Mortality and morbidity of reusing dialysers. A report by the registration committee of the European Dialysis and Transplant Association.

The practice of reusing dialysers in renal units in the UK was surveyed by examining the patient questionnaires returned to the EDTA registration committee for 1976 and by a special questionnaire sent to all UK renal units. Altogether 65.6% of the 1785 patients treated with non-disposable dialysers and 49.6% of the 1109 treated with disposable dialysers reused their equipment. Reuse of dialysers caused some morbidity but no mortality. Most centres where disposable dialysers were used accepted that their reuse was necessary because of financial constraints and was ethically defensible.     

Local infusion of urokinase and heparin into renal arteries in impending renal cortical necrosis.

Two patients with presumed impending cortical necrosis, after haemolytic uraemic syndrome in one and after concealed accidental haemorrhage in the other, were treated by local infusion of urokinase and heparin into the renal artery. Both recovered and one regained normal renal function. Local infusion of anticoagulants or thrombolytic drugs into one renal artery offers the possibility of a controlled examination of the efficacy of this treatment in preventing cortical necrosis.     

Hybrid formation between scallop myofibrils and foreign regulatory light-chains

Scallop myofibrils (Placopecten magellanicus) from which regulatory light-chains had been completely removed by EDTA treatment at 30 °C were hybridized with regulatory light-chains of different myosins. Pure hybrids, containing only foreign regulatory light-chains with a stoichiometry of two moles per myosin, were readily formed with all the light-chains tested. Some of the regulatory light-chains restored regulatory functions to desensitized myofibrils by selectively inhibiting the actin activated Mg-ATPase in the absence of calcium. Light-chains from Mercenaria, Spisula Loligo and Urechis behaved as scallop regulatory light-chains, were inhibitory in the absence of calcium, and restored high-affinity calcium binding sites. Regulatory light-chains of Limulus, cricket, chicken gizzard and platelet were also inhibitory; however, calcium binding was restored with a lowered affinity and the hybrids required higher calcium concentrations for ATPase activation. Hybrids formed with the regulatory light-chains of vertebrate striated (rabbit, chicken, skate), bovine cardiac and lobster tail and claw muscles remained insensitive to calcium, their ATPase activity was not selectively depressed in the absence of calcium and specific high-affinity calcium binding sites were not restored. Phosphorylation of the light-chains (rabbit, cardiac and gizzard) has no effect on ATPase activity. The behaviour of the hybrids supports the interpretation that in vertebrate striated muscles myosin does not function as a regulatory switch.Foreign regulatory light-chains (Spisula, Loligo, Mercenaria, rabbit) bind to desensitized myofibrils with a similar or slightly higher affinity as scallop regulatory light-chains. The two light-chain binding sites of myosin are equivalent and differences in affinity appear to be the result of an interaction between the two halves of the myosin molecules.     

A genetically engineered attenuated coxsackievirus B3 strain protects mice against lethal infection

Coxsackievirus B3 (CVB3) is a common human pathogen that is endemic throughout the world. There is currently no vaccine available, although the virus is known to be highly lethal to newborns and has been associated with heart disease and pancreatitis in older children and adults. Previously, we showed that the virulence of CVB3 is reduced by a lysine-to-arginine substitution in the capsid protein VP2 (K2168R) or a glutamic acid-to-glycine substitution in VP3 (E3060G). In this report, we show that the double mutant virus CVB3(KR/EG) displays additional attenuation, particularly for the pancreas, in A/J mice. In addition, two other attenuating mutations have been identified in the capsid protein VP1. When either the aspartic acid residue D1155 was replaced with glutamic acid or the proline residue P1126 was replaced with methionine, the resulting mutant also possessed an attenuated phenotype. Moreover, when either of these mutations was incorporated into CVB3(KR/EG), the resulting triple mutant viruses, CVB3(KR/EG/DE) and CVB3(KR/EG/PM), were completely noncardiovirulent and caused only small foci of damage to the pancreas, even at a high dose. Both triple mutants were found to be immunogenic, and a single injection of young A/J mice with either was found to protect them from a subsequent lethal challenge with wild-type CVB3. These findings indicate that the triple mutants could be exploited for the development of a live attenuated vaccine against CVB3.     

Peritoneal dialysis in infants.

A commercially available closed dialysis system and a new peritoneal cannula with potential advantages for infants have been developed. The dialysis set includes three dialysate bags that may be connected to the filling burette; the warming coil of the set is placed in a thermostatically controlled water bath. The peritoneal catheter comprises a flexible tube with side holes and a sharp short bevelled needle with obturator. Advantages of the new equipment over previously available equipment are that the cannula is easier to insert; there is less risk of contaminating the dialysate since the tubing set is unbroken from supply to cannula; the mix of the dialysate may be changed easily without interrupting dialysis; and the equipment may be assembled easily by unskilled staff.     

Plasma C3 and C4 Concentrations in Management of Glomerulonephritis

As part of a larger study of serial complement profiles in glomerulonephritis plasma C3 and C4 concentrations were measured using commercially available immunodiffusion plates. A total of 303 samples were obtained from 128 patients suffering from forms of nephritis associated with hypocomplementaemia—namely, lupus nephritis, mesangiocapillary glomerulonephritis (M.C.G.N.), and acute glomerulonephritis.These simple measurements of C3 and C4 gave clinically useful information. In lupus nephritis C3 and C4 generally correlated and C4 concentrations were more often and more profoundly depressed than C3 concentrations. Neither C3 nor C4 concentrations alone correlated well with the antinuclear factor titre.In both acute glomerulonephritis and M.C.G.N. the C3 concentrations were frequently lower than 20% of normal (which was never the case in patients with lupus), while the C4 concentration was usually normal and was almost never depressed in the absence of C3 depression. This suggests activation of complement at the C3 level by the “bypass” pathway in acute nephritis as well as in M.C.G.N., though both may be operating in some patients. In acute glomerulonephritis but not in M.C.G.N. C3 concentrations returned to normal within eight to 12 weeks.The two varieties of M.C.G.N. identified by the site of the deposits in the capillary glomerular walls differed in their C3 levels. In 10 patients with intramembranous dense linear deposits the C3 was always low over very long periods of time, rising in three out of four patients only after transplantation and immunosuppression. Other patients with M.C.G.N., in contrast, often showed normal C3 concentrations. Concentrations of C4 did not differ in either group, being normal in 80% of samples from all types.     

The major outer membrane protein of Chlamydia trachomatis: critical binding site and conformation determine the specificity of antibody binding to viable chlamydiae

The major outer membrane protein (MOMP) is the prime candidate for the development of a chlamydial vaccine. Antibodies to the subspecies-specific epitope neutralize chlamydial infection. Monoclonal antibodies (MAbs) to this epitope were prepared either by immunization with whole chlamydiae or with a 16 amino acid synthetic peptide. The critical binding site on the subspecies epitope for these MAbs was determined to single amino acid resolution using several hundred solid-phase peptides. A frame shift of just one amino acid in critical binding site completely prevented antibody binding to viable chlamydiae. A single MAb to whole organisms was capable of spanning both the surface-exposed, conformation-dependent, subspecies epitope and a buried, conformation-independent species epitope some 10 A distant. Immunization with peptide generated an MAb with reduced binding constraints which permitted the antibody to bind with broadened species-specificity at the subspecies binding site. The results show for the first time the importance of both critical binding site and conformation at the subspecies epitope. We suggest that the conformational flexibility of short, epitopic peptide vaccines may in some cases be advantageous, giving rise to extended specificity not attained with the natural protein.