Diagnostic value of immunoassays for heparin-induced thrombocytopenia: a systematic review and meta-analysis.

Immunoassays are essential in the workup of patients with suspected heparin-induced thrombocytopenia. However, the diagnostic accuracy is uncertain with regard to different classes of assays, antibody specificities, thresholds, test variations, and manufacturers. We aimed to assess diagnostic accuracy measures of available immunoassays and to explore sources of heterogeneity. We performed comprehensive literature searches and applied strict inclusion criteria. Finally, 49 publications comprising 128 test evaluations in 15 199 patients were included in the analysis. Methodological quality according to the revised tool for quality assessment of diagnostic accuracy studies was moderate. Diagnostic accuracy measures were calculated with the unified model (comprising a bivariate random-effects model and a hierarchical summary receiver operating characteristics model). Important differences were observed between classes of immunoassays, type of antibody specificity, thresholds, application of confirmation step, and manufacturers. Combination of high sensitivity (>95%) and high specificity (>90%) was found in 5 tests only: polyspecific enzyme-linked immunosorbent assay (ELISA) with intermediate threshold (Genetic Testing Institute, Asserachrom), particle gel immunoassay, lateral flow immunoassay, polyspecific chemiluminescent immunoassay (CLIA) with a high threshold, and immunoglobulin G (IgG)-specific CLIA with low threshold. Borderline results (sensitivity, 99.6%; specificity, 89.9%) were observed for IgG-specific Genetic Testing Institute-ELISA with low threshold. Diagnostic accuracy appears to be inadequate in tests with high thresholds (ELISA; IgG-specific CLIA), combination of IgG specificity and intermediate thresholds (ELISA, CLIA), high-dose heparin confirmation step (ELISA), and particle immunofiltration assay. When making treatment decisions, clinicians should be a aware of diagnostic characteristics of the tests used and it is recommended they estimate posttest probabilities according to likelihood ratios as well as pretest probabilities using clinical scoring tools.

Acute hemorrhagic edema of young children: a prospective case series.

Acute hemorrhagic edema of young children is a rare leukocytoclastic vasculitis that has been reported exclusively in small retrospective cases series, case reports, or quizzes. Considering that retrospective experience deserves confirmation in at least one observational prospective study, we present our experience with 16 children (12 boys and 4 girls, 5-28 months of age) affected by acute hemorrhagic edema. The patients were in good general conditions and with a low-grade or even absent fever. They presented with non-itching red to purpuric targetoid lesions not changing location within hours, with non-pitting and sometimes tender indurative swelling, and without mucous membrane involvement or scratch marks. Signs for articular, abdominal, or kidney involvement were absent. Antinuclear or antineutrophil cytoplasmic autoantibodies were never detected. The cases were managed symptomatically as outpatients and fully resolved within 4 weeks or less. No recurrence or familiarity was noted. CONCLUSION This is the first prospective evaluation of hemorrhagic edema. Our findings emphasize its distinctive tetrad: a well-appearing child; targetoid lesions that do not change location within hours; non-pitting, sometimes tender edema; complete resolution without recurrence. What is known • Acute hemorrhagic edema of young children is considered a benign vasculitis. • There have been ≈100 cases reported in small retrospective case series. What is new • The first prospective evaluation of this condition emphasizes its features: febrile prodrome; well-appearing child; targetoid lesions not changing location within hours; non-pitting, sometimes tender indurative edema; absent extracutaneous involvement; resolution within 3 weeks. • Antineutrophil cytoplasmic autoantibodies do not play a pathogenic role.

Decreasing Proportion of Recent Infections among Newly Diagnosed HIV-1 Cases in Switzerland, 2008 to 2013 Based on Line-Immunoassay-Based Algorithms.

