Evolution of MHC class I genes in Japanese and Russian raccoon dogs, Nyctereutes procyonoides (Carnivora: Canidae).

Major histocompatibility complex (MHC) genes have been widely studied to assess the immunological fitness and evolutionary adaptation of animal populations. Among the Canidae, the raccoon dog's adventurous nature, omnivorous behavior, and high variability of intracellular pathogens make it ideal to study selection on MHC class I in a non-model canid species. Here, we examined allelic diversity and evolutionary patterns of MHC class I genes in the raccoon dog (Nyctereutes procyonoides). We identified 48 novel MHC class I alleles from 31 raccoon dogs from Japan and Russia. Some alleles were geographically restricted, whereas others were widely distributed across the species' range. The rate of non-synonymous substitutions was greater than that of synonymous substitutions for both exon 2 and exon 3 encoding α1 and α2 domains, respectively, in the α chain of the MHC class I protein. Positively selected sites at the amino acid level were evident in both the α1 and α2 domains, and a recombination breakpoint was found in exon 3. Bayesian phylogenetic trees showed no evidence of trans-species polymorphism (TSP) with alleles from carnivoran species in other families but did detect TSP between raccoon dogs and the domestic dog, Canis familiaris, indicative of long-term balancing selection in canids. Our results indicate that the extensive allelic diversity of MHC class I in Japanese and Russian raccoon dogs has been influenced and maintained by pathogen-driven positive selection, recombination, and long-term balancing selection. Supplementary Information: The online version contains supplementary material available at 10.1007/s13364-021-00561-y.

Prader-Willi syndrome and polygonosomal abnormalities in males:about a Prader-Willi/47,XYY patient.

We herein report a male patient known as having a XYY karyotype. At the age of 26 years a Prader-Willi syndrome (PWS) was diagnosed. Before that time the whole symptomatology was ascribed to the XYY syndrome. This is the first reported association of PWS and polygonosomal abnormality in a male adult (whose height is above average).

Evaluation of the Schiller BR-102 ambulatory blood pressure system according to the protocols of the British Hypertension Society and the Association for the Advancement of Medical Instrumentation.

OBJECTIVE: To evaluate the Schiller BR-102 monitor for ambulatory blood pressure measurement according to the protocols of the British Hypertension Society (BHS) and the Association for the Advancement of Medical Instrumentation (AAMI). DESIGN: The BHS protocol is divided into two parts. Part I, which is the part applicable to this study, comprises the main validation procedure and has five phases: before-use device calibration; in-use (field) phase; after-use device calibration; static device validation; and report of evaluation. METHOD: Three Schiller BR-102 recorders passed the before-use device calibration test, after which they entered the in-use (field) assessment phase during which the three recorders were each worn by 10 subjects for 24 h, after which calibration was again assessed. Because there was no difference in results of calibration testing among the three devices, one was selected randomly and the main validation test was carried out on 85 subjects with a wide range of blood pressures both for the auscultatory mode and for the oscillometric mode using the Sphygmocorder. The results were analysed according to the BHS grading system from A to D. The data were also analysed according to the standard of the Association for the Advancement of Medical Instrumentation (AAMI), which stipulates that the mean difference between the test device and the standard shall be 160/100 mmHg) the Schiller BR-102 was less accurate in the high pressure range for diastolic blood pressure but more accurate for systolic blood pressure, achieving A/C grading, while satisfying the AAMI criteria both for systolic and for diastolic blood pressure in the auscultatory mode. In the oscillometric mode the device performed less accurately in the high-pressure range, achieving grade D/C, while failing to satisfy the AAMI criteria both for systolic and for diastolic blood pressure. The means+/-SD of the first mercury sphygmomanometer measurements were 143+/-32 mmHg for systolic blood pressure and 88+/-21 mmHg for diastolic blood pressure. Acceptability to subjects was good and the manufacturer's manual was satisfactory. CONCLUSION: On the basis of these results, the Schiller BR-102 can be recommended for ambulatory blood pressure measurement in clinical practice using the auscultatory mode, but the oscillometric mode, which operates only if the device fails in the auscultatory mode, does not provide accurate measurements.

