON study: profiles of blood product transfusion recipients in the Netherlands.

BACKGROUND: Transfusion recipient data are needed for correct estimation of cost-effectiveness in terms of recipient outcomes after transfusion. Also, such data are essential for monitoring blood use, estimation of future blood use and benchmarking. STUDY DESIGN AND METHODS: A sample of 20 of 93 Dutch hospitals was selected. Datasets containing all blood product transfusions between 1996 and 2006 were extracted from hospital blood bank computer systems, containing transfusion date, blood product type and recipient characteristics such as gender, address, date of birth. The datasets were appended and matched to national hospitalization datasets including primary discharge diagnoses (ICD-9). Using these data, we estimated distributions of blood recipient characteristics in the Netherlands. RESULTS: The dataset contains information on 290,043 patients who received 2,405,012 blood products (1,720,075 RBC, 443,697 FFP, 241,240 PLT) from 1996 to 2006. This is 28% of total blood use in the Netherlands during this period. Comparable diagnosis and age distributions of all hospitalizations indicate included hospitals to be representative, per hospital category, for the Netherlands. Of all red blood cells (RBC), fresh-frozen plasma (FFP) and platelets (PLT), respectively 1.7%, 2.5% and 4.5% were transfused to neonates. Recipients of 65 years or older received 57.6% of RBC, 41.4% of FFP and 29.0% of PLT. Most of the blood products were transfused to patients with diseases of the circulary system (25.1%) or neoplasms (22.0%). CONCLUSION: Transfusion data from a limited sample of hospitals can be used to estimate national distributions of blood recipient characteristics.

Monitoring viral incidence rates: tools for the implementation of European Union regulations.

BACKGROUND AND OBJECTIVES: European legislation requires manufacturers of plasma products to report epidemiological data on human immunodeficiency virus, hepatitis B virus and hepatitis C virus in donor populations. The incidence rates of such infections are directly related to the risk of infection transmission. We propose two statistical tests to evaluate these incidence rates. MATERIALS AND METHODS: Infection data of the four Dutch blood collection centres from 2003 through 2006 were analysed. For transversal comparison of centres and detection of increased incidence rates, a new statistical test was developed (outlier test). For longitudinal detection of trends in incidence rates, a generic test for trend is proposed. The power and risk of non-detection are evaluated for both tests. RESULTS: Application of the outlier test did not reveal any significantly increased incidence rates among centres in The Netherlands. The test for trend showed no significant increase in incidence rates in individual centres, but on national level a statistically significant increase in hepatitis C virus incidence was observed (P-value of 0.01). CONCLUSION: The proposed tests allow signalling of outlier centres and trends in incidence rates both at individual centre and at national levels. Graphical support and the use of as much relevant historical data as possible is recommended. The statistical tests described are generic and can be applied by any blood establishment and plasma fractionation institute.

Augmentation with silicone stabilizes proximal femur fractures: an in vitro biomechanical study.

BACKGROUND: Prevention of hip fracture surgery in the elderly imposes great benefit for patient care as well as for society. The incidence of contra-lateral, second hip fractures after hip fracture surgery is as high as 20%. Augmentation of the contra-lateral proximal femur with silicone femoroplasty during hip fracture surgery of the ipsilateral hip could be a new preventive strategy. This study compared the degree of dislocation after a controlled induced fracture between treated and control cadaver femora. METHODS: Ten paired cadaver femora were randomly assigned for silicone femoroplasty and biomechanically tested for fracture load and dislocation against their native contra-lateral control. A load testing machine was used for fracture induction. All femurs were first fractured in a simulated fall configuration followed by dislocation in a "single leg stance" configuration. Dislocation was accessed using the AO-classification and measuring the Caput-Collum-Diaphysis angle. FINDINGS: Fracture loads were approximately 10% lower in the treated group (P=0.304). Forces needed to dislocate the proximal femur fractures did not significantly differ in both groups nor did the fracture type and AO-classification. All treated femurs showed complete reposition according to Caput-Collum-Diaphysis angle after dislocation versus only two of the controls (P<0.001). INTERPRETATION: From the results of this study we conclude silicone femoroplasty stabilizes the proximal femur by restoring hip geometry according to the Caput-Collum-Diaphysis angle after fracture. Future improvements in minimal invasive excavation and injection could make silicone femoroplasty an attractive alternative strategy in the prevention of hip fracture surgery in the growing population of low-demand, elderly patients.