BACKGROUND: HIV surveillance requires monitoring of new HIV diagnoses and differentiation of incident and older infections. In 2008, Switzerland implemented a system for monitoring incident HIV infections based on the results of a line immunoassay (Inno-Lia) mandatorily conducted for HIV confirmation and type differentiation (HIV-1, HIV-2) of all newly diagnosed patients. Based on this system, we assessed the proportion of incident HIV infection among newly diagnosed cases in Switzerland during 2008-2013. METHODS AND RESULTS: Inno-Lia antibody reaction patterns recorded in anonymous HIV notifications to the federal health authority were classified by 10 published algorithms into incident (up to 12 months) or older infections. Utilizing these data, annual incident infection estimates were obtained in two ways, (i) based on the diagnostic performance of the algorithms and utilizing the relationship 'incident = true incident + false incident', (ii) based on the window-periods of the algorithms and utilizing the relationship 'Prevalence = Incidence x Duration'. From 2008-2013, 3'851 HIV notifications were received. Adult HIV-1 infections amounted to 3'809 cases, and 3'636 of them (95.5%) contained Inno-Lia data. Incident infection totals calculated were similar for the performance- and window-based methods, amounting on average to 1'755 (95% confidence interval, 1588-1923) and 1'790 cases (95% CI, 1679-1900), respectively. More than half of these were among men who had sex with men. Both methods showed a continuous decline of annual incident infections 2008-2013, totaling -59.5% and -50.2%, respectively. The decline of incident infections continued even in 2012, when a 15% increase in HIV notifications had been observed. This increase was entirely due to older infections. Overall declines 2008-2013 were of similar extent among the major transmission groups. CONCLUSIONS: Inno-Lia based incident HIV-1 infection surveillance proved useful and reliable. It represents a free, additional public health benefit of the use of this relatively costly test for HIV confirmation and type differentiation.

Desiccation of phyllosilicate-bearing samples as analog for desiccation cracks on Mars: Experimental setup and initial results

The surface of Mars is host to many regions displaying polygonal crack patterns that have been identified as potential desiccation cracks. These regions are mostly within Noachian-aged terrains and are closely associated with phyllosilicate occurrences and smectites in particular. We have built a laboratory setup that allows us to carry out desiccation experiments on Mars-analog materials in an effort to constrain the physical and chemical properties of sediments that display polygonal cracks. The setup is complemented by a pre-existing simulation chamber that enables the investigation of the spectral and photometric properties of analog materials in Mars-like conditions. The initial experiments that have been carried out show that (1) crack patterns are visible in smectite-bearing materials in varying concentrations down to similar to 10% smectite by weight, (2) chlorides, and potentially other salts, delay the onset of cracking and may even block it from occurring entirely, and (3) the polygonal patterns, while being indicative of the presence of phyllosilicates, cannot be used to differentiate between various phyllosilicate-bearing deposits. However, their size-scale and morphology yields important information regarding their thickness and the hydrological conditions at the time of formation. Furthermore, the complementary spectral measurements for some of the analog samples shows that crack patterns may develop in materials with such low concentrations of smectites that would not be expected to be identified using remote-sensing instruments. This may explain the presence of polygonal patterns on Mars in sediments that lack spectral confirmation of phyllosilicates. (C) 2015 Elsevier Ltd. All rights reserved.

Magnetic Resonance Imaging Finding in Small Ruminants with Brain

Brain disease is an important cause of neurologic deficits in small ruminants, however few MRI features have been described. The aim of this retrospective, case series study was to describe MRI characteristics in a group of small ruminants with confirmed brain disease. A total of nine small ruminants (six sheep and three goats) met inclusion criteria. All had neurologic disorders localized to the brain and histopathologic confirmation. In animals with toxic-metabolic diseases, there were bilaterally symmetric MRI lesions affecting either the gray matter (one animal with polioencephalomalacia) or the white matter (two animals with enterotoxemia). In animals with suppurative inflammation, asymmetric focal brainstem lesions were present (two animals with listeric encephalitis), or lesions typical of an intra-axial (one animal) or dural abscess (one animal), respectively. No MRI lesions were detected in one animal with suspected viral cerebellitis and one animal with parasitic migration tracts. No neoplastic or vascular lesions were identified in this case series. Findings from the current study supported the use of MRI for diagnosing brain diseases in small ruminants.

Tp53-dependent repression of cell cycle target genes: Global and mechanistic analysis

Most studies of p53 function have focused on genes transactivated by p53. It is less widely appreciated that p53 can repress target genes to affect a particular cellular response. There is evidence that repression is important for p53-induced apoptosis and cell cycle arrest. It is less clear if repression is important for other p53 functions. A comprehensive knowledge of the genes repressed by p53 and the cellular processes they affect is currently lacking. We used an expression profiling strategy to identify p53-responsive genes following adenoviral p53 gene transfer (Ad-p53) in PC3 prostate cancer cells. A total of 111 genes represented on the Affymetrix U133A microarray were repressed more than two fold (p ≤ 0.05) by p53. An objective assessment of array data quality was carried out using RT-PCR of 20 randomly selected genes. We estimate a confirmation rate of >95.5% for the complete data set. Functional over-representation analysis was used to identify cellular processes potentially affected by p53-mediated repression. Cell cycle regulatory genes exhibited significant enrichment (p ≤ 5E-28) within the repressed targets. Several of these genes are repressed in a p53-dependent manner following DNA damage, but preceding cell cycle arrest. These findings identify novel p53-repressed targets and indicate that p53-induced cell cycle arrest is a function of not only the transactivation of cell cycle inhibitors (e.g., p21), but also the repression of targets that act at each phase of the cell cycle. The mechanism of repression of this set of p53 targets was investigated. Most of the repressed genes identified here do not harbor consensus p53 DNA binding sites but do contain binding sites for E2F transcription factors. We demonstrate a role for E2F/RB repressor complexes in our system. Importantly, p53 is found at the promoter of CDC25A. CDC25A protein is rapidly degraded in response to DNA damage. Our group has demonstrated for the first time that CDC25A is also repressed at the transcript level by p53. This work has important implications for understanding the DNA damage cell cycle checkpoint response and the link between E2F/RB complexes and p53 in the repression of target genes. ^