Evaluation of the Profilomat II ambulatory blood pressure system according to the protocols of the British Hypertension Society and the Association for the Advancement of Medical Instrumentation.

OBJECTIVE: To evaluate the Profilomat II monitor for ambulatory blood pressure measurement according to the protocols of the British Hypertension Society (BHS) and the Association for the Advancement of Medical Instrumentation (AAMI). DESIGN: The BHS protocol is divided into two parts. Part I, which is the part applicable to this study, comprises the main validation procedure and has five phases: before-use device calibration; static device validation; and report of evaluation. METHOD: Three Profilomat II recorders passed the before-use device calibration test. They then entered the in-use (field) assessment phase during which the three recorders were each worn by ten subjects for 24-h, after which the calibration was again assessed. Since no difference in calibration testing was observed between the three devices, one was selected randomly and the main validation test was carried out in 85 subjects, who had a wide range of blood pressures, using the sphygmocorder. The results were analysed according to the BHS grading system from A to D. The data was also analysed according to the standard of the Association for the Advancement of Medical Instrumentation (AAMI) which stipulates that the mean difference between the test device and the standard shall be 160/100 mmHg), the Profilomat II was less accurate in the high pressure range, achieving a D/C grading, and failed the AAMI criteria for systolic and diastolic blood pressures. The mean and standard deviation of the first mercury sphygmomanometer measurements were 145+/-34/87+/- 20 mmHg. Subject acceptability was good and the manufacturers manual was satisfactory. CONCLUSION: On the basis of these results, the Profilomat II cannot be recommended for ambulatory blood pressure measurement in clinical practice where accurate measurements are required.

Evaluation of three devices for self-measurement of blood pressure according to the revised British Hypertension Society Protocol: the Omron HEM-705CP, Philips HP5332, and Nissei DS-175.

OBJECTIVE: We evaluated three devices for self-measurement of blood pressure - the Omron HEM-705CP, the Philips HP5332 and the Nissei DS-175 - according to the revised protocol of the British Hypertension Society (BHS). The results were also analysed according to the criteria for accuracy of the revised standard of the Association for the Advancement of Medical Instrumentation (AAMI). DESIGN: The revised BHS protocol is divided into two parts. Part I, the part applicable to this study, comprises the main validation procedure and has five phases: Before-use device calibration; in-use (field) phase; after-use device calibration; static device validation; report of evaluation. METHODS: Three models of each device passed the before-use device calibration test, after which they entered the in-use phase, which involved use of the three recorders for a month; inter-device calibration was assessed again at the end of the month. There was no difference in calibration testing between the three models of each device, and therefore one of each was selected randomly; the main validation test was carried out in 85 subjects with a wide range of pressures, and the results were analysed according to the BHS grading system from A to D. RESULTS: The Omron HEM-705CP achieved an overall B/A grading and fulfilled the AAMI accuracy criteria; the Philips HP5332 achieved an overall C/A grading and failed the AAMI accuracy criteria for measuring systolic pressure; the Nissei DS-175 achieved an overall D/A grading and failed the AAMI accuracy criteria for measuring systolic pressure. When the BHS and AAMI criteria were applied to tertiles of pressure (low-pressure range < 130/80 mmHg; medium-pressure range 130-160/80-100 mmHg; high-pressure range > 160/100 mmHg) all three devices were less accurate in the high-pressure range: the Omron HEM-705CP achieved C/B grading while continuing to fulfil the AAMI criteria; the Philips HP5332 dropped to D grading for systolic pressure and the Nissei DS-175 achieved a lower D grading for systolic pressure. The mean and standard deviation of the first mercury sphygmomanometer measurements were 148+/-35/88+/-22 mmHg. Acceptability by the users was good and the manufacturer's manual was satisfactory for all three devices. CONCLUSIONS: On the basis of these results, the Omron HEM-705CP was the most accurate of the three devices tested, achieving Grade B for systolic and Grade A for diastolic pressure, as well as fulfilling the AAMI criteria for accuracy for both systolic and diastolic pressure. It can therefore be recommended for the clinical measurement of blood pressure and is the first inexpensive device to satisfy the accuracy criteria of these protocols.

