A Novel HLA-A*32 Variant Allele, HLA-A*32:174 Detected in a Kidney Transplant Recipient.
A missense nucleotide substitution at codon 106 of HLA-A*32:01:01:01 results in the novel allele HLA-A*32:174.
Humans↗
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Dose-response relationship after immunization of volunteers with a new, surface-antigen-adsorbed influenza virus vaccine.
Volunteers (15 per group) were given inoculations of various doses (5-400 international units [IU]) of surface-antigen-adsorbed influenza virus A/Port Chalmers/73 vaccine; this vaccine was prepared from purified virus hemagglutinin and neuraminidase antigens and adsorbed to alhydrogel. The titers of hemagglutination-inhibiting (HAI) and neuraminidase-inhibiting antibodies in serum after immunization showed a clear dose-response relationship. Thus, for volunteers given 400, 100, 25, or 5.0 IU of vaccine, the titers of HAI antibody in serum increased 174-, 32-, 12-, and eightfold, respectively. A similar dose response was observed for production of local neutralizing antibody. Immunization with A/Port Chalmers/73 virus vaccine also induced serum HAI antibody to influenza viruses A/Scotland/74, A/England/72, and A/Hong Kong/68; the increase in titers of antibody to these viruses corresponded directly to the degree of cross-reactivity between the virus tested and the vaccine virus. Four weeks after immunization, all volunteers were challenged with attenuated WRL-105 influenza virus. Evidence of viral infection was found in one, two, and two volunteers in each group of 15 subjects previously immunized with 400, 100, and 25 IU of vaccine, respectively; in six of the 15 volunteers given 5.0 IU of vaccine; and in 10 of 15 control subjects. The results suggest that equivalent immunity was induced in volunteers given greater than or equal to 25 IU of vaccine.
Adult↗
Naturally occurring intracytoplasmic inclusions in the canine exocrine pancreas.
Bodies similar to acidophilic intracytoplasmic inclusions were found by light microscopy in the pancreatic acinar cells of 56 of 174 (32%) healthy male and female purebred Beagles and 14 of 97 (14%) of healthy male mongrel dogs. The inclusions were ovoid, acidophilic and often granular with basophilic particulates. Many seemed to be enclosed within halos of various widths. Electron microscopically the inclusions consisted of whorls of rough endoplasmic reticulum, vacuoles, and cytoplasmic organelles in various stages of decomposition. These inclusion bodies were interpreted as evidence of focal intracytoplasmic degradation. They appeared similar to the dense ribosomal autophagic vacuoles, hitherto described only in association with various experimental procedures.
Animals↗
Serum ferritin as a possible marker of the hemochromatosis allele.
To determine whether a correlation exists between the biochemical expression of hemochromatosis and the HLA genotype, we studied 174 family members of 32 persons with the disease. Persons who shared both HLA haplotypes with the proband (and presumably having two hemochromatosis alleles) differed significantly from those who shared only one haplotype (and presumably having one hemochromatosis allele) in terms of serum iron (P less than 0.001 for both sexes), unsaturated iron-binding capacity (P less than 0.01 for female and P less than 0.0001 for male subjects) and serum ferritin (P less than 0.0001 for female and P less than 0.00001 for male subjects). The only significant difference between relatives having one hemochromatosis allele and age and sex-matched controls was related to serum ferritin values in male subjects (P less than 0.05, despite considerable overlap). In our hands, serum ferritin was the best indicator of disordered iron metabolism and was elevated among most homozygous but among few heterozygous family members.
Adolescent↗
[Blood group opinion and judicial judgement 1. 250 paternity cases 1965-1970 (author's transl)].