Concomitant Mycobacterium tuberculosis infection and type 2 diabetes: A descriptive model with global health implications

The type 2 diabetes (diabetes) pandemic is recognized as a threat to tuberculosis (TB) control worldwide. This secondary data analysis project estimated the contribution of diabetes to TB in a binational community on the Texas-Mexico border where both diseases occur. Newly-diagnosed TB patients > 20 years of age were prospectively enrolled at Texas-Mexico border clinics between January 2006 and November 2008. Upon enrollment, information regarding social, demographic, and medical risks for TB was collected at interview, including self-reported diabetes. In addition, self-reported diabetes was supported by blood-confirmation according to guidelines published by the American Diabetes Association (ADA). For this project, data was compared to existing statistics for TB incidence and diabetes prevalence from the corresponding general populations of each study site to estimate the relative and attributable risks of diabetes to TB. In concordance with historical sociodemographic data provided for TB patients with self-reported diabetes, our TB patients with diabetes also lacked the risk factors traditionally associated with TB (alcohol abuse, drug abuse, history of incarceration, and HIV infection); instead, the majority of our TB patients with diabetes were characterized by overweight/obesity, chronic hyperglycemia, and older median age. In addition, diabetes prevalence among our TB patients was significantly higher than in the corresponding general populations. Findings of this study will help accurately characterize TB patients with diabetes, thus aiding in the timely recognition and diagnosis of TB in a population not traditionally viewed as at-risk. We provide epidemiological and biological evidence that diabetes continues to be an increasingly important risk factor for TB.^

Epidemiological trends of influenza A positive patients hospitalized at St. Luke's Episcopal Hospital, Houston, Texas September, 2009--January, 2010

This study was a descriptive analysis of 437 influenza A positive inpatients and outpatients during the five month period between September, 2009 and January, 2010. The objective of the study was to describe the epidemiological trends of the total influenza A positive population and more specifically the clinical features of patients hospitalized with influenza A at St. Luke's Episcopal Hospital in Houston, Texas from September 2009 through January 2010. Eligible cases were included if they tested positive for influenza A test using the rapid antigen test and/or rRT-PCR. Hospitalized cases were included based on the laboratory confirmation of influenza A as well as hospital admission for at least 24 hours. Data was collected from medical record abstraction and included patient demographics, clinical history and history of chronic disease. Clinical findings in the differential diagnosis that led to laboratory-confirmation of influenza A as well as course of treatment during the hospital admission were summarized. Finally, co-morbid conditions charted during the hospital visit were reviewed and evaluated for associations with influenza A complications. During the study period, forty-eight patients were included in the study of which 27 tested positive for the H1N1 subtype. Females were more likely to be hospitalized than men. The median age of all patients admitted to St. Luke's Episcopal Hospital with influenza A was 42. The distribution for admitted cases was 15 White, 15 Black, and 18 Hispanic. Patients with co-morbid disease constituted 81% of the admissions for Influenza A. The presence of an underlying medical condition remains a risk factor for both seasonal and H1N1 influenza. Although respiratory conditions such as asthma and COPD are commonly associated with complications of seasonal influenza, patients with metabolic disorders such as kidney disease and/or diabetes were admitted more frequently (58%) during the study period. The patients in the study also of a much younger age than the age that is usually associated with complications of influenza infection, i.e. no patients greater than 65 years of age were admitted with a diagnosis of influenza A. Lower infection rates among elderly populations were similarly reported in other studies of influenza during the same time period. Older patient populations may benefit from antibodies to previous H1N1 strains that have circulated during the twentieth century, whereas younger age groups lack these exposures.^

