566 Persistent Sleep Apnea and Desaturation in Preterm Children at 18 Months of Age at High Altitude (2640 M)

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A223-A224
Author(s):  
Elida Duenas-Meza ◽  
Maria Escamilla ◽  
Laura Rincon ◽  
Andrea Parra ◽  
Maria Bazurto-Zapata ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
High Altitude ◽  
Apnea Hypopnea Index ◽  
Age Group ◽  
Preterm Children ◽  
Desaturation Index ◽  
Group Iii ◽  
Group I ◽  
Group Ii ◽  
Over Time

Abstract Introduction Children born at term who live at high altitude (HA) (≥ 2500 m) have different respiratory patterns from those that live at sea level. It is essential to determine these patterns in preterm children due to their high risk of Sleep Apnea-Hypopnea Syndrome (SAHS). The evolution of the apnea hypopnea index (AHI), desaturation index (ODI), and oxygen saturation (SpO2) is unknown in this group at HA. The objective was to characterize the respiratory patterns during sleep of preterm children living at HA and compare it with those of healthy children born at term. Methods We conducted a cross-sectional study in Bogotá, Colombia (altitude: 2640 m). We included 302 children, 127 were preterm with an average of gestational age of 31weeks (SD: 2.9) and an average weight at birth of 1600 g (SD: 594) and 175 healthy full-term infants. Three groups were defined according to age: Group I: 3–4 months, Group II: 6–7 months,, Group III: 10–18 months. All children underwent nocturnal polysomnogram to evaluate their respiratory variables: AHI, average and minimum SpO2, ODI, and T90 during sleep and analyzed the data according to the parameters of the American Academy of Sleep Medicine Results 302 polysomnograms were performed, 54.3% were girls and were distributed by groups as follows: Group I:105 patients (34.8%), 16 preterm, Group II: 107 patients (35.4%), 46 preterm and Group III: 90 patients (29.8%), 65 preterm. We observed higher respiratory parameters within each age strata in premature infants compared to children born at term. Preterm infants had higher ODI, AHI, obstructive apnea hypopnea index (O-AHI), and Central Apnea hypopnea index (C-AHI). Although the effect decreases over time, we found a significant difference in the first age group. There was a high persistence index in children with a history of preterm birth living at high altitude. We also found a significant decrease in AHI, ODI across time in healthy and preterm children p<0.01 Conclusion Premature children living at HA persist with higher ODI and AHI compared to children of similar ages born at term. The high desaturation index indicates the presence of intermittent hypoxia that persists in these children over time Support (if any):

Effects of a 1-yr stay at altitude on ventilation, metabolism, and work capacity

1992 ◽  
Vol 73 (5) ◽  
pp. 1749-1755 ◽  
Author(s):  
T. V. Serebrovskaya ◽  
A. A. Ivashkevich
Keyword(s):  
High Altitude ◽  
Sea Level ◽  
Ventilatory Response ◽  
Second Phase ◽  
Separate Analysis ◽  
Group Iii ◽  
Group I ◽  
Ventilatory Drive ◽  
Group Ii ◽  
End Tidal

The hypoxic and hypercapnic ventilatory drive, gas exchange, blood lactate and pyruvate concentrations, acid-base balance, and physical working capacity were determined in three groups of healthy males: 17 residents examined at sea level (group I), 24 sea-level natives residing at 1,680-m altitude for 1 yr and examined there (group II), and 17 sea-level natives residing at 3,650-m altitude for 1 yr and examined there (group III). The piecewise linear approximation technique was used to study the ventilatory response curves, which allowed a separate analysis of slopes during the first phase of slow increase in ventilation and the second phase of sharp increase. The hypoxic ventilatory response for both isocapnic and poikilocapnic conditions was greater in group II and even greater in group III. The first signs of consciousness distortion in sea-level residents appeared at an end-tidal O2 pressure level (4.09 +/- 0.56 kPa) higher than that of temporary residents of middle (3.05 +/- 0.12) and high altitude (2.90 +/- 0.07). The hypercapnic response was also increased, although to a lesser degree. Subjects with the highest hypoxic respiratory sensitivity at high altitude demonstrated greater O2 consumption at rest, greater ventilatory response to exercise, higher physical capacity, and a less pronounced anaerobic glycolytic flux but a lower tolerance to extreme hypoxia. That is, end-tidal O2 pressure that caused a distortion of the consciousness was higher in these subjects than in those with lower hypoxic sensitivity. Two extreme types of adaptation strategy can be distinguished: active, with marked reactions of “struggle for oxygen,” and passive, with reduced O2 metabolism, as well as several intermediate types.(ABSTRACT TRUNCATED AT 250 WORDS)

Changing Pattern of Presentation in Monoclonal Gammopathy of Undetermined Significance: A Study on 1400 Cases

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 2706-2706
Author(s):  
Marzia Varettoni ◽  
Gian Matteo Pica ◽  
Federica Cocito ◽  
Silvia Mangiacavalli ◽  
Cristiana Pascutto ◽  
...  
Keyword(s):  
Serum Albumin ◽  
Malignant Transformation ◽  
Monoclonal Gammopathy ◽  
M Protein ◽  
Group Iii ◽  
Β2 Microglobulin ◽  
Group I ◽  
Group Ii ◽  
Over Time ◽  
Undetermined Significance

Abstract Background. Monoclonal gammopathy of undetermined significance (MGUS) is defined by the presence of a serum M-protein <3 g/dL, bone marrow plasma cells (BMPC) <10% and absence of end-organ damage. The risk of malignant transformation is 1% per year. Size and type of M-protein and an abnormal serum free-light chains (FLC) ratio at diagnosis are reported as the main risk factors for transformation. Aims of the study. To evaluate whether the pattern of presentation of MGUS has changed over the last three decades. Patients and methods. The charts of MGUS patients (pts) diagnosed from 1975 to 2007 were reviewed. The following data were gathered: age, sex, haemoglobin (Hgb), type and size of serum M-protein, uninvolved Ig levels, serum FLC, urine M-protein, BMPC, serum albumin and β2-microglobulin. The study included 1400 pts divided into three groups according to the date of diagnosis: 1975–1987 (group I, 102); 1988–1997 (group II, 380); 1998–2007 (group III, 918). Differences among groups were evaluated using chi-square test for categorical variables and Kruskal-Wallis non-parametric Anova for numerical variables. A P-value ≤0.05 was considered statistically significant. Results., The median age of patients was 63 years (range 20–92), 740 were males and 660 females. The median time from the first detection of M-protein to diagnosis of MGUS was 3.2 months (range 1–264). Serum M-protein was 73% IgG, 13% IgM, 11% IgA, 3% biclonal; light chain was k in 63% of pts, λ in 37%. The serum M-protein was <1 g/dL in 284 patients (21%), 1–1.5 g/dL in 502 (36%), 1.5–2 g/dL in 373 (27%) and ≥2 g/dL in 216 (16%). M-protein size was not reported in 25 cases. The median levels of uninvolved IgG, IgM and IgA were 1350 mg/dL (range 110–7460), 94 mg/dL (range 40–4680) and 162 mg/dL (range 22–2370) respectively. In 236 evaluable pts, median levels of serum FLC k and λ were 17.1 mg/L (range: 1.4–423) and 17.3 mg/L (range: 2–299). Urine M-protein was detected in 19% of pts with a median level of 23.8 mg/L (range 4–450). The median BMPC percentage was 5 (range: 1–10). The median values of Hgb, serum albumin and β2-microglobulin were 14 g/dL (range: 8.6–19.7), 4.3 g/dL (range 2.5–6) and 1930 mcg/L (range 865–44300) respectively. The comparison among the three groups showed statistically significant reduction of serum M-protein levels (p<0.0001), BMPC (p<0.0001), β2-microglobulin (p=0.0001) and increase of Hgb (p<0.0001) and albumin (p=0.0001) over time. In particular, the proportion of pts with a serum M-protein <1 g/dL increased from 4% in group I to 12% in group II and to 26% in group III. A serum M-protein ≥2 g/dL was present in 35%, 22%, 11% of pts in the three groups respectively (p<0.0001). With a median follow-up was 40 months (range: 3–396), corresponding to 7577 person-year, the cumulative probability of malignant transformation was 9%, 18%, 28% at 5, 10, 15 years respectively. Group III pts had a significantly lower 5-year probability of transformation (5%) as compared to groups I and II (20% and 11% respectively). Conclusions. The pattern of presentation of MGUS has changed over time. Patients diagnosed in the last decade have more favourable presenting features as compared to those diagnosed before. This could be due to the availability of more sensitive diagnostic techniques able to detect minimal M-proteins. Another possible explanation is that pts are more frequently and promptly referred by their treating physicians to an hematologic centre, allowing an earlier diagnosis. Both circumstances could led to the identification of a subset of pts with different presentation and maybe a better outcome with respect to the MGUS diagnosed in the past decades. This could entail a different approach of physicians in the management of MGUS patients.

scholarly journals ACUTE MYOCARDIAL INFARCTION

2006 ◽  
Vol 13 (02) ◽  
pp. 178-185
Author(s):  
ABDUL REHMAN ABID ◽  
M. Shahid Naveed ◽  
LIAQAT ALI ◽  
Siraj Munir Ahmed Tarin ◽  
M. TAHIR MOHYUDDIN ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Group Iv ◽  
Age Group ◽  
Group Iii ◽  
Group I ◽  
Significant Difference ◽  
Group Ii

Women with acute myocardial infarction have higher in-hospital mortalitythan men mainly due to greater age on presentation. Objective: To evaluate the age specific sex difference in inhospitalmortality of acute myocardial infarction. Design: Descriptive study. Place and duration: Coronary Care Unitand cardiology ward of Nishtar Hospital Multan from 15 of th September 2002 till 30th of April 2003. Material & Methods:Four hundred and fifty patients of acute myocardial infarction who fulfilled our inclusion criteria were studied while theywere admitted to the hospital. Patients were divided into four groups according to age and sex i.e. Group I (male <45years), Group II (male $45 years), Group III (female <45 years) and Group IV (female $45 years). In-hospital mortalitywas compared between different age groups by Chi-square test. Results: The total in-hospital mortality was76(16.9%).In Group III none of the patients expired. In Group I in-hospital mortality was 6(7.1%) patients followed byGroup II 50(18.3%) patients and Group IV 20(23.3%) patients p<0.019. In-hospital mortality was greater in Group IVthan in any other group. Group IV patients were more frequently diabetic and hypertensive than patients in any othergroup. Group IV patients presented late to the hospital. There was no significant difference in site of myocardialinfarction in different groups. Higher Killip class was observed in Group II and IV p<0.05. Streptokinase injection wasgiven less frequently in Group IV than in any other group p <0.012. Only 34(39.5%) patients in Group IV had nocomplication during hospital stay while more patients in other groups had uneventful hospital stay p<0.001.Conclusion: Female sex is associated with higher in-hospital mortality in older age group as compared to the malepatients of same age group.

A Study of Sleep Disorders in Patients with Chronic Kidney Disease (CKD)

2017 ◽  
Vol 9 (5) ◽  
Author(s):  
Hussein A. ◽  
El–Hadidy A. ◽  
Gomaa N. ◽  
Amin Y. ◽  
El-Shabouny T.
Keyword(s):  
Chronic Kidney Disease ◽  
Sleep Apnea ◽  
Kidney Disease ◽  
Respiratory Distress ◽  
Oxygen Saturation ◽  
Kidney Function ◽  
Group Iii ◽  
Group I ◽  
Ckd Stage ◽  
Group Ii

Sleep apnea is an important comorbidity in patients with chronic kidney disease (CKD). Although the increased prevalence of sleep apnea in patients with CKD is well established, few studies have examined the full spectrum of kidney function. We sought to determine the prevalence of sleep apnea and associated nocturnal hypoxia in patients with CKD. We hypothesized that the prevalence of sleep apnea would increase progressively as kidney function declines. 45 patients were recruited from outpatient nephrology clinics, nephrology department, and hemodialysis units. All patients completed an overnight inpatient polysomnograhy test to determine the prevalence of sleep apnea (AHI ≥ 5 events /h) and nocturnal hypoxia (oxygen saturation (SaO2) below 90% for ≥12% of the nocturnal monitoring time). Patients were stratified according to their estimated glomerular filtration rate (eGFR) at the time of the study visit into three groups as follows: CKD stage 2 (eGFR 60 to 89 mL/min/1.73 m2) (control group), CKD stages 3 and 4 (eGFR 15 to 59 mL/min/1.73 m2), and CKD stage 5 (eGFR less than 15 mL/min/1.73 m2). eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Out of the 45 patients included in our study with the full spectrum of kidney function, ranging from those with eGFR 60 to 89 ml/min./1.73m2 to patients with eGFR less than 15 ml/min./1.73m2, 15 (33.3%) had sleep apnea (Mean AHI; 8.71±5.86). Our study found that prevalence of sleep apnea increased as kidney function declined (Group (I), 20%; Group (II), 36.4%; Group (III), 37.5%). Furthermore, severity of sleep apnea increased as kidney function declined (Group (I), mean AHI: 5.75±0.35; Group (II), mean AHI: 6±1.38; Group (III), mean AHI: 10.6±7.04). We also found that prevalence of nocturnal hypoxia which is characteristically associated with sleep apnea was greater among groups (II) and (III) (27.3% and 16.7%, respectively) than in group (I) (10%). Severity of nocturnal hypoxia increased as kidney function declined (Group (I), 13%; Group (II), 13.6±1.22%; Group (III), 16.75±3.30%). Overall, 8 out of the 45 studied CKD patients (17.8%) had nocturnal hypoxia (Mean SaO2 below 90% for ≥12% of the nocturnal monitoring time; 15.1±2.87%). Our study revealed that as kidney function declined, Apnea/Hypopnea (AHI) indices increased, oxygen desaturation indices increased, minimal peripheral capillary oxygen saturation values decreased, peripheral capillary oxygen saturation time less than 90% increased, and snore indices increased. Also, respiratory distress index (RDI) was higher among groups (II) and (III) than in group (I). However, only differences between groups as regards respiratory distress events, respiratory distress indices, snore events, and snore indices were statistically significant. These results show that as kidney function declines, several respiratory parameters deteriorate during sleep. In addition, wake events and indices, and sleep stage 1 (%) increased as kidney function deteriorated. Sleep efficiency (%) was highest among group (I) patients and lower among groups (II) and (III), Light sleep (%) was lowest among group (I) patients and higher among groups (II) and (III), and deep sleep (%) was highest among group (I) patients and lower among groups (II) and (III). It is clear from the above results that as kidney function declines, sleep efficiency deteriorates, wake indices increase, light sleep (%) increases, and deep sleep (%) decreases. We concluded that prevalence and severity of sleep apnea in patients with CKD increase as kidney function declines. Almost 18% of patients with CKD experience nocturnal hypoxia, which may contribute to loss of kidney function.

scholarly journals ACUTE MYOCARDIAL INFARCTION

2006 ◽  
Vol 13 (03) ◽  
pp. 178-185
Author(s):  
ABDUL REHMAN ABID ◽  
M. Shahid Naveed ◽  
LIAQAT ALI ◽  
Siraj Munir Ahmed Tarin ◽  
M. TAHIR MOHYUDDIN ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Group Iv ◽  
Age Group ◽  
Group Iii ◽  
Group I ◽  
Significant Difference ◽  
Group Ii

Women with acute myocardial infarction have higher in-hospital mortalitythan men mainly due to greater age on presentation. Objective: To evaluate the age specific sex difference in inhospitalmortality of acute myocardial infarction. Design: Descriptive study. Place and duration: Coronary Care Unitand cardiology ward of Nishtar Hospital Multan from 15 of th September 2002 till 30th of April 2003. Material & Methods:Four hundred and fifty patients of acute myocardial infarction who fulfilled our inclusion criteria were studied while theywere admitted to the hospital. Patients were divided into four groups according to age and sex i.e. Group I (male <45years), Group II (male $45 years), Group III (female <45 years) and Group IV (female $45 years). In-hospital mortalitywas compared between different age groups by Chi-square test. Results: The total in-hospital mortality was76(16.9%).In Group III none of the patients expired. In Group I in-hospital mortality was 6(7.1%) patients followed byGroup II 50(18.3%) patients and Group IV 20(23.3%) patients p<0.019. In-hospital mortality was greater in Group IVthan in any other group. Group IV patients were more frequently diabetic and hypertensive than patients in any othergroup. Group IV patients presented late to the hospital. There was no significant difference in site of myocardialinfarction in different groups. Higher Killip class was observed in Group II and IV p<0.05. Streptokinase injection wasgiven less frequently in Group IV than in any other group p <0.012. Only 34(39.5%) patients in Group IV had nocomplication during hospital stay while more patients in other groups had uneventful hospital stay p<0.001.Conclusion: Female sex is associated with higher in-hospital mortality in older age group as compared to the malepatients of same age group.

The Effect of Age on Blunt Traumatic Brain-Injured Patients

2010 ◽  
Vol 76 (9) ◽  
pp. 966-968 ◽  
Author(s):  
Indermeet S. Bhullar ◽  
Eric E. Roberts ◽  
Lianne Brown ◽  
Heidi Lipe
Keyword(s):  
Resource Use ◽  
Geriatric Patients ◽  
Clinical Decision Making ◽  
Injury Severity ◽  
Group Iv ◽  
Age Group ◽  
Group Iii ◽  
Group I ◽  
Significant Difference ◽  
Group Ii

An increasing number of super geriatric (age older than 80 years) patients are being hospitalized with traumatic brain injury (TBI). Although geriatric (age older than 65 years) patients have been reported to have a worse functional outcome compared with younger patients who present with the same or less severe degree of TBI; the mortality for the super geriatric (age older than 80 years) remains to be determined. Knowledge of their hospital mortality may help improve clinical decision-making protocols and resource use. A retrospective chart review of patients who sustained TBI after blunt trauma was performed over a 3-year period (June 2005 to June 2008) at a Level II trauma center. Mortality was calculated for various age groupings and data analyzed using analysis of variance test and χ2 test. We hypothesized that mortality would increase significantly with increasing age from the geriatric to the super geriatric group. A total of 2369 patients were evaluated with 744 pediatric patients in Group I (age younger than 17 years), 1297 adult patients in Group II (age 17-64 years), 185 geriatric patients in Group III (age 65-80 years), and 143 super geriatric patients in Group IV (age older than 80 years). The respective mortalities for each group were as follows: Group I (6%), Group II (9%), Group III (21%), and Group IV (6%). There was no significant difference in the Injury Severity Score for the four groups. In comparing Group III with Groups I and II, we found a significant increase in mortality with increasing age as reported in the literature (21 vs 6%, P = 0.01 and 21 vs 9%, P = 0.04). However, in comparing Group IV with the other three groups, there was no significant difference in mortality. There was a trend toward decrease in mortality from age