Paying for blood donations: still a risk?

It is presently disputed whether studies indicating a higher risk of infectious diseases among paid blood donors are lessons of the past, or still hold relevance. Comparative studies published between 1968 and 2001 were assessed for a possible trend of change in the relative risk for infectious disease markers between paid and unpaid blood or plasma donors. Studies reporting that paid donors had lower risk were found, but most studies, including recent ones, continued to report that paid donors have higher rates of infectious disease markers than unpaid donors. By log-linear regression analysis of the relative risk estimates for infectious disease markers among paid and unpaid donors from 28 published data sets, evidence was not found to indicate that the difference in risk for infectious disease markers between paid donors and unpaid donors had diminished over time (P = 0.128, not significant). Paid donors are still more likely than unpaid donors to donate blood in the period during which infectious donations escape detection by blood-screening tests (the "window-period"). Therefore, paid donations have a higher risk that labile blood components (such as red blood cells and platelets) are infected. Additional safety measures for handling plasma donations, and the preparation, purification and viral-inactivation steps employed for the production of plasma derivatives, may render the difference in infectious disease marker rates in donors irrelevant for plasma products. However, not all viruses are inactivated and paid donors were repeatedly found to have higher frequencies of markers for emerging agents. In a quality system, critical steps of the process should be addressed, and selection of the donor population is one of the first steps in this process. It is advised that blood establishments present yearly reports (with complete and raw data) to authorities on the incidence and prevalence of infectious disease markers among their donors as an ongoing surveillance on the "quality" of their donor populations. Paid blood or plasma donors still have higher rates for infectious disease markers than unpaid donors.

Human immunodeficiency virus (HIV) antibodies detected by new assays that are enhanced for HIV-1 subtype O.

BACKGROUND: Human immunodeficiency virus type 1 (HIV-1) subtype O infections are not reliably detected by commonly used anti-HIV-1/2 screening assays. Therefore, anti-HIV-1/2 assays have been modified to increase their sensitivity in detecting antibodies to HIV-1 subtype O. STUDY DESIGN AND METHODS: Two new anti-HIV-1/2 enzyme-linked immunosorbent assays (ELISAs) (Abbott Plus and Ortho Enhanced) were compared with a currently used anti-HIV-1/2 ELISA (Abbott Recombinant) in various serum panels: 91 Western blot-confirmed anti-HIV-1-positive samples, 20 samples from Western blot-confirmed HIV-1-infected patients in log3 serial dilutions, and 1463 samples from consecutive, volunteer, nonremunerated blood donors. RESULTS: Among 91 anti-HIV-1 Western blot-positive samples, 2 (2.2%) were missed by the Abbott Recombinant ELISA, but all 91 were detected by the Abbott Plus and Ortho Enhanced ELISAs. In contrast, two discrepant samples were found to react in viral lysate-based assays. In serial dilutions, Ortho Enhanced ELISA was significantly less sensitive than the Abbott Recombinant and Abbott Plus ELISAs, with the latter two being of comparable sensitivity. The specificities of Abbott Recombinant, Abbott Plus, and Ortho Enhanced ELISAs in 1463 blood donors were 100, 99.93, and 99.86 percent, respectively. Routine testing of 29,102 donations with the enhanced Abbott Plus ELISA revealed a specificity of 99.93 percent. CONCLUSION: Two Western blot-confirmed anti-HIV-1-positive samples were missed by the Abbott Recombinant ELISA but detected by the Abbott Plus and Ortho Enhanced ELISAs. The analytic sensitivity of the Ortho Enhanced ELISA was inferior to that of both Abbott ELISAs. The specificities of the Abbott Recombinant, Abbott Plus, and Ortho Enhanced ELISAs were comparable.