SERIOUS MORBIDITY DUE TO ACUTE RESPIRATORY DISEASE ASSOCIATED WITH EPIDEMIC INFLUENZA

Current measures of the health impact of epidemic influenza are focused on analyses of death certificate data which may underestimate the true health effect. Previous investigations of influenza-related morbidity have either lacked virologic confirmation of influenza activity in the community or were not population-based. Community virologic surveillance in Houston has demonstrated that influenza viruses have produced epidemics each year since 1974. This study examined the relation of hospitalized for Acute Respiratory Disease (ARD) to the occurrence of influenza epidemics. Considering only Harris County residents, a total of 13,297 ARD hospital discharge records from hospitals representing 48.4% of Harris County hospital beds were compiled for the period July 1978 through June 1981. Variables collected from each discharge included: age, sex, race, dates of admission and discharge, length of stay, discharge disposition and a maximum of five diagnoses. This three year period included epidemics caused by Influenza A/Brazil (H1N1), Influenza B/Singapore, Influenza A/England (H1N1) and Influenza A/Bangkok (H3N2).^ Correlations of both ARD and pneumonia or influenza hospitalizations with indices of community morbidity (specifically, the weekly frequency of virologically-confirmed influenza virus infections) are consistently strong and suggest that hospitalization data reflect the pattern of influenza activity derived from virologic surveillance.^ While 65 percent of the epidemic period hospital deaths occurred in patients who were 65 years of age or older, fewer than 25 percent of epidemic period ARD hospitalizations occurred in persons of that age group. Over 97 percent of epidemic period hospital deaths were accompanied by a chronic underlying illness, however, 45 percent of ARD hospitalizations during epidemics had no mention of underlying illness. Over 2500 persons, approximately 35 percent of all persons hospitalized during the three epidemics, would have been excluded in an analysis for high risk candidates for influenza prophylaxis.^ These results suggest that examination of hospitalizations for ARD may better define the population-at-risk for serious morbidity associated with epidemic influenza. ^

Correlates of prenatal care initiation among low -income Hispanic women

Because Hispanic women are even less likely than women of other ethnic groups to receive early prenatal care, the purpose of this study was to identify factors that may influence these women to initiate care. After giving consent, 300 Hispanic women (100 who initiated first trimester care, 100 who initiated second trimester care, and 100 who initiated third trimester care or received no care) were interviewed in the post partum unit of a local public hospital. The interview included recollection of events leading to the first prenatal appointment, including first physical indicators of pregnancy, confirmation of pregnancy, feelings about the pregnancy, appointment making behavior, and system barriers encountered. The Health Belief Model was used as the theoretical framework for determining psychosocial variables. Using this model, perceived susceptibility to problems during pregnancy, perceived seriousness of possible problems, perceived benefits of prenatal care, perceived barriers to care, and cues to action were assessed. Time of entry into prenatal care was assessed by interview.^ In this sample of low-income Hispanic women, a higher perception of barriers to care was associated with later initiation of care and non-use of care, higher perceived benefits of care for the baby were associated with earlier care, especially in women without a card to access hospital district services, and having a card to access hospital district services was associated with earlier care. Several barriers to care were mentioned by women on open-ended questioning including long waiting times, embarrassment, and lack of transportation.^ Recommendations for practice included decreasing the number of visits for low-risk women while increasing the time spent with the provider, decreasing the number of vaginal exams for low-risk women, increasing the use of midwives, training lay workers to do risk assessment, giving specific messages about benefits of care to baby, and increasing general health motivation through community intervention methods. More research on the psychosocial and cultural factors associated with initiation of care is needed. In the meantime, the recommendations for practice can be implemented now to increase the use of prenatal care by low-income Hispanic women. ^

The yeast STM1 protein binds G*G multiplex nucleic acids in vitro and associates with ribosomes in vivo

The formation of triple helical, or triplex DNA has been suggested to occur in several cellular processes such as transcription, replication, and recombination. Our laboratory previously found proteins in HeLa nuclear extracts and in S. cerevisiae whole cell extracts that avidly bound a Purine-motif (Pu) triplex probe in gel shift assays, or EMSA. In order to identify a triplex DNA-binding protein, we used conventional and affinity chromatography to purify the major Pu triplex-binding protein in yeast. Peptide microsequencing and data base searches identified this protein as the product of the STM1 gene. Confirmation that Stm1p is a Pu triplex-binding protein was obtained by EMSA using both recombinant Stm1p and whole cell extracts from stm1Δ yeast. Stm1p had previously been identified as G4p2, a G-quartet DNA- and RNA-binding protein. To study the cellular role and identify the nucleic acid ligand of Stm1p in vivo, we introduced an HA epitope at either the N- or C-terminus of Stm1p and performed immunoprecipitations with the HA.11 mAb. Using peptide microsequencing and Northern analysis, we positively identified a subset of both large and small subunit ribosomal proteins and all four rRNAs as associating with Stm1p. DNase I treatment did not affect the association of Stm1p with ribosomal components, but RNase A treatment abolished the association with all ribosomal proteins and RNA, suggesting this association is RNA-dependent. Sucrose gradient fractionation followed by Western and EMSA analysis confirmed that Stm1p associates with intact 80S monosomes, but not polysomes. The presence of additional, unidentified RNA in the Stm1p-immunoprecipitate, and the absence of tRNAs and elongation factors suggests that Stm1p binds RNA and could be involved in the regulation of translation. Immunofluorescence microscopy data showed Stm1p to be located throughout the cytoplasm, with a specific movement to the bud during the G2 phase of the cell cycle. A dramatically flocculent, large cell phenotype is observed when Stm1p has a C-terminal HA tag in a protease-deficient strain background. When STM1 is deleted in this background, the same phenotype is not observed and the deletion yeast grow very slowly compared to the wild-type. These data suggest that STM1 is not essential, but plays a role in cell growth by interacting with an RNP complex that may contain G*G multiplex RNA. ^

