Characterization of a galectin-like activity from the parasitic nematode, Haemonchus contortus, which modulates ovine eosinophil migration in vitro.

The development of eosinophilia is a characteristic feature of helminth infection, although the exact nature of the interaction between eosinophils and parasites remains to be fully defined. Previously, it has been reported that Haemonchus contortus and other nematodes produce eosinophil-specific chemoattractants. This paper describes studies aimed at isolating and identifying the factor(s) responsible. Initial studies showed that soluble extracts of infective larvae (L3) of H. contortus provoked a chemokinetic, rather than chemotactic, response in ovine bone marrow eosinophils in vitro. This activity was inhibited by lactose to a markedly greater extent than sucrose suggesting a galectin-like identity. Lactose affinity chromatography of soluble H. contortus extracts resulted in the isolation a specific bound fraction which retained biological activity. SDS-PAGE gel electrophoresis indicated a single Coomassie-stained band at between 31 and 41kDa. Subsequent, mass spectrometric analysis confirmed that the bound fraction contained a mixture of nematode galectins. The results confirm that H. contortus larvae produce several galectin-like proteins, at least one of which demonstrates eosinophil chemokinetic activity in vitro. The possibility of the parasite-derived factor mimicking the mammalian galectin-9, a known eosinophil chemokine, is discussed.

The revised burn diagram and its effect on diagnosis-related group coding.

Diagnosis-related group (DRG) codes for burn injuries are defined by thresholds of the percentage of total body surface area and depth of burns, and by whether surgery, debridement, or grafting or both occurred. This prospective study was designed to determine whether periodic revisions of the burn diagram resulted in more accurate assignment of the International Classification of Diseases and DRG codes. The admission burn diagrams were revised after admission and after each surgical procedure. All areas grafted (deep second-and third-degree burns) were diagrammed as "third-degree," after the current convention that both are biologically the same and require grafting. The multiple diagrams from 82 charts were analyzed to determine the disparities in the percentage of total body surface area burn and the percentage of body surface area third-degree burn. The revised diagrams differed from the admission diagrams in 96.5% of the cases. In 77% of the cases, the revised diagram correctly depicted the percentage of body surface area third-degree burn as confirmed intraoperatively. In 7.3% of the cases, diagram revision changed the DRG code. Documenting wound evolution in this manner allows more accurate assignment of the International Classification of Diseases and DRG codes, assuring optimal reimbursement under the prospective payment system.

Cooking-related burn injuries in the elderly preventing the "granny gown" burn.

Cooking-related burn injuries accounted for 27% of the elderly female admissions at one burn center. The primary mode of injury was found to be ignition of clothing while reaching across a stove. To develop a prevention program for this problem, biologic and environmental hazards were identified. From this information, a two-phase prevention program was designed. Phase one, education, entailed the development, publication, and distribution of a pamphlet to a variety of local agencies. Phase two, an environment evaluation, consisted of contacting consumer relation departments of major stove manufacturers suggesting a product safety review. The community response to this program has been favorable. Its design should provide the foundation for preventing increased incidence of cooking-related burn injuries.

Results of bone grafting of tibial defects in uncemented total knee replacements.

Bony defects of the articular surface are frequently encountered in total knee replacement. As an alternative to excising more tibia and using a thicker tibial component, autogenous bone grafts have been used to fill these defects. The authors have analysed 43 cases in which bone grafts were used in conjunction with an uncemented tibial component. The follow-up was 2 to 7 years. The results in these cases were compared with those in a similar group using uncemented components in which bone grafting was not required. There were 15 central grafts and 28 edge grafts. All the edge grafts and seven large central grafts were fixed with screws. If the graft size was more than 1 cm2, patients were not permitted to bear weight for 4 to 6 weeks. In the others, weight bearing was allowed immediately. All grafts united, most within 6 months, and substantial collapse was not observed. Notable sinking of the tibial component occurred in one late case, in which a rotatory subluxation developed due to patellar dislocation. Collapse of the graft in a recent case, however, suggests that when large grafts are used, a heavy central stem should be used on the tibial component.