Cerebral Hemodynamics Patterns by Transcranial Doppler in Patients With Acute Liver Failure.

INTRODUCTION: About half of patients with acute liver failure (ALF) show clinical signs of cerebral edema and intracranial hypertension. Neuroimaging diagnostics and electroencephalography have poor correlation with intracranial pressure measurement. OBJECTIVE: The objective of this study was to characterize the cerebral hemodynamics patterns with transcranial Doppler (TCD) sonography in patients with ALF. METHOD: We studied 21 patients diagnosed with ALF, admitted to the intensive care unit (ICU) at the Centro de Investigaciones Médico Quirúrgicas of Cuba. All of these patients had a TCD performed on arrival at ICU, evaluating the following: systolic (SV), diastolic (DV), and medium (MV) flows velocities and pulsatility index (PI) in right middle cerebral artery (RMCA) via temporal windows. RESULTS: The sonographic patterns of cerebral hemodynamics were as follows: low-flow, 12 patients (57.1%); high resistance, 5 patients (23.8%); and hyperemic, 4 patients (19%). Patients who died while waiting had lower MV RMCA (56.1 vs 58.1 cm/s) and higher PI (1.71 vs 1.41) than patients who could undergo transplantation (P = .800 and P = .787, respectively). CONCLUSIONS: In patients diagnosed with ALF admitted to the ICU the predominating cerebral hemodynamic pattern was low-flow with resistance increase. The TCD was shown to be a useful tool in the initial evaluation for prognosis and treatment.

[Interobserver concordance in functional assessment by Barthel Index]. / Concordancia interobservador en la valoración funcional mediante el índice de Barthel.

BACKGROUND: The aim of this study is to analyze interobserver "reproductiveness" between clinical nurses in gerontology and residents in family medicine in their first contact with the Barthel Index (BI). MATERIALS AND METHODS: One hundred patients were assessed. BI at two weeks before admission was scored by a patient or carer interview. Eighteen patients were excluded because interviews were not completed. RESULTS: Mean BI of 82 patient included, assessed by nurses was 87.3 and by residents 88.2. In 40 patients some differences in the mean values of BI were observed. When analyzing the overall BI score the agreement was high (r=0.793) but interobserver agreement was low (kappa<0.4) in some fields such as eating, dressing and transfers and medium in others (kappa from 0.40 to 0.75). CONCLUSIONS: Low reproductiviness interobserver in some patients of the BI when clinical nurses in gerontology and residents in family medicine are compared suggest that they need specific training in functional capacity evaluation in order to improve the BI use.

Concordancia interobservador en la valoración funcional mediante el índice de Barthel / Interobserver concordance in functional assessment by Barthel index

Fundamentos. El objetivo del estudio es evaluar la reproductividad interobsevador entre enfermeras clínicas expertas en geriatría y médicos residentes en su primer contacto con el índice de Barthel (IB). Material y métodos. Se evaluaron 100 pacientes. El IB, dos semanas previas al ingreso, se recogió mediante entrevista al enfermo o al cuidador principal. Se excluyeron 18 pacientes en que fue imposible la revaloración. Resultados. En los 82 pacientes incluidos la media del IB valorada por la enfermera fue de 87,3 (19) y la del médico residente de 88,2 (21). En 40 pacientes existía alguna diferencia en el valor medio del IB. El acuerdo al examinar el total de la escala era bueno (r = 0,793); no obstante, el acuerdo interobservador era bajo (kappa < 0,4) en los apartados de comer, arreglo y trasferencias. Conclusiones. La baja reproductividad interobsevador en algunos apartados del IB entre enfermeras clínicas expertas en geriatría y médicos residentes en su período de formación en geriatría sugiere la necesidad que tienen éstos de un período de aprendizaje en evaluación de la capacidad (AU)

Background. The aim of this study is to analyze interobserver «reproductiveness» between clinical nurses in gerontology and residents in family medicine in their first contact with the Barthel Index (BI). Material and methods. One hundred patients were assessed. BI at two weeks before admission was scored by a patient or carer interview. Eighteen patients were excluded because interviews were not completed. Results. Mean BI of 82 patient included, assessed by nurses was 87.3 and by residents 88.2. In 40 patients some differences in the mean values of BI were observed. When analyzing the overall BI score the agreement was high (r = 0.793), but interobserver agreement was low (kappa < 0.4) in some fields such as eating, dressing and transfers and medium in others (kappa from 0.40 to 0.75). Conclusions. Low reproductiviness interobserver in some patients of the BI when clinical nurses in gerontology and residents in family medicine are compared suggest that they need specific training in functional capacity evaluation in order to improve the BI use (AU)

Isolation of the receptor for Amaranthus leucocarpus lectin from murine naive thymocytes.