In 250 paternity actions (one-man one-child affairs 1965-1970) without exclusion by blood group opinion, which include 48 cases involving persons from abroad, 41 men acknowledged the paternity or withdrew the suit during the process. 32 cases were judged by default. 174 men were judged of child support according to the former 1717 BGB, 13 of these after an anthropological expertise. In 2 cases the anthropological opinion gave an indication of nonpaternity; accordingly, the court dismissed the action. In 157 cases the plausibility of paternity according to Essen-Möller's formula was calculated by the expert and dealt with in the blood group opinion. It appears, however, that the W values had no remarkable influence on the decision of the court.
Anthropology↗
Antral gastrin concentration in upper-gastrointestinal disease.
Antral gastrin concentration (AGC) was measured in prepyloric mucosa specimens obtained by forceps biopsy during endoscopic examination of 174 clinic and hospital patients. AGC in 32 patients who had normal endoscopic findings, the control group, varied widely from 2 to 38.6 ng gastrin/mg tissue. The mean AGC of the control patients was 14.2 +/- 1.4 (mean +/- 1 SE) ng gastrin/mg tissue. AGC was similar to control values in 18 patients with duodenal ulcer, 14.7 +/- 2.1; 12 patients with a pyloric channel or antral ulcer, 16.4 +/- 3.5; and 48 patients with miscellaneous diagnoses, 14.3 +/- 1.5. AGC was significantly less than control values in 13 patients with a ulcer in the body or fundus of the stomach, 5.9 +/- 1.5, and 4 patients with the Zollinger-Ellison syndrome, 4.9 +/- 2.4. AGC was significantly greater than in control values in 16 patients with gastritis, 25.8 +/- 4.3;22 patients with esophagitis, 23.2 +/- 3.0; and 9 patients with gastric atrophy and fasting serum hypergastrinemia 44.6 +/- 12.3. In group of 77 of these patients with heterogeneous diagnoses, meal-stimulated 3-hr integrated gastrin output was directly related to AGC (r = 0.47, P less than 0.001). In a group of 106 patients AGC was inversely related to histalogstimulated maximum acid output. The correlation was very weak (r = -0.20) but significant (P less than 0.05).
Atrophy↗
The responses of Golgi tendon organs to stimulation of different combinations of motor units.
1. Afferent discharges were recorded from stretch receptors identified as Golgi tendon organs, in the medial gastrocnemius and soleus muscles of the cat. 2. The response of a tendon organ was recorded during stimulation of one or more motor units selected for the intensity of discharge elicited from the receptor during twitch and tetanic contractions. 3. Repetitive stimulation of a single motor unit could evoke in a tendon organ a firing rate of up to 174 impulses/sec. The mean rate for a total of 90 motor units was 65 (+/- 32 S.D.) impulses/sec. No significant difference in effectiveness could be detected between motor units covering a wide range of contraction speeds, tetanic tensions and susceptibility to fatigue. 4. The response of a tendon organ to contraction of several motor units in combination was greater than from stimulating any one motor unit alone but less than predicted from the algebraic sum of individual responses. 5. The relation between firing rate and tension was plotted for combined stimulation of up to ten motor units. The relation was found to be a straight line provided the size of the response elicited by each motor unit in the stimulated bundle was similar or when responses were ranked according to their intensity. When one motor unit evoked a much more powerful response than others it tended to dominate the discharge and disturb the linearity. 6. Evidence is provided that the sites of stimulus transduction for motor units which exert their effect directly on the receptor can be relatively independent of one another. It is argued that on such occasions summation of responses may be attributed to mechanisms operating at the level of impulse generation.
Action Potentials↗
[Detection of late lung cancer metastases].
The authors report the data on lung cancer metastases in abdominal and retroperitoneal space organs in 174 patients died due to postoperative complications during 2 months following resection of the lung. Distant metastases were recognized in 32 cases (18.3%). 29 of 49 metastases (58%) were detected in abdominal organs. In stages I-II remote metastases were found in 2 of 32 cases, in stage III--in 29 of 142 cases, i.e. 35 times as frequently. Laparoscopy and laparotomy, performed if indicated, are conclusive surgical methods of establishing the precise diagnosis of the tumor spread, and these allow the elaboration of a rational plan of treatment in lung cancer patients.