A new audiovisual technique for recording blood pressure in research: the Sphygmocorder.

OBJECTIVE: To devise a method of blood pressure measurement capable of being substituted for the fallible human observer in validation of blood pressure measuring devices. DESIGN: A number of components used to measure blood pressure have been combined innovatively with audiovisual recording technology to produce a system, named the Sphygmocorder, which consists of a mercury sphygmomanometer, an occluding cuff, an inflation source, a stethoscope, a microphone capable of detecting Korotkoff sounds, a camcorder and a display screen. METHODS: To determine the accuracy of the Sphygmocorder against the trained human observer, the Sphygmocorder has been validated in three separate studies in which three devices for self-measurement of blood pressure, the Omron HEM-705CP, the Phillips HP5332 and the Nissei DS-175, were being validated against two trained observers in 85 subjects with a wide range of blood pressure according to the protocol of the British Hypertension Society. RESULTS: The Sphygmocorder was as accurate as at least one of the observers in each of the validation studies and therefore allows replacement of trained observers by the new device. CONCLUSION: The Sphygmocorder, which retains the time-honoured technique of blood pressure measurement with a mercury sphygmomanometer and an auscultating observer, and provides, in addition, objective evidence of the measurement recorded, which can be stored and re-examined, can be used as a substitute for human observers in validation studies of blood pressure-measuring devices.

[Cerebral protection by selective cerebral perfusion during surgery on the aortic arch]. / Protection cérébrale par perfusion cérébrale sélective dans la chirurgie de la crosse aortique.

The aim of this study was to evaluate the technique of cerebral protection by selective cerebral perfusion with moderate hypothermia during surgery of the transverse aortic arch. Twenty-three patients were operated for partial or total replacement of the transverse aortic arch between January 1987 and December 1993 by the technique of selective cerebral perfusion by bilateral carotid cannulation. There were 12 cases of aneurysm of the ascending aorta and/or transverse aortic arch, one aneurysm of the innominate artery and 10 Stanford type A aortic dissections. The selective cerebral flow rate was 1-1.5 l/min; the perfusion pressure 60-80 mmHg and the temperature of cerebral perfusion 25-28 degrees C. The perioperative mortality was 13%; the causes of death were not neurological (3 haemorrhages). The neurological morbidity was 10% (one brachial monoparesis and one bulbar tetraparesis). This is therefore a useful technique of cerebral protection which avoids the complications of deep hypothermia with circulatory arrest and does not limit the time of aortic repair.

A method of quantifying retinal microvascular alterations associated with blood pressure and age.

OBJECTIVE: To find an objective, sensitive method for quantifying microvascular alterations associated with level of blood pressure and age. DESIGN: A prospective cross-sectional study. SUBJECTS AND METHODS: Seventy-four previously untreated hypertensive patients, referred to a hospital outpatients department, and 26 normotensive volunteers participated. Twenty-four-hour ambulatory blood pressure monitoring and bilateral fundal photography were performed. The fundal photographs were projected on a screen such that the optic disc filled a circle of radius 5 cm. Microvessels crossing the border of a concentric circle of radius 20 cm were identified as arteriolar or venular, counted and their luminal diameters measured. MAIN OUTCOME MEASURES: Arteriolar and venular numbers, mean diameters and vascularities (arteriolar and venular vascularities defined as the sum of arteriolar and venular diameters, respectively). RESULTS: The technique was reproducible. As blood pressure increased, arteriolar vascularity declined and venular vascularity increased. These associations resulted in a strong inverse correlation between blood pressure level and the ratio arteriolar vascularity: venular vascularity (r = 0.48, P < 0.001). Arteriolar number declined with increasing diastolic blood pressure (r = 0.22, P < 0.05). Mean arteriolar diameter appeared to have a U-shaped relationship with diastolic blood pressure levels (r = 0.27, P < 0.05). Venular dilation was associated with increasing blood pressure levels (r = 0.22, P < 0.05). Mean arteriolar and venular diameters declined significantly with age (r = 0.33 and 0.26, respectively; P < 0.01) and there was no association between arteriolar vascularity:venular vascularity ratio and age. CONCLUSIONS: The method detected disparate retinal microvascular alterations with age and blood pressure. The arteriolar vascularity:venular vascularity ratio shows promise as a non-invasive, prognostic and therapeutic guide in hypertension.

