This study shows that key RBC quality variables, hemolysis, and ATP concentration may be predictive of their 24-hour recovery and t(1/2) survival. These variables will now be used to assess modifications to the system including storage duration, storage temperature, and appropriate energy dose for treatment.
Human albumin has the ability to bind cobalt at the N-terminus. The exposure of circulating albumin to ischemic tissue alters the ability of albumin to bind cobalt, probably through a mechanism involving free-radical production. The Albumin Cobalt Binding (ACB) test measures the alteration in albumin metal binding, and elevation of the ACB test is thought to be an early indicator of myocardial ischemia. In a previous multicenter study of chest pain patients presenting to the emergency department (ED), this test demonstrated high negative predictive value and sensitivity in the sample collected at presentation for predicting cardiac troponin I (cTnI)-negative or cTnI-positive results 6-24 h later. Since the completion of that report, the European Society of Cardiology (ESC) and the American College of Cardiology (ACC) have redefined the criteria for the diagnosis of acute myocardial infarction (AMI). The data from the multicenter ACB study were re-examined using the new diagnostic criteria for AMI to determine if combining the ACB test with troponin improved the sensitivity of either assay used alone for early diagnosis of AMI. Assay values were compared to either the final discharge diagnosis made at each site or to a diagnosis of AMI using the strict application of the ESC/ACC guidelines. Using the criterion of physician's discharge diagnosis and using blood collected at ED presentation, the cTnI test alone had a sensitivity of 23.9%, and the ACB test alone had a sensitivity of 39.1%, but the sensitivity significantly increased to 55.9% (p < 0.001 over cTnI alone) when both tests were used in combination. The sensitivity of the combination of ACB and cTnI tests at the 1- to 6-h time-point was 86.7% and at the >6- to 12-h time-point was 93.5%, but they were not significantly improved over the cTnI test alone. In conclusion, using the new ESC/ACC criteria, the combination also resulted in a statistically significant higher diagnostic sensitivity on blood collected at presentation. These data indicate a possible role of the ACB test in the early triage of patients with chest pain.
CD21 (C3dg/EBV receptor) is physically associated on B cells with a complex of proteins that includes CD19 and the widely distributed tetraspan 4 (TM4) family protein CD81 as well as other TM4 proteins (CD53, CD37 and CD82). Monoclonal antibodies (mAb) were generated that blocked homotypic adhesion induced by CD21 ligands in the human B cell line Balm-1. One inhibitory mAb (3A8) was found to recognize the ecto-enzyme gamma-glutamyl transpeptidase (GGT), a membrane protein involved in recycling extracellular glutathione and regulating intracellular redox potential. Molecular associations between GGT and TM4 proteins CD81, CD53 and CD82, in addition to CD21 and CD19, were detected by co-precipitation and co-capping analysis. GGT is expressed on several B and T cell lines independently of CD21 expression. These results demonstrate that GGT is a component of widely distributed TM4 complexes, and that on B cells the GGT-containing TM4 complexes also contain CD19 and CD21.
To the Editor Cost-effectiveness is a relatively new discipline, for which guidelines continue to be developed and refined. The article by Dr Sanders and colleagues 1 offered updated reference cases and perspectives as well as a checklist in an attempt to improve standards and minimize bias in published studies.There is evidence that cost-effectiveness studies sponsored by pharmaceutical companies are more likely to report positive cost-effective results. 2 As a means to address this and other potential biases, we agree with the authors' recommendations to require a true societal health care perspective and include an impact inventory.The authors included in the checklist that an analytic plan be described within the article. We propose that not only should the analytic plan be described in the methods section, but it should also be made public prior to the analysis. This would hold cost-effectiveness studies to the same standards as systematic reviews and randomized clinical trials, both of which have guidelines that require registration of studies that detail the methods and outcomes prior to execution. 3,4 Registration of systematic reviews and randomized clinical trials have been incorporated into guidelines in an effort to address the problems of multiple comparisons and selective outcomes reporting.Requiring cost-effectiveness investigators to commit to a prespecified analytic plan would promote transparency and differentiation between a priori and post hoc analyses. This differentiation would encourage investigators to develop robust analytic plans prior to performing their analysis and would limit the risk of manipulation of the model until the desired result is obtained, a problem similar to that found in multiple comparisons. The additional transparency would allow readers to understand more thoroughly how the investigators arrived at their results and see what modifications they made along the way.Cost-effectiveness methodology has developed significantly during the last few decades and these new recommendations should help advance it even further. An added recommendation of trial registration would be another means of guarding against bias in a field just coming of age.
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