Abdominal Neoplasms↗
Management of the urethra in patients undergoing radical cystectomy for bladder carcinoma.
Computerized data on 174 male patients who underwent radical cystectomy for bladder carcinoma were studied in relationship to the incidence of urethral involvement. Simultaneous or delayed urethrectomies were done on 32 patients, 7 of whom had overt urethral carcinoma (4 per cent of the total number of male patients) and 10 of whom had carcinoma in situ (5.7 per cent of the total number of male patients). The low incidence of these 2 phenomena leads us to the conclusion that routine urethrectomy need not be done on patients undergoing radical cystectomy unless overt urethral carcinoma or positive margins are found at cystectomy. We believe that the use of urethral cytologies is crucial to the routine followup of patients who have undergone radical cystectomy for bladder cancer and should be combined with clinical followup to establish the indication for urethrectomy.
Biopsy↗
Two infectious forms of bacteriophage phi X 174.
Infectious particles with S values of 114 and 132 were isolated from cells infected with bacteriophage phi chi 174. Electron micrographs of the 132S particle revealed a spherical structure with a diameter of about 40 nm. The 114S particle had spikelike projections and a diameter of about 32 nm. The 132S particles could be converted to 114S particles in vitro. However, pulse and pulse-chase experiments indicated no precursor-product relationship between these two particles in vivo.
Coliphages↗
[Haptoglobin phenotypes and liver cirrhosis. I (author's transl)].
The distribution of haptoglobin phenotypes (Hp) 1--1, 2--1 and 2--2 in 174 patients suffering from liver cirrhosis was determined and compared with a reference group consisting of 194 healthy subjects. The study revealed a high frequency of the Hp 1--1 phenotype (32%) in the patients as compared with the control group (14%). This difference is statistically highly significant (p less than 0.00025). It was calculated that in individuals of type Hp 1--1, the risk of liver cirrhosis is 4.3-fold higher than in persons with the phenotype Hp 2--2.
Adolescent↗
Controlled comparison of amikacin and gentamicin.
Amikacin or gentamicin was used to treat 174 patients with suspected severe gram-negative infections in a prospective, randomized, double-blind trial. Enteric gram-negative bacilli were pathogenic in 71 cases (39 treated with amikacin, and 32 with gentamicin). Amikacin was effective in 10 to 12 bacteremias, 21 of 24 urinary-tract infections, two of five pneumonias and four of six other serious tissue infections. The toal favorable response rate was 77 per cent for amikacin and 78 per cent for gentamicin. Nephrotoxicity and auditory toxicity could be evaluated in 124 and 67 cases respectively. Definite nephrotoxicity developed in five of 62 (8 per cent) receiving amikacin and seven of 62 (11 per cent) given gentamicin, and possible nephrotoxicity developed in four patients in both groups. Definite ototoxicity developed in four patients in both groups. Definite otoxicity developed in two of 34 (6 per cent) and three of 30 (10 per cent) respectively. These differences were not statistically significant (by chisquare analysis, P greater than 0.05). The results indicate that amikacin is effective against severe gram-negative infections and is not more and not less ototoxic or nephrotoxic than gentamicin.
Adult↗
Open Dialogue versus treatment as usual for adults presenting in crisis to mental health services in England (the ODDESSI Trial): a multisite cluster-randomised trial.