International collaborative study on the second EUROHEP HCV-RNA reference panel.

Eighty-six laboratories participated in a collaborative study and tested the second EUROHEP HCV-RNA reference panel. The coded panel comprised 4 HCV-RNA positive plasma samples (one weak positive), 6 HCV-RNA negative plasma samples and two dilution series of HCV-RNA genotype 1 and 3 plasma standards. The 86 laboratories submitted 136 coded data forms for evaluation. Of these data sets 99 were tested using a PCR assay developed in-house, 28 using a commercially available HCV-PCR test (AMPLICOR, Roche Diagnostic Systems) and 9 using other amplification methods. Twenty-two data forms (16%) had faultless results, 39 (29%) missed the weak positive sample only and 75 data sets (55%) had false positive and/or false negative results. Participants using the commercial HCV-PCR test tended to reach a sufficient quality score more often than investigators using assays developed in-house (64% versus 45%, P = 0.11). The UNG system in the commercial HCV-PCR test did not prevent five laboratories generating false-positive results in the 6 HCV-RNA negative samples. Among the laboratories with satisfactory results, up to 10000-fold differences in sensitivity were observed in the dilution series. The 50% and 90% laboratories detection endpoints in the dilution series of the HCV genotype 1 plasma standard were approximately 600 genome equivalents per ml (geq/ml) and 7750 geq/ml according to a standard applied in a signal amplification assay (bDNA, Chiron). Our results suggest that the detection efficiency for genotype 3 by commercial HCV-RNA assays is lower than by the in-house assays. Internationally characterized HCV-RNA plasma standards should be made available for validation and standardization of HCV-RNA assays for HCV diagnosis and virological safety testing of blood products.

Subsets of CD34+ cells and rapid hematopoietic recovery after peripheral-blood stem-cell transplantation.

PURPOSE: To study whether there is a relationship between transplanted cell dose and rate of hematopoietic recovery after peripheral-blood stem-cell (PBSC) transplantation, and to obtain an indication whether specific subsets of CD34+ cell populations contribute to rapid recovery of neutrophils or platelets. PATIENTS AND METHODS: Based on data from 59 patients, we calculated for each day after PBSC transplantation the dose of CD34+ cells that resulted in rapid recovery of either neutrophils or platelets in the majority (> 70%) of patients. Using dual-color flow cytometry, subsets of peripheral-blood CD34+ cells were quantified and the numbers of CD34+ cells belonging to each of the reinfused subsets correlated with hematopoietic recovery following high-dose chemotherapy. RESULTS: The calculated threshold values with a high probability of engraftment showed a steep dose-effect relationship between CD34+ cell dose and time to recovery of both neutrophils or platelets. Predominantly CD34+ cells with the phenotype of myeloid precursors were mobilized. A minority of CD34+ cells expressed the erythroid and megakaryocytic lineage-associated antigens and a low but distinct population of CD34+ cells expressed antigens associated with multipotent stem cells. Analysis showed that the number of CD34+CD33- cells (r = -.74, P < .05), as well as the number of CD34+CD41+ cells (r = -.81, P < .005), correlated significantly better with time to neutrophil and platelet recovery, respectively, than with the total number of CD34+ cells (r = -.55 and r = -.56, respectively). CONCLUSION: The numbers of CD34+CD33- cells and CD34+CD41+ cells may help to predict short-term repopulation capacity of PBSCs, especially when relatively low numbers of CD34+ cells per kilogram are reinfused.

Expression of adhesion molecules on CD34+ cells: CD34+ L-selectin+ cells predict a rapid platelet recovery after peripheral blood stem cell transplantation.

