A critical retrospective and prospective review of designs and materials in in-line solid-phase extraction capillary electrophoresis.

Several strategies have been developed to decrease the concentration limits of detection (LODs) in capillary electrophoresis (CE). Nowadays, chromatographic-based preconcentration using a microcartridge integrated in the separation capillary for in-line solid-phase extraction capillary electrophoresis (SPE-CE) is one of the best alternatives for high throughput and reproducible sample clean-up and analyte preconcentration. This review covers different designs (geometrical configurations, with frits or fritless, capillary types, compatibility with commercial instrumentation, etc.) and materials (sorbents, supports, affinity ligands, etc.) applied for almost 30 years to prepare in-line SPE-CE microcartridges (i.e. analyte concentrators), with emphasis on the conventional unidirectional configuration in capillary format. Advantages, disadvantages and future perspectives are analyzed in detail to provide the reader a wide overview about the great potential of this technique to enhance sensitivity and address trace analysis.

Mejora de la gestión de la demanda en un equipo de Atención Primaria / Improvement in the management of demand in a primary care team

Introducción La gestión de la demanda y en particular de la demanda sin cita constituye un reto que preocupa a gestores y profesionales. Aunque los motivos han sido ampliamente estudiados, la solución al problema no es sencilla. Introducción Dado que la excesiva demanda percibida era el principal motivo de insatisfacción de los profesionales de nuestro equipo, planificamos e implantamos un cambio organizativo con intervenciones sobre profesionales, organización y estructura con el objetivo de mejorar la gestión global de la demanda (en especial la generada sin citación previa), disminuir la hiperfrecuentación e incrementar además la calidad de la atención a todos los pacientes del equipo de Atención Primaria. Material y métodos Detección de los procesos a mejorar. Material y métodos Planificación multidisciplinar. Material y métodos Creación de dos sistemas independientes de atención a la visita programada y a la visita sin cita. Material y métodos Eliminación de los aspectos burocráticos de las consultas. Material y métodos laboración de pautas y unificación de critEerios de actuación sobre las visitas con y sin cita. Material y métodos Potenciación del rol de los profesionales de enfermería y administrativos en la atención a la población, tanto en la visita programada como en la visita sin cita. Material y métodos Cambios de ubicación para mejorar la colaboración médico-enfermera. Material y métodos Análisis estadístico y evaluación de resultados. Resultados Se ha conseguido una disminución significativa del número de visitas totales con o sin cita previa del centro así como las de los pacientes hiperfrecuentadores (ambas con p<0,001). Los roles de los profesionales no facultativos se han reforzado. Las encuestas de satisfacción de usuarios y profesionales con el nuevo sistema son positivas...(AU)

Introduction Demand management and particularly demand with no previous appointment is a challenge that concerns managers and professionals. Although the reasons have been extensively studied, the solution is not simple. Introduction Since perception of excessive demand was the main reason of dissatisfaction of our professional team, we planned and implemented an organizational change with interventions on professional organization and structure to improve overall management of demand and particularly that generated with no previous appointment, to reduce excessive use and also increase the quality of the care to all the patients of the Primary Care Team (PCT). Material and methods Detection of the processes to improve. Some of the most important interventions are summarized: multidisciplinary planning; creation of two separate care systems for the scheduled visit and the visit without an appointment; elimination of the bureaucratic aspects of the consultations; development of standards and standardization of performance criteria on visits with and without appointment; enhancing the role of nurses and administrative attention to the population in both the scheduled visit and in the spontaneous visit; changes of location to enhance the doctor-nurse collaboration. Material and methods A statistical analysis and evaluation of results were performed. Results A significant reduction was achieved in the total number of visits to the center of those with or without an appointment and in those patients with a high number of visits (both p<0.001). The roles of nurse and administrative were strengthened. The satisfaction surveys of the users and professionals regarding the new system have been positive. Conclusion A multidisciplinary strategy, developed and agreed on by the whole team, has a positive influence on demand and improves quality of care (AU)