BACKGROUND: Open Dialogue is a person-centred, transdiagnostic model of mental health care that emphasises continuity, therapeutic relationships, and collaboration with the service user's social network. Open Dialogue is a service-wide approach to care involving network meetings with the service user, members of their social network, and usually two practitioners who support the network throughout the duration of care. In this cluster-randomised trial, we aimed to evaluate the clinical effectiveness of Open Dialogue versus treatment as usual for adults presenting in crisis to community mental health services in England. METHODS: This multicentre, parallel two-arm, cluster-randomised, controlled superiority trial was conducted in mental health services in five National Health Service trusts in London and the South of England. Clusters were defined at the level of primary care practices within service catchment areas. Participants were adults aged 18 years or older presenting in crisis to mental health services and registered with a practice within trial clusters. Randomisation was done at the cluster level (1:1), stratified by catchment area, and balanced on average general practice (GP) list size and Index of Multiple Deprivation (2015). The chief investigator, senior statistician, and assessors of the primary outcome were masked in the study. Participants either received Open Dialogue or treatment as usual, which refers to the functional team model currently implemented throughout English mental health services. The primary outcome was time (days) to first relapse following initial recovery from the index crisis censored at the end of the 2-year follow-up period. Participant-reported secondary outcomes were EuroQol Visual Analogue Scale, Social Provisions Scale, Lubben Social Network Scale, Questionnaire about the Process of Recovery, and the Client Satisfaction Questionnaire, measured at five timepoints over 2 years, and clinical measures were extracted from electronic health records. People with relevant lived experience were involved in the design and execution of the study. Fidelity to the model of care in Open Dialogue and treatment as usual, and adherence to the delivery of Open Dialogue, were measured prior to each site starting participant recruitment, then every 6 months thereafter until the final participant follow-up in that site. The trial was retrospectively registered (ISRCTN52653325) and is complete. FINDINGS: 185 general practices associated with six mental health Trusts across England were identified for screening. 105 practices were excluded, and 80 were included in cluster formation, forming 32 clusters that were randomly assigned (16 to treatment as usual and 16 to the Open Dialogue intervention). One mental health trust (two clusters) withdrew, resulting in five mental health trusts (30 clusters) participating in the trial. Between June 25, 2019, and Dec 9, 2021, 494 participants (266 [54%] female gender, 221 [45%] male gender, 341 [69%] White British) with a mean age of 38·1 years (SD 13·4) provided consent for study inclusion (223 in the treatment as usual group and 271 in the Open Dialogue group). Of these, 174 (78%) in the treatment as usual group and 225 (83%) in the Open Dialogue group recovered and had data enabling relapse determination; there was no significant difference between groups on the primary outcome of time to relapse following initial recovery (marginal hazard ratio 0·95 [95% CI 0·67-1·32]). For secondary outcomes, Open Dialogue was associated with significantly lower probabilities of psychiatric inpatient admission and re-referral to crisis care or secondary mental health services, and with improvements in self-rated recovery, health-related quality of life, and satisfaction with services. There were no significant differences in social network quality or size. There were 386 serious adverse events (281 in the treatment as usual group and 105 in the Open Dialogue group); 376 (97%) were deemed to be unrelated to the intervention. INTERPRETATION: Open Dialogue did not reduce time to first relapse compared with treatment as usual, the primary outcome, but it reduced acute inpatient bed use, improved service user reported outcomes and experience, and there were no significant safety concerns. Further investigation is required to determine whether Open Dialogue can enhance the effectiveness and acceptability of crisis care and continuing care in community mental health services. FUNDING: National Institute for Health Research.
Humans↗
Real-time sonography in obstetrics.
Three hundred fifty real-time scans were performed on pregnant women for various indications. Placental localization was satisfactorily obtained in 173 of 174 studies. Estimates of fetal gestation from directly measured biparietal diameter were +/-2 weeks of actual gestation in 153 of 172 (88.9%) measurements. The presence or absence of fetal motion and cardiac activity established a diagnosis of fetal viability or fetal death in 32 patients after the first trimester. Accurate diagnosis was made in 52 of 57 patients with threatened abortions, and two of these errors occurred in scans performed before completion of the eighth postmenstrual week. Because of the ability to demonstrate fetal motion, real-time sonography should have many applications in obstetrics.