Adhesion molecules play a role in the migration of hematopoietic progenitor cells and regulation of hematopoiesis. To study whether the mobilization process is associated with changes in expression of adhesion molecules, the expression of CD31, CD44, L-selectin, sialyl Lewisx, beta 1 integrins very late antigen 4 (VLA-4) and VLA-5, and beta 2 integrins lymphocyte function-associated 1 and Mac-1 was measured on either bone marrow (BM) CD34+ cells or on peripheral blood CD34+ cells mobilized with a combination of granulocyte colony-stimulating factor (G-CSF) and chemotherapy. beta 1 integrin VLA-4 was expressed at a significantly lower concentration on peripheral blood progenitor cells than on BM CD34+ cells, procured either during steady-state hematopoiesis or at the time of leukocytapheresis. No differences in the level of expression were found for the other adhesion molecules. To obtain insight in which adhesion molecules may participate in the homing of peripheral blood stem cells (PBSCs), the number of CD34+ cells expressing these adhesion molecules present in leukocytapheresis material was quantified and correlated with hematopoietic recovery after intensive chemotherapy in 27 patients. The number of CD34+ cells in the subset defined by L-selectin expression correlated significantly better with time to platelet recovery after PBSC transplantation (r = -.86) than did the total number of CD34+ cells (r = -.55). Statistical analysis of the relationship between the number of CD34+L-selectin+ cells and platelet recovery resulted in a threshold value for rapid platelet recovery of 2.1 x 10(6) CD34+ L-selectin+ cells/kg. A rapid platelet recovery (< or = 14 days) was observed in 13 of 15 patients who received > or = 2.1 x 10(6) CD34+ L-selectin+ cells/kg (median, 11 days; range, 7 to 16 days), whereas 10 of 12 patients who received less double positive cells had a relative slow platelet recovery (median, 20 days; range, 13 to 37 days). The L-selectin+ subpopulation of CD34+ cells also correlated better with time to neutrophil recovery (r = -.70) than did the total number of reinfused CD34+ cells (r = -.51). However, this latter difference failed to reach statistical significance. This study suggests that L-selectin is involved in the homing of CD34+ cells after PBSC transplantation.

T cell function in vitro is an independent progression marker for AIDS in human immunodeficiency virus-infected asymptomatic subjects.

The predictive value of low T cell reactivity to CD3 monoclonal antibodies for development of AIDS was evaluated and compared with low CD4+ cell numbers and the presence of syncytium-inducing human immunodeficiency virus (HIV) variants in 122 seropositive asymptomatic homosexual men for 4.5 years. Low T cell reactivity was a strong predictor for progression to AIDS in a multivariate proportional hazards analysis using these markers as covariates at entry and as time-dependent covariates. The combination of the three markers was associated with development of AIDS in 6 of 7 men within 15 months. In contrast, the group that lacked any of these markers had a very low risk (11%) for developing AIDS. In groups with one or two of these three markers, progression rates were 33% and 66%, respectively. These data demonstrate that measurement of T cell function in vitro is of value for staging of HIV infection and may be useful for monitoring therapy.

Comparison of quantitative cDNA-PCR with the branched DNA hybridization assay for monitoring plasma hepatitis C virus RNA levels in haemophilia patients participating in a controlled interferon trial.