Mejora de la gestión de la demanda en un equipo de Atención Primaria / Improvement in the management of demand in a primary care team

Introducción: La gestión de la demanda y en particular de la demanda sin cita constituye un reto que preocupa a gestores y profesionales. Aunque los motivos han sido ampliamente estudiados, la solución al problema no es sencilla. Introducción: Dado que la excesiva demanda percibida era el principal motivo de insatisfacción de los profesionales de nuestro equipo, planificamos e implantamos un cambio organizativo con intervenciones sobre profesionales, organización y estructura con el objetivo de mejorar la gestión global de la demanda (en especial la generada sin citación previa), disminuir la hiperfrecuentación e incrementar además la calidad de la atención a todos los pacientes del equipo de Atención Primaria. Material y métodos: Detección de los procesos a mejorar. Material y métodos: Planificación multidisciplinar. Material y métodos: Creación de dos sistemas independientes de atención a la visita programada y a la visita sin cita. Eliminación de los aspectos burocráticos de las consultas. Elaboración de pautas y unificación de criterios de actuación sobre las visitas con y sin cita. Potenciación del rol de los profesionales de enfermería y administrativos en la atención a la población, tanto en la visita programada como en la visita sin cita. Cambios de ubicación para mejorar la colaboración médico-enfermera. Análisis estadístico y evaluación de resultados. Se ha conseguido una disminución significativa del número de visitas totales con o sin cita previa del centro así como las de los pacientes hiperfrecuentadores (ambas con p<0,001). Los roles de los profesionales no facultativos se han reforzado. Las encuestas de satisfacción de usuarios y profesionales con el nuevo sistema son positivas. Conclusión: Una estrategia multidisciplinar, trabajada y consensuada por todo el equipo, consigue incidir de manera positiva sobre la demanda y mejorar la calidad asistencial (AU)

Introduction: Demand management and particularly demand with no previous appointment is a challenge that concerns managers and professionals. Although the reasons have been extensively studied, the solution is not simple. Introduction: Since perception of excessive demand was the main reason of dissatisfaction of our professional team, we planned and implemented an organizational change with interventions on professional organization and structure to improve overall management of demand and particularly that generated with no previous appointment, to reduce excessive use and also increase the quality of the care to all the patients of the Primary Care Team (PCT). Material and methods: Detection of the processes to improve. Some of the most important interventions are summarized: multidisciplinary planning; creation of two separate care systems for the scheduled visit and the visit without an appointment; elimination of the bureaucratic aspects of the consultations; development of standards and standardization of performance criteria on visits with and without appointment; enhancing the role of nurses and administrative attention to the population in both the scheduled visit and in the spontaneous visit; changes of location to enhance the doctor-nurse collaboration. Material and methods: A statistical analysis and evaluation of results were performed. Results: A significant reduction was achieved in the total number of visits to the center of those with or without an appointment and in those patients with a high number of visits (both p<0.001). The roles of nurse and administrative were strengthened. The satisfaction surveys of the users and professionals regarding the new system have been positive. Conclusion: A multidisciplinary strategy, developed and agreed on by the whole team, has a positive influence on demand and improves quality of care (AU)

Dental management of the patient with ischemic heart disease: an update.

Ischemic heart disease is the most common cause of death in developed countries. The classical protocols for providing dental care in these patients with chest angina or myocardial infarction were based on the classification of the American Society of Anesthesiologists (ASA), postponing therapy for a minimum of 6 months after infarction in order to ensure safer dental treatment. However, advances in diagnostic techniques and medical and surgical treatments in patients with heart disease have led to the development of more precise risk assessment protocols, thus allowing earlier post-infarction dental treatments and oral surgery, with acceptable safety margins.

Neutralizing human monoclonal antibodies to conformational epitopes of human T-cell lymphotropic virus type 1 and 2 gp46.

