Concentrations of albumin, IgG, IgA, IgM, α1-acid glycoprotein, α1-anti-trypsin, α2-macroglobulin, transferrin, haptoglobin, and coeruloplasmin were determined by radial immunodiffusion in the blood sera and bronchial washings of 8 patients without clinical, radiologic or bronchoscopic evidence of lung diseases. The local production of the proteins was calculated with a formula used by Deuschl and Johansson for the estimation of local synthesis of bronchial immunoglobulins. The formula was completed by a reduction factor established by the authors, based on their previous investigations The calculations indicated that the individual proteins were secreted locally in various percentages of the total amount found in the secretion, as follows: IgG, 37%; IgA, 84.5%; transferrin, 44.5%, α1-antitrypsin, 15.2%; coeruloplasmin, 11.3%. Local synthesis of IgM was found only in 3 patients. The α1-acid glycoprotein and the haptoglobin do not seem to be secreted locally by the normal bronchial mucosa; they reach the mucus from blood only, through ultrafiltration
COHE physicians who more often adopted occupational health best practices had 57% fewer disability days (p ϭ 0.001) compared with patients treated by COHE physicians who less frequently adopted best practices. CONCLUSIONS: Physician financial incentives, coupled with care management support, can improve outcomes and reduce costs for patients receiving occupational health care. OBJECTIVES:Kyphosis due at least one vertebral compression fracture (VCF) is prevalent among osteoporotic patients, resulting in well documented symptoms and impact on functioning and well-being. Assessing health outcomes of interventions concentrates on consequences of back pain, omitting relevant aspects of increased morbidity. A three-part study led to development of a conceptual measurement framework for comprehensive assessment of symptoms, impact and treatment benefits in kyphosis. METHODS: We developed a literature-based (PubMed, Medline) Disease Model (DM) for kyphosis for selecting and developing outcome measures, as recommended by regulatory agencies. In-depth interviews were conducted among patients (nϭ10) and physicians (nϭ10) to test the DM. Physician respondents were PCPs or specialists currently treating patients with osteoporotic kyphosis. Patient respondents were Ͼ50 years old with an osteoporotic VCF Ͼϭ 90 days prior. Relevant Patient-Reported Outcome instruments (PROs) were evaluated for appropriateness in this population. RESULTS: The DM included signs, symptoms, causes/triggers, exacerbations, and functional/well-being impact of kyphosis. The DM content was largely confirmed by all respondents, however patients offered new concepts of emotional and functional impact and clinicians discounted psychosocial concepts (well-being and sleep impairment) and added clinical evaluations of the spinal deformity. Related to these findings, PRO instruments lacked adequate content validity or measurement properties for evaluating kyphosis outcomes. Close matches were the IOF Quality of Life questionnaire (Qualeffo-41) and the Osteoporosis Assessment Questionnaire (OPAQ), though neither includes gastrointestinal or respiratory symptoms. CONCLUSIONS: This study confirms the need for more comprehensive assessment of health outcomes in kyphosis, because current approaches omit key concepts (gastrointestinal and respiratory symptoms) and functional impact being a major cost-driver. A comprehensive evaluation of the severity and impact of kyphosis requires clinician evaluation of spinal deformity and patient-report of symptoms (spinal, respiratory, GI) and functional impact and a more complete understanding of the unique information provided by different measurements.
A szerzők egy fi atal, egészséges egyén esetét ismertetik, akinél az izolált aszpartát-aminotranszferáz-emelkedés diagnosztikai nehézséget jelentett. A probléma megoldására polietilénglikol precipitációs tesztet, aszpartát-aminotranszferáz-szérumelektroforézist és immunfi xációt alkalmaztak. Kimutatták, hogy a beteg szérummintáiban polietilén glikol-precipitációt követően az aszpartát-aminotranszferáz-aktivitás majdnem teljesen megszűnt. Az aszpartát-aminotranszferáz a kontrollmintákban az anód, míg a betegmintában a katód felé vándorolt. Immunfi xációs gélen szélesebb és intenzívebben festődő csík volt látható az immunglobulin-A-régióban a betegmintában a kontrollmintához képest. Ezek a laboratóriumi tesztek megerősítették, hogy az aszpartát-aminotranszferáz-aktivitás makroformáció következményeként is megemelkedhet. Esetükben az emelkedett immunglobulin-A-szint és a szelektív poliklonális immunglobulin-A-(κ-és λ-könnyűláncok) növekedés makroformátumot jelzett, amit az aszpartát-aminotranszferázhoz való immunglobulin-A-kötődés hozott létre. Orv. Hetil., 2014, 155(39), 1558-1562. Kulcsszavak: makroenzimek, makroaszpartát-aminotranszferáz, májbetegségIsolated aspartate aminotransferase elevation in a young, healthy person. Case reportThe authors present diagnostic methods used in a young healthy person who had isolated aspartate aminotransferase elevation. Polyethylene glycol precipitation test, aspartate aminotransferase serum electrophoresis and immunofi xation were performed for measuring the macro-aspartate aminotransferase. It was found that aspartate aminotransferase activity in the patient was almost completely eliminated after precipitation of immunoglobulins with polyethylene glycol. In addtion, aspartate aminotransferase migrated in the control samples to the anode while in the patient towards the cathode. Finally, a wider and more intense staining band was visible in the region of immunoglobulin A in the patient sample on the immunofi xation gel as compared to the control sample. The authors conclude that that increased aspartate aminotransferase activity was due to macro formation. The elevated level of immunoglobulin A and selective increase of polyclonal immunoglobulin A (κ and λ light chains) indicated that the macro format was created by immunoglobulin A bound to aspartate aminotransferase.
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