The branched DNA (bDNA) assay was compared with a semi-quantitative cDNA-polymerase chain reaction (cDNA-PCR) assay for monitoring HCV RNA levels in plasma in 17 haemophilia patients participating in a controlled alpha-interferon trial. Good correlation between the HCV RNA levels as detected by the two assays was observed, with a correlation co-efficient of 0.83 (P < 0.0001) and 0.90 (P < 0.0001) at week 0 and 24, respectively. Hepatitis C virus RNA (HCV RNA) levels could be assessed with the bDNA assay in 14/17 (82 percent) HCV cDNA-PCR positive pretreatment samples. The bDNA assay apparently failed to detect low viral titres. Interferon treated patients (n = 11) showed either a complete response, being a large reduction in HCV RNA level to below the detection limit of the HCV cDNA-PCR assay (6/11) or no significant reduction in HCV RNA level (5/11). A "partial" virological response was not observed. The changes in HCV RNA plasma levels in non-responders during interferon (IFN) treatment were similar to the (small) natural fluctuations in viral load observed in controls (untreated patients). Although the bDNA assay was not as sensitive as cDNA-PCR, given its user friendliness and quantitative results, it is concluded that it is a useful test for monitoring HCV RNA levels in patients treated with interferon. However, patients who are non-reactive in the bDNA assay have to be retested by cDNA-PCR because low viral titres are not detected by the bDNA assay.

Early antihepatitis C virus response with second-generation C200/C22 ELISA.

Detection of early antibody to hepatitis C virus (HCV) by a new second-generation C200/C22 anti-HCV enzyme-linked immunosorbent assay (ELISA) and a four-antigen recombinant immunoblot assay (4-RIBA) was compared with the first-generation anti-HCV C100 ELISA using sequential serum samples of 9 recipients who were infected with HCV, as detected by polymerase chain reaction after transfusion of blood products. Within 26 weeks after transfusion, 9/9 (100%) recipients seroconverted with C200/22 ELISA, and 6/9 (67%) seroconverted with C100 ELISA. Compared with C100 ELISA, C200/C22 ELISA seroconversion occurred simultaneously in 3 cases, 5-6 weeks earlier in 3 other cases, and 20 weeks earlier in 1 case. Seven of 9 (78%) recipients became positive, and 2/9 (22%) became indeterminate with 4-RIBA. In 8 cases with clinical posttransfusion hepatitis non-A, non-B (PTH-NANB), anti-HCV C200/C22 ELISA seroconversion occurred 2-17 (mean 6) weeks after the onset of hepatitis. In 6 cases of PTH-NANB, anti-HCV C100 ELISA seroconversion occurred 2-26 (mean 9) weeks after the onset of hepatitis. It is concluded that the second-generation C200/C22 ELISA is more sensitive than the C100 ELISA for the detection of antibody during early HCV infection. Indeterminate 4-RIBA results are found in the early phase of HCV infection.

Enhanced sensitivity of a second generation ELISA for antibody to hepatitis C virus.

A second generation ELISA for combined detection of antibodies to three hepatitis C virus (HCV) recombinant proteins, i.e. C100, C33c and core, was compared with a first generation anti-HCV ELISA in which only antibodies to C100 are detected. The results of the ELISAs were evaluated in 225 haemophilia patients (panel A) and 44 patients with non-A, non-B (NANB) hepatitis (panel B). HCV infection was established by cDNA-polymerase chain reaction (PCR) (in panel B only) and by studying the anti-HCV reaction patterns in 4 separate ELISAs for detection of antibodies to the recombinant proteins C100, C33c, core and a combination of two synthetic peptides sp67/65 derived from the C100 region. The sensitivity for the detection of HCV infection had increased from 0.92[95% confidence interval (CI): 0.87-0.95] to 1.00 (95% CI: 0.89-1.00) in haemophiliacs and from 0.84 (95% CI: 0.66-0.95) to 1.00 (95% CI: 0.89-1.00) in NANB hepatitis patients when the second generation ELISA was used instead of the first generation ELISA. Concurrently the chance of a false negative result was reduced in panel A and B from 0.37 to 0 and from 0.28 to 0, respectively. Analysis of anti-HCV reaction patterns revealed that 172 of 206 (83.5%) anti-HCV ELISA-reactive haemophilia patients had antibodies to all 4 antigens tested. In the NANB hepatitis patients 18 of 31 (58.1%) anti-HCV ELISA-reactive subjects reacted with 4 antigens. In the PCR tested panel of NANB hepatitis patients 2 subjects who showed antibody reactivity to only one antigen and 5 patients with reactivity to 2 antigens were PCR-positive.(ABSTRACT TRUNCATED AT 250 WORDS)

Elevated levels of a soluble form of the T cell activation antigen CD27 in cerebrospinal fluid of multiple sclerosis patients.