Ten human monoclonal antibodies derived from peripheral B cells of a patient with human T-cell lymphotropic virus (HTLV)-associated myelopathy are described. One monoclonal antibody recognized a linear epitope within the carboxy-terminal 43 amino acids of HTLV gp21, and two monoclonal antibodies recognized linear epitopes within HTLV type 1 (HTLV-1) gp46. The remaining seven monoclonal antibodies recognized denaturation-sensitive epitopes within HTLV-1 gp46 that were expressed on the surfaces of infected cells. Two of these antibodies also bound to viable HTLV-2 infected cells and immunoprecipitated HTLV-2 gp46. Virus neutralization was determined by syncytium inhibition assays. Eight monoclonal antibodies, including all seven that recognized denaturation-sensitive epitopes within HTLV-1 gp46, possessed significant virus neutralization activity. By competitive inhibition analysis it was determined that these antibodies recognized at least four distinct conformational epitopes within HTLV-1 gp46. These findings indicate the importance of conformational epitopes within HTLV-1 gp46 in mediating a neutralizing antibody response to HTLV infection.

Unique monocyte subset in patients with AIDS dementia.

BACKGROUND: 15-30% of patients infected with HIV will develop a debilitating dementia. Whilst HIV enters the brain soon after infection, presumably within monocyte-derived macrophages, not all patients with HIV become demented. Blood monocytes probably cross the blood-brain barrier and give rise ultimately to parenchyma macrophages. We looked for a specific monocyte subset in AIDS patients with dementia. METHODS: Peripheral blood monocytes from three groups were compared: AIDS patients with (n = 12) and without (n = 11) dementia, and ten HIV seronegative healthy controls. We used flow cytometry to analyse monocytes, and cell lysis and apoptosis assays to examine monocyte effects on human brain cells in vitro. FINDINGS: We found a unique subset of monocytes in patients with AIDS dementia. These monocytes were more dense and granular and expressed CD14/CD16 and CD14/CD69. Means (SD) for CD14/CD16 in HIV-negative controls and in AIDS non-dementia and AIDS dementia patients were 6.5% (4), 16% (13), and 37% (21), respectively (p = 0.008 between the two groups of patients). The corresponding means for CD14/CD69 were 7% (6), 8% (10), and 69% (18) (p < 0.0001). INTERPRETATION: CD69 is a member of the natural-killer-cell gene complex that is expressed after activation. Supernatants from cultures containing these dense cells can trigger apoptosis of human brain cells in vitro. The monocyte subset we found in patients with AIDS dementia might enter the brain and expose neural cells to toxic factors.

Protection against gram-negative bacteremia in neutropenic mice with recombinant granulocyte-macrophage colony-stimulating factor.

Granulocyte-macrophage colony-stimulating factor (GM-CSF) stimulates production of neutrophils in bone marrow and may decrease the incidence of infection during neutropenia. We evaluated the protective role of recombinant GM-CSF against Pseudomonas aeruginosa challenge in neutropenic mice. CD-1 mice treated with cyclophosphamide on days 1 and 2 of the experiment were given GM-CSF (1, 2, or 4 micrograms/day) starting at day 4 of the experiment according to the following protocol: 1) 1 microgram of GM-CSF 2 hr and 24 hr after challenge; 2) 1 microgram 24 hr before challenge, 2 hr and 24 hr after challenge; 3) 2 micrograms injected 24 hr before and 2 hr after challenge; 4) 2 micrograms given 24 hr before and 2 micrograms given 2 hr and 24 hr after challenge; 5) 4 micrograms administered 2 hr and 24 hr after challenge; and 6) saline and bovine albumin controls. The number of blood neutrophils by days 4 and 5 was similar for GM-CSF-treated and untreated animals. Survival was significantly greater in animals given 2 micrograms of GM-CSF at 24 hr before and at 2 hr and 24 hr after challenge with Pseudomonas. Neutrophils and splenic macrophages obtained from GM-CSF-treated mice (2 micrograms/animal) produced significantly greater amounts of O2- (204 +/- 36 nmoles/10(5) cells) than controls (21 +/- 10 nmoles/10(5) cells). Additionally, neutrophils and macrophages from GM-CSF-treated mice killed significantly more bacteria (P. aeruginosa) in vitro and had a greater number of C3b and Fc receptors (78 +/- 12% and 89 +/- 8%) than did cells obtained from control animals.(ABSTRACT TRUNCATED AT 250 WORDS)

Monoclonal antibodies for treatment of gram-negative infections.