High altitude dives in the Nepali Himalaya.

British divers undertook no-stop decompression dives at altitudes of 15,700 and 16,000 ft (4,785 and 5,33 m) in the Everest region of the Nepali Himalaya. They performed 23 dives on oxygen and two on nitrox (60% N2:50% O2. The dives took place under ice in two lakes, Gokyo Tsho and Donag Tsho. The maximum depth achieved was 98 feet fresh water (29.32 msw), maximum duration was 39 min in water, 44 min on gas.

[Tracheobronchial healing after lung and heart-lung transplantations. Apropos of 64 anastomoses]. / Etude de la cicatrisation trachéo-bronchique après transplantations pulmonaires et cardio-pulmonaires. A propos de 64 anastomoses.

The authors report an analysis concerning the healing of tracheo-bronchial anastomoses after lung- and heart-lung transplantation. The present study includes 64 anastomoses selected from a total of 80 cases. Sixteen had to be excluded because of early post-operative death; none of these deaths was related to an air-way complication. Bronchial healing was assessed by bronchoscopic follow-up; the appearance of the suture-line was classified according to Couraud's grades. The initial reference was the examination at 2 weeks, which was compared to subsequent follow-up. At the initial assessment, 42 anastomoses were grade 1, 4 were grade II, and 18 were grade III. The subsequent anatomic result was satisfactory for 52 sutures (81%). The complications were malacia in 2 cases, stenoses treated with a stenting device in 4 cases, dehiscence in 6 cases. The duration of ischemia and postoperative mechanical respiratory support, as well as the proximal or distal site of the anastomosis appeared to be of significant prognostic value.

Using Hawksley random zero sphygmomanometer as a gold standard may result in misleading conclusions.

We combined a database of paired blood pressure measurements taken using the Hawksley random-zero sphygmonanometer and a standard mercury sphygmomanometer and a database of paired measurements made on a SpaceLabs 90202 ambulatory blood pressure recorder and standard sphygmomanometer to determine how the SpaceLabs 90202 would have fared if it had been assessed against the Hawksley random-zero sphygmomanometer instead of a standard sphygmomanometer. The pooled database contained 255 triplicate readings. Using the standard sphygmomanometer as gold standard, the Spacelabs had a median error of 2 mm/Hg for both systolic and diastolic. Against the Hawksley random-zero sphygmomanometer, median error was -3 mm systolic and -6 mm diastolic. The proportion of errors > 10 mm rose from 11% (systolic) and 9% (diastolic) with the standard sphygmomanometer to 16% and 29% with the Hawksley random-zero sphygmomanometer. Because it underestimates systolic and diastolic pressures, the use of the Hawksley random-zero sphygmomanometer as a gold standard may have resulted in misleading conclusions about performance of some automated BP recorders.

[Reflections on 10 years of medically induced abortions in Ille-et-Vilaine]. / Réflexions sur 10 ans d'interruptions médicales de grossesse (IMG) en Ille-et-Vilaine.

The medical files of 532 patients who underwent medically induced abortion over a 10-year period (1982-1991) in the French department of Ille-et-Vilaine were studied in order to evaluate the indications and outcomes. Among the patients, 358 resided in the department (67%). Comparatively with the number of births during the 10-year period, there was a relative increase in the number of medically induced abortions from 3.5/1000 to 5.5/1000. This parameter was taken into consideration for the interpretation of a parallel decrease in the perinatal mortality during the same period, from 5.9/1000 to 5.1/1000. There was a maternal indication in 91 cases which correspond to the former category of therapeutic induced abortions. There was a clear increase in 1991 corresponding to abortions induced because of extremely premature rupture of the membranes which were formerly allowed to continue to dead births. Foetal indications were frequent: 441 cases (83%). Exogenous causes were lower (15.6%), particularly due to the disappearance of indications resulting from maternal irradiation. For indications related to infection, the vaccination against rubella and improved prenatal diagnosis resulted in the disappearance of rubella as an indication during the last three years of the study and a clear decrease in the number of toxoplasmosis indications. There were few indications due to maternal infection by human immunodeficiency virus (4 cases). Chromosomal abnormalities were the main cause of medically induced abortion among the foetal indications (27.7%).(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of blood pressure measuring devices.