A propósito de la pertinencia de una sociología del conocimiento "materialista"

Partiendo, por un lado, de la innegable constatación de que todo conocimiento científico es producido socialmente y, por el otro, del hecho de que lo considerado como Sociología del Conocimiento ha entrado en crisis en relación a la pertinencia de su objeto, el artículo pretende dar cuenta de las posibilidades de esa disciplina en el campo del materialismo histórico o Ciencia de la Historia. Una vez establecido ello, se aportan instrumentos generales para una sociología del pensamiento científico.

La novela autobiográfica en Abelardo Arias : a propósito de La vara de fuego

En el presente trabajo se analiza La vara de fuego del escritor mendocino Abelardo Arias, en tanto novela que, junto con Álamos talados, representa el filón autobiográfico de su narrativa y el eje central de su poética. En particular nos centramos en sus características principales y en el ineludible diálogo que entabla con Álamos talados (1942) y La viña estéril (1969). Obras con las cuales el autor conforma un tríptico, en el que se refracta su personalidad, y cuyas bisagras están compuestas por el juego interno de imbricación de la realidad con la ficción y de la ficción en la ficción. Asimismo, se estudia la relación simbólica entre las tres obras, basada en el mito del Edén Perdido y en la confirmación de su leit-motiv: el desencuentro humano (en el amor y en la amistad), necesario castigo luego de la bíblica caída.

Algunas consideraciones sobre la teoría del espacio público

Este trabajo intenta marcar las líneas fundamentales del modelo explicativo elaborado por Jürgen Habermas para dar cuenta del proceso de configuración de un espacio público en la modernidad, y observar sus posibilidades de aplicación a la realidad del mundo revolucionario iberoamericano de comienzos del siglo XIX. Asimismo, se ocupa de la trayectoria del concepto de opinión pública como recurso de legitimidad del sistema representativo liberal que intentó ser aplicado en las antiguas colonias a todo lo largo del siglo.

Phosphorus concentrations and accumulation rates of ODP Leg 130 sites

Little is known about the fluxes to and from the ocean during the Cenozoic of phosphorus (P), a limiting nutrient for oceanic primary productivity and organic carbon burial on geologic timescales. Previous studies have concluded that dissolved river fluxes increased worldwide during the Cenozoic and that organic carbon burial decreased relative to calcium carbonate burial and perhaps in absolute terms as well. To examine the apparent contradiction between increased river fluxes of P (assuming P fluxes behave like the others) expected to drive increased organic carbon burial and observations indicating decreased organic carbon burial, we determined P accumulation rates for equatorial Pacific sediments from Ocean Drilling Program leg 138 sites in the eastern equatorial Pacific and leg 130 sites on the Ontong Java Plateau in the western equatorial Pacific. Although there are site specific and depth dependent effects on P accumulation rates, there are important features common to the records at all sites. P accumulation rates declined from 50 to 20 Ma, showed some variability from 20 to 10 Ma, and had a substantial peak from 9 to 3 Ma centered at 5-6 Ma. These changes in P accumulation rates for the equatorial Pacific are equivalent to substantial changes in the P mass balance. However, the pattern resembles neither that of weathering flux indicators (87Sr/86Sr and Ge/Si ratios) nor that of the carbon isotope record reflecting changes in organic carbon burial rates. Although these P accumulation rate patterns need confirmation from other regions with sediment burial significant in global mass balances (e.g., the North Pacific and Southern Ocean), it appears that P weathering inputs to the ocean are decoupled from those of other elements and that further exploration is needed of the relationship between P burial and net organic carbon burial.