The expression of the T cell membrane molecule CD27--a molecule that has recently been shown to belong to the nerve growth factor receptor superfamily--is strongly increased after activation of T lymphocytes via the T cell receptor/CD3 complex. In addition, activated cells release a 28-32 kDa soluble form of CD27 in their supernatant which can also be detected in serum and urine of healthy individuals. In this study we show that levels of soluble (s) CD27 are significantly elevated in cerebrospinal fluid (CSF) of multiple sclerosis (MS) patients and of patients and of suffering from other inflammatory neurological diseases (OIND), whereas increased levels of sCD25 (soluble interleukin-2 receptor) were only found in CSF of patients with OIND. In MS patients, a significant correlation was found between CSF sCD27 titer and IgG index.

Prevalence of anti-HCV antibodies confirmed by recombinant immunoblot in different population subsets in The Netherlands.

The prevalence of antibodies to hepatitis C virus (anti-HCV) was studied in various population subsets in the Netherlands with anti-HCV C100 enzyme linked immunosorbent assay (ELISA), and confirmed with recombinant immunoblot assay (RIBA). Anti-HCV C100 ELISA positivity and RIBA positivity were found in 39 (0.7%) and 5 (0.1%) of 5,434 blood donors from Amsterdam; 25 (5%) and 2 (0.4%) of 481 blood donors from Surinam (South America); 19 (9%) and 2 (1%) of 213 multitransfused patients; 28 (4%) and 15 (2%) of 633 hemodialysis patients; 179 (80%) and 150 (67%) of 225 hemophilia A and B patients; 8 (80%) and 4 (40%) of 10 intravenous drug abusers; 18 (15%) and 2 (2%) of 119 anti-HIV-positive homosexual men; 2 (2%) and none of 106 anti-HIV-negative homosexual men; 6 (32%) and 3 (16%) of 19 patients with acute hepatitis non-A, non-B (NANBH); 13 (65%) and 8 (40%) of 20 patients with chronic NANBH and/or cryptogenic cirrhosis; and 4 (40%) and 1 (10%) of 10 patients with idiopathic autoimmune chronic hepatitis. Among blood donors, a positive correlation between a history of jaundice after the age of 18 years and the presence of RIBA-confirmed anti-HCV antibodies was found. Among both blood donors and hemodialysis patients, a positive correlation of RIBA-confirmed anti-HCV positivity with elevated alanine aminotransferase levels, but not with the presence of anti-hepatitis B core antibodies was found.(ABSTRACT TRUNCATED AT 250 WORDS)

Infectivity of blood seropositive for hepatitis C virus antibodies.

Stored serum samples from 5150 blood product transfusions and 383 recipients were tested for antibodies to hepatitis C virus (anti-HCV) by a recombinant enzyme-linked immunosorbent assay (ELISA) as part of a prospective study on post-transfusion non-A, non-B hepatitis (NANBH). Donor cofactors associated with HCV infectivity of anti-HCV-positive blood products were raised alanine aminotransferase concentrations (6 of 9 infective vs 1 of 26 not infective); a mean ELISA optical density/cut-off ratio greater than or equal to 2 (7 of 9 vs 9 of 26); both preceding factors (together in 6 blood products, all of which transmitted infection); and persistent donor anti-HCV seropositivity. Use of anti-HCV screening to prevent post-transfusion NANBH was compared with measurement of alanine aminotransferase concentrations: a corrected efficacy of 63% and 65%, a specificity of 93% and 64%, and a positive predictive value of 16.2% and 3.6% were found, respectively; 0.7% or 3.8% of blood donations, respectively, would be discarded. Blood donor screening for anti-HCV is recommended to reduce the incidence of post-transfusion NANBH.