Validation of blood pressure measuring devices is a relatively new field of research. There are two national protocols for validating blood pressure measuring devices: the protocol of the American Association for the Advancement of Medical Instrumentation (AAMI) and the protocol of the British Hypertension Society (BHS), each of which has recently been revised. 19 blood pressure measuring devices have been validated according to one or both of these protocols. These protocols have been beneficial in drawing attention to the potential inaccuracy of blood pressure measuring systems, they permit comparison between devices and they have brought manufacturers of blood pressure measuring devices into closer contact with the profession. There are some inherent weaknesses in both protocols which include the fallibility of the 'gold standard', the lack of provision for validation in special circumstances and in special groups, such as the elderly and pregnant women, and failure to allow for deteriorating accuracy with higher pressure levels. The revised BHS protocol attempts to redress these deficiencies.

Twenty-four-hour ambulatory blood pressure measurement in a primigravid population.

OBJECTIVE: To establish the profiles of 24-h non-invasive ambulatory blood pressure measurement (ABPM) during the trimesters of pregnancy and the puerperium in normotensive healthy primigravidae. DESIGN: A prospective study in which 24-h ABPM was performed on five occasions in each subject: in the first trimester between 9 and 16 weeks' gestation; in the second trimester between 18 and 24 weeks; in the third trimester between 26 and 32 weeks and between 33 and 40 weeks; and finally at 6 weeks post partum. METHOD: One hundred and six Caucasian primigravid women who were normotensive at their first booking visit were recruited consecutively from the antenatal clinic and had 24-h ABPM performed with the SpaceLabs 90207 ambulatory system. RESULTS: Of the 106 women recruited, 98 completed 24-h ABPM on four of the five measurement occasions. Four women delivered prematurely before 33 weeks' gestation, thereby missing one ABPM measurement. Changes during pregnancy and the puerperium were assessed against the ABPM performed in the first trimester. There was no difference for daytime or night-time systolic blood pressure between 9 and 33 weeks, but it rose significantly from 33 to 40 weeks. At 6 weeks post partum, systolic blood pressure was not significantly different from the daytime pressure in the first-trimester ABPM but was raised significantly at night. Diastolic blood pressure decreased significantly between 18 and 24 weeks for both daytime and night-time. From 33 to 40 weeks it increased in parallel with systolic blood pressure, and at 6 weeks post partum it was raised significantly compared with first-trimester values for daytime and night-time. The nocturnal fall in blood pressure was preserved throughout pregnancy with a significant difference between daytime and night-time measurements present on all measurement occasions for systolic, diastolic and mean blood pressures and heart rate. There were significant differences between daytime ABPM and clinic blood pressure for both systolic and diastolic blood pressure up to 33 weeks. From 33 weeks until 6 weeks post partum there was no significant difference between daytime ambulatory and clinic blood pressures. CONCLUSION: This study provides reference values for ABPM in healthy primigravidae with generally uncomplicated pregnancies.

Comparative accuracy of six ambulatory devices according to blood pressure levels.