Abortion, Threatened↗
Prevalence of Toxoplasma gondii antibodies in wild and domestic animals in northern California.
Wild and domestic animals from 3 geographic-climatologic areas in northern California were tested for antibodies against Toxoplasma gondii. A total of 2,796 serum samples representing 37 species of wild mammals, 35 species of wild birds, and 5 species of domestic animals were tested by the indirect hemagglutination test. Of 1,174 wild mammal serums tested, 10.8% were positive, which compared with 14.7% of the 1,221 domestic mammal serums. Of 229 wild carnivores tested, 45% were seropositive, including 69% of 86 bobcats, 28% of 58 coyotes, 48% of 25 raccoons, 27% of 26 gray foxes, 22% of 32 striped skunks, a civet cat, and a mink. Serologic evidence of infection was found in 38% of 47 rural domestic cats, but none of the 7 dogs tested was seropositive. Of 160 murid rodents (rats and house mice) in rural habitats, 4% were seropositive, which compared with 2% of 399 cricetine rodents (mostly deer mice) collected from wilderness habitats. Seven percent of 56 wild Artiodactyla (deer and feral pigs) were seropositive, which compared with 15% of 1,048 domestic sheep tested. Of 401 birds tested, 3.5% had antibodies against T gondii. The highest prevalence of antibodies among birds was in crows (14%). Toxoplasma was isolated from 1 raven, by mouse inoculation. In general, the highest prevalence of seropositive carnivores, rodents, and sheep was in the coastal region below 100 ft elevation, where the weather is cool and damp for much of the year. In the central valley the highest prevalence among sheep was in areas under irrigation. The prevalence of antibodies was lowest in the mountain areas, where climatologic extremes prevail at various seasons of the year.
Animals↗
[Myocardial infarction in early postoperative complications in operations of myocardial revascularization: incidences, clinical study and mechanisms].
A study of the electrocardiograms and enzyme levels after surgery to revascularise the myocardium in a group of 174 consecutive patients has allowed us to demonstrate 19 cases of early postoperative myocardial infarction (EPOMI) (10.9%). 10 of these cases had no clinical features of EPOMI; 9 had clinical signs (collapse of altered systemic pressures, arrhythmias) or haemodynamic disorders (raised left atrial pressure). The EPOMI turned out to be fatal in 3 cases (19%), and to be complicated by left ventricular failure in 6 cases (32%). Post-operative coronary arteriography showed that 8 out of 20 grafts were occluded in 13 patients; ventriculography showed the myocardial damage consequent upon EPOMI in 8 patients out of 12; Autopsy showed graft occlusion in each of the two patients. The means of diagnosis of EPOMI must be electrocardiographic and enzymatic. An attempt has been made to study the causes of EPOMI: aortocoronary bypass hazardous because of poor distal supply (6 cases) or surgical difficulties (6 cases); progression of the atheromatous lesions (3 cases); infarct already inicipient at the time of surgery (1 case). EPOMI is a complication of cardiac surgery which must be recognised; the mechanisms are diverse, and any of the factors which are relevant to the surgical procedure may be a cause.
Adult↗
The natural history of the perforated duodenal ulcer treated by suture plication.
This retrospective study of 174 patients with proven duodenal ulcer perforation was undertaken to delineate the natural history of those patients primarily managed by suture plication. During this 25-year period, 122 patients (70%) were treated with suture plication and 52 (30%) underwent a definitive procedure. There were 13 deaths in the overall group (7.4%) of which the mortality was 6.5% in the plicated group and 9.6% in the definitive group. Of the 122 patients treated with suture plication, 48% either 1) died of ulcer complications later, 2) required reoperation for ulcer disease, or 3) were under active treatment for ulcer symptoms. The reperforation rate in the entire series was 9% and the reoperation rate 32%. Suture plication is a time-honored, life-saving procedure, however, definitive surgery is a superior form of long-term management of the perforated duodenal ulcer patient.
Adult↗