From murine medullary thymocytes we purified the receptor for the Amaranthus leucocarpus lectin (ALL) using a complex with the biotin-labeled lectin and avidin-agarose as the affinity matrix. Most ALL(+)thymocytes (83%) are naive cells with the CD4(+)CD8(-)CD45RB(+)phenotype. The receptor for this lectin is a 70 kDa glycoprotein that contains 20% of sugar by mass. It is constituted mainly by aspartic and glutamic acids, serine, proline, and glycine; its glycosidic portion contains mainly O-glycosidically linked glycans with Gal, GalNAc and NeuAc residues as well as one N-glycosidically linked glycan per molecule. Ionic strength chromatography revealed that the ALL-thymocyte receptor (ALLTr) is made up by three isoforms, which possess similar amino acid composition but show slight differences in their sugar composition. The N-terminal amino acid residues are blocked both in the receptor and its purified isoforms. Analyses of the receptor's peptides, obtained by trypsin digestion with MALDI-TOF (matrix assisted laser desorption ionization-time of flight), were compared with the relative values obtained from the NCBInr (Swiss-Prot 10/01/99) database. Our results indicate that the peptides of ALLTr show low homology (<17%) with the human KIIA protein, the Fas-associated death domain protein, and the transforming growth factor-beta type II receptor. Our results suggest that the ALL thymocyte receptor could be considered a novel phenotypic marker specific for naive T cells.

A comparative study on the purification of the Amaranthus leucocarpus syn. hypocondriacus lectin.

Amaranthus leucocarpus lectin is a homodimeric glycoprotein of 35 kDa per sub-unit, which interacts specifically with N-acetyl-galactosamine. In this work, we compared different glycoproteins that contain Galbeta1-3 GalNAcalpha1-3 Ser/Thr or GalNAcalpha1-3 Ser/Thr in their structure as ligands to purify the A. leucocarpus lectin. From the glycoproteins tested, fetuin was the most potent inhibitor of the hemagglutinating activity and the better ligand for lectin purification; however, the use of desialylated stroma from erythrocytes represented the cheapest method to purify this lectin. O-linked glycans released from the glycoproteins used as affinity matrix and those from different erythrocytes were less inhibitory than parental glycoproteins. The NH2-terminal of the lectin is blocked; moreover, this is the only example of a lectin isolated from this genus to be a glycoprotein. Analysis of the glycoprotein sequences with inhibitory activity for the lectin, showed a different pattern in the O-glycosylation, which confirms that A. leucocarpus lectin recognizes conformation and, probably, distances among O-linked glycans moieties.

Isolation of the receptor for Amaranthus leucocarpus lectin from murine peritoneal macrophages.

The receptor for Amaranthus leucocarpus lectin from CD-1 resident macrophages was purified with affinity chromatography with biotin labeled A. leucocarpus lectin and using avidin-agarose as affinity matrix. The receptor is a glycoprotein of 70 kDa that contains 18% of sugar by weight; it is mainly composed of galactose and N-acetyl-D-galactosamine in its saccharidic portion, and lacks sialic acid; the protein is rich in glycine, serine and alanine and lacks cysteine residues. The amino terminus of the receptor is blocked. By ionic strength chromatography on a mono P column in anionic form we purified three isoforms from the affinity purified receptor, each showing quantitative differences in glycosylation. The A. leucocarpus lectin receptor is identified only in resting, not activated, macrophages suggesting that it plays a role in activation mechanisms of macrophages.

Amaranthus leucocarpus lectin recognizes human naive T cell subpopulations.

Amaranthus leucocarpus lectin (ALL) is specific for GalNAc residue found in the inner core of Gal beta 1,3GalNAc alpha 1,O-Ser/Thr disaccharide (T-antigen) or GalNAc alpha 1,O-Ser/Thr (Tn-antigen). Flow cytometric analysis using fluorescein-labeled lectin and monoclonal antibodies against human cell surface markers indicated that 5.7% of mononuclear cells from human healthy donors are recognized by ALL. These cells have the phenotype CD2+CD4+CD19- and most of the lymphocytes recognized are also CD27+, CD45RA+ and CD43+. ALL possesses mitogenic activity on lymphocytes after neuraminidase treatment. Our results indicate that the receptors recognized by ALL could be considered surface markers for naive human T lymphocyte subsets.

Effect of lectins on mouse peritoneal macrophage phagocytic activity.

We studied the in vitro ability of lectin-treated murine peritoneal macrophages to attach and phagocytize particulate antigens. Glucose and mannose specific lectins such as Con-A and lentil lectin, as well as complex lactosamine residues specific lectins, such as Phaseolus vulgaris var. cacahuate and Phaseolus coccineus var. alubia, increased the macrophage phagocytic activity towards heterologous erythrocytes, whereas peanut agglutinin, a galactose-specific lectin, diminished the macrophage phagocytic activity. These results suggest that a galactose-N-acetyl-D galactosamine-containing structure could participate as negative modulator of the phagocytic activity.

Separation and isolation of lymphocyte subpopulations of different affinity for the antigen.

In order to separate, isolate, and determine the number and distribution of the subpopulations of lymphocytes of diverse affinities that are present in an immune response toward a single hapten, anti-trinitrophenyl (TNP) lymphocytes from immunized animals were purified by cell chromatography. Non-adherent spleen cells were passed through a column consisting of TNP-substituted polyacrylamide beads. The retained cells were eluted by applying a linear concentration gradient of TNP-lysine. Elution profiles having a limited number of peaks were obtained in all cases. The avidity of the cells in each fraction was measured by inhibition of formation of immune rosettes by free hapten. Results showed that each peak was located along the gradient according to its affinity since there was a direct correlation between the affinity and the concentration of hapten needed for the elution. The cells in each peak appeared to belong to a homogeneous subpopulation as shown by the slope of the curves obtained in the determination of avidity, suggesting that each peak corresponded to one expanded clone.