OBJECTIVE: To assess the accuracy of six ambulatory blood pressure measuring systems at low, medium and high blood pressures. RESULTS: The CH-Druck, Profilomat, SpaceLabs 90207 and Novacor DIASYS 200R, having previously achieved A to C grading for systolic and diastolic blood pressures according to the British Hypertension Society (BHS) protocol and having fulfilled the criteria of the Association for the Advancement of Medical Instrumentation, have been recommended for measurement of ambulatory blood pressure in clinical practice; the Pressurometer IV and Takeda TM-2420, achieved only C and D grades and failed to satisfy the Association for the Advancement of Medical Instrumentation criteria. In this study the data from the original validations are re-analysed for three pressure ranges of systolic and diastolic blood pressures: low range < or = 130/80 mmHg, medium range 130-160/80-100 mmHg and high range > or = 160/100 mmHg. All six devices maintained their overall grading or improved them slightly in the low and medium blood pressure ranges, but in the high blood pressure range the CH-Druck slipped from an overall A/A grading to B/C, the Profilomat from B/A to C/D, the SpaceLabs from B/B to C/C and the Pressurometer IV from C/D to D/D. The Takeda remained unchanged with a D grading, but the results within this grading were worse in the higher blood pressure range, and the Novacor rose from C/C to C/B. CONCLUSIONS: This analysis suggests that the CH-Druck is the most accurate ambulatory system across the pressure range, although it does not perform as well in the high blood pressure range as in the medium and low blood pressure ranges. The SpaceLabs 90207 is accurate in the low and medium blood pressure ranges and reasonably accurate in the high blood pressure range. If blood pressures only in the low and medium ranges are to be measured, a wider selection of ambulatory systems becomes available because, in addition to the CH-Druck and SpaceLabs 90207, the Profiloat and Novacor DIASYS 200R are accurate.

Expression of the multidrug resistance-associated P-glycoprotein (P-170) in 59 cases of de novo acute lymphoblastic leukemia: prognostic implications.

Immunocytochemical detection of the multidrug resistance (MDR)-associated membrane protein (P-170) was performed at time of diagnosis in a series of 36 children and 23 adults with acute lymphoblastic leukemia (ALL) using two monoclonal antibodies JSB1 and C219. Immunophenotypes were obtained in all cases and karyotypes were analyzed in 37 cases. Detection with JSB1 or with C219 led to similar results in terms of positive cells and cases, but the intensity of staining was higher with JSB1. In the populations studied, the rate of first complete remission differed between MDR-positive and MDR-negative in adult patients only (56% v 93%, respectively, P = .05). Of the 16 MDR-positive patients who had presented a first complete remission, 13 (81%) relapsed, compared with 13 of 35 (37%) MDR-negative (P = .008) patients. A higher rate of relapse among MDR-positive compared with MDR-negative patients was observed in adults and in children taken separately (adults 100% v 46%; children 73% v 32%, respectively). The survival rates (Kaplan-Meier method) were significantly higher in MDR-negative compared with MDR-positive populations as a whole (P = .002) and among children (P = .05) and adults (P = .03) taken separately. Event-free survival curves followed this trend. The percentage of second complete remission was very low in the MDR-positive group (15%) compared with 38% for the MDR-negative group. These results were shown by multivariate analysis to be independent of age, immunophenotypes, and karyotypes and clearly show the importance of MDR phenotype detection in ALL.

[Results of surgical treatment of persistent or recurrent pneumothorax]. / Résultats du traitement chirurgical des pneumothorax persistants ou récidivants.

From 1st January 1988 to 31st December 1991, 107 patients were operated on for spontaneous idiopathic (N = 69) or secondary pneumothorax (N = 38). Surgery was performed for recurrence (63.6%) or failure to respond to management by tube drainage (36.4%). Ninety seven patients underwent pleural abrasion, and 10 underwent parietal pleurectomy. Prolonged continuous epidural analgesia was performed in 57 cases. Postoperative complications occurred in 15 patients (14%). Overall morbidity was significantly higher in patients with chronic lung disease (26.3%) than in patients without chronic lung disease (7.2%) (p < or = 0.01). As far as postoperative hospital stay was concerned, the same significant difference was observed (16.8 days versus 12.7 days) (p < or = 0.005). In patients with idiopathic pneumothorax, postoperative hospital stay was significantly shorter in those with epidural pain relief (11.7 days) than in the others (13.6 days) (p < or = 0.025). No recurrence was observed with a mean follow-up of 27 months. We conclude that: 1) surgery is the most efficient treatment of persistent or recurrent pneumothorax; 2) operative morbidity is related to the underlying lung disease and not to the procedure itself; 3) epidural analgesia is beneficial in this surgery.