Monoclonal antibody technology has permitted researchers to dissect out the protective antibody response to conserved regions of gram-negative bacillary lipopolysaccharides (endotoxins). Some anticore antibodies can bind to lipid A and have a neutralizing, but not opsonic, activity; these antibodies are usually IgM. IgG antibodies to outer core regions may be weakly opsonic. The outcome of animal protection studies is critically dependent on the choice of challenge organism, dose, timing and rate of antibody administration, and additional factors such as antimicrobial therapy. Protective activity against a wide variety of gram-negative bacillary challenges with the IgM anticore and lipid A reactive antibody, which we have designated E5, is reviewed. Protection in a therapeutic model is demonstrable when the antibody is used in conjunction with appropriate antimicrobial therapy. This antibody is now being assessed in clinical trials. Optimal use of monoclonal antibodies may involve a "cocktail" of antibodies with complementary binding specificities.

[A case of rhinophyma]. / Un caso de rinofima.

A case of rhinophyma, surgically treated, is reported, for being a process with low incidence and for its big size.

Functionally active monoclonal antibody that recognizes an epitope on the O side chain of Pseudomonas aeruginosa immunotype-1 lipopolysaccharide.

A murine monoclonal antibody (MAb) was prepared against Pseudomonas aeruginosa immunotype-1 (It-1) lipopolysaccharide (LPS). The MAb bound It-1 LPS in the enzyme-linked immunosorbent assay and in the immunodiffusion and immunoblotting assays, agglutinated and opsonized It-1 bacteria, and protected against challenge with live It-1 organisms in a murine burn infection model. All of these activities were immunotype specific. Correlation of the opsonic and protective properties of the MAb with its recognition site on the LPS O side chain confirmed that such immunotype-specific determinants are important targets for protective antibodies in Pseudomonas disease. The functional equivalence of this MAb and polyclonal antibodies from hyperimmune plasma underscores the therapeutic potential of single MAbs which recognize critical determinants in the LPS O side chain.

Mouse monoclonal antibody to a melanoma-carcinoma-associated antigen synthesized by a human melanoma cell line propagated in serum-free medium.

A monoclonal antibody, F11, was produced against a tumor-associated antigen from the spent medium of the M14 human malignant melanoma cell line which was grown continuously in serum-free medium. Ouchterlony double-diffusion study revealed that the F11 monoclonal antibody is an immunoglobulin G1. The F11 monoclonal antibody reacted positively with seven of eight (88%) melanoma, five of five (100%) carcinoma, zero to five normal, and zero of two lymphoblastoid cell lines by indirect immunofluorescence test. Also, by indirect immunofluorescence test, F11 monoclonal antibody reacted with cryostat sections from four of five (80%) melanomas, six of seven (86%) carcinomas, zero of one benign nevus, and zero of two benign breast diseases. By the indirect avidin:biotin:peroxidase complex immunoperoxidase method, the F11 monoclonal antibody reacted positively with cryostat sections from five of five (100%) melanomas, five of five (100%) breast cancers, two of two (100%) colon cancers, zero of one benign nevus, and zero of one Hodgkin's disease spleen. Thus, the tumor-associated antigen that the F11 monoclonal antibody recognizes appears to be expressed by melanomas and carcinomas, hence the designation melanoma-carcinoma-associated antigen. Microscopic observations disclosed that the melanoma-carcinoma-associated antigen is present in the cytoplasm, on the membrane of melanoma and carcinoma cells, and in the lumen of glandular structures of breast and colon carcinomas. The molecular weight of the melanoma-carcinoma-associated antigen in spent medium from the M14 CEM cell line is 100,000 as determined by sodium dodecyl sulfate:polyacrylamide gel electrophoretic analysis of indirect immunoprecipitates obtained with the F11 monoclonal antibody.