Inter-Laboratory Concordance of Cerebrospinal Fluid and Serum Kappa Free Light Chain Measurements

The kappa index (K-Index), calculated by dividing the cerebrospinal fluid (CSF)/serum kappa free light chain (KFLC) ratio by the CSF/serum albumin ratio, is gaining increasing interest as a marker of intrathecal immunoglobulin synthesis. However, data on inter-laboratory agreement of these measures is lacking. The aim was to assess the concordance of CSF and serum KFLC measurements, and of K-index values, across different laboratories. KFLC and albumin of 15 paired CSF and serum samples were analyzed by eight participating laboratories. Four centers used Binding Site instruments and assays (B), three used Siemens instruments and assays (S), and one center used a Siemens instrument with a Binding Site assay (mixed). Absolute individual agreement was calculated using a two-way mixed effects intraclass correlation coefficient (ICC). Cohen’s kappa coefficient (k) was used to measure agreement on positive (5.8) K-index values. There was an excellent agreement in CSF KFLC measurements across all laboratories (ICC (95% confidence interval): 0.93 (0.87–0.97)) and of serum KFLC across B and S laboratories (ICC: 0.91 (0.73–0.97)), while ICC decreased (to 0.81 (0.53–0.93)) when including the mixed laboratory in the analysis. Concordance for a positive K-Index was substantial across all laboratories (k = 0.77) and within S laboratories (k = 0.71), and very good (k = 0.89) within B laboratories, meaning that patients rarely get discordant results on K-index positivity notwithstanding the testing in different laboratories and the use of different platforms/assays

A multi-element psychosocial intervention for early psychosis (GET UP PIANO TRIAL) conducted in a catchment area of 10 million inhabitants: study protocol for a pragmatic cluster randomized controlled trial

Multi-element interventions for first-episode psychosis (FEP) are promising, but have mostly been conducted in non-epidemiologically representative samples, thereby raising the risk of underestimating the complexities involved in treating FEP in 'real-world' services

On the evolution of trade and sanitary and phytosanitary standards: The role of trade agreements

Trade agreements and trade measures are policy instruments thought to favour trade by providing a degree of harmonisation among members. We analyse how the agri-food trade and the incidence of Sanitary and Phytosanitary Standards (SPSs) have evolved within countries sharing agreements. We examine, through a regression discontinuity design, whether the approval of agreements affects the evolution of trade and SPSs over time, and quantify the trade effects of SPSs. We also provide differences before and after the introduction of agreements, and among the most regulated agri-food products. Findings show that trade agreements tend to favour the increase of trade and the reduction of policy measures between members. However, regulation inequalities exist across trade agreements covering different geo-economic areas: after the approval of agreements, the existence and the importance of SPSs become relevant among developing countries, whereas the pervasiveness of SPSs becomes less stringent between developed and developing countries. Our analyses also prove that trade agreements and trade measures are trade-enhancing only at aggregate level: product-specific analyses show that cereal is the only sector that benefits from the joint influence of trade agreements and SPSs. The harmonisation of SPSs within agreements may be determinant in avoiding distortions in favour of members

Community reinforcement training for family and significant others of drug abusers: A unilateral intervention to increase treatment entry of drug users

We randomly assigned 32 concerned family members and significant others (FSOs) of drug users (DUs) to a community reinforcement training intervention or a popular 12-step self-help group. We measured problems arising from the DU\u27s behavior, social functioning of the DU and FSO, and mood of the FSO at baseline and 10 weeks later. We also monitored the FSOs\u27 treatment attendance and treatment entry of the DUs. The treatment groups showed equal reductions from baseline to follow-up in problems and improvements in social functioning and mood of the FSO. However the community reinforcement intervention was significantly better at retaining FSOs in treatment and inducing treatment entry of the DUs. Copyright (C) 1999 Elsevier Science Ireland Ltd

Come monitorare e analizzare i tassi d'infezione in un centro trapianti d'organo solido

Le infezioni rappresentano un’importante causa di mortalità e morbilità nei pazienti trapiantati d’organo solido. Per conoscere il numero e l’impatto di queste complicanze in ambiente ospedaliero è necessario implementare un sistema di monitoraggio di tutte le infezioni correlate alle pratiche assistenziali (ICPA) mettendole in relazione con altre informazioni legate al ricovero

The activity 'in vitro' of trospectomycin against high-level antibiotic-resistant enterococci.

Trospectomycin, a new aminocyclitol antibiotic, was uniformly active against 69 isolates of enterococci with high-level resistance to steptomycin (54 isolates), gentamicin (27 isolates), ampicillin (19 isolates), ciprofloxacin (17 isolates), vancomycin (3 isolates), or teicoplanin (3 isolates). In time-killing studies, trospectomycin alone demonstrated no bactericidal activity. No synergistic interaction was demonstrated when trospectomycin was combined with ampicillin, vacomycin or ciprofloxacin

Longitudinal mapping of protective CD4+ T cell responses against HCV: analysis of fluctuating dominant and subdominant HLA-DR11 restricted epitopes.

Cellular immunity plays an important role in the control of persistent virus infections such as hepatitis C virus (HCV). Antiviral CD4(+) T cell responses have been shown to accompany resolution of acute disease and there is also a consistent association between HLA Class II genes, notably HLADRB1*1101 (and the closely linked HLADQB1*0301) and disease resolution. We initially mapped longitudinal CD4(+) T cell responses in an individual after spontaneous resolution of acute HCV, and identified three HLA-DR11-restricted responses which vary in immunodominance over time. Functional assays and HLA Class II tetramer staining revealed one to be a response to a commonly recognized epitope, NS3(1248-1261), although cytokine capture assays showed these specific cells to be at a very low frequency. In this patient, and in others reported, this most frequently recognized HLA-DR11 restricted epitope is not immunodominant. We analysed whether sequence variability within and between genotypes might account for differences in recognition of HLA-DR11 restricted epitopes. We found that a limited number, including NS3(1248-1261), showed extreme sequence conservation. Within NS3, the ability of peptides to accept amino acid substitutions was clearly related to the structure of the protein. Overall the data provide a deeper understanding of the relationship between protein structure and variability of HLA-DR11 restricted peptides and may explain the apparent dominance of responses to NS3(1248-1261) across studies but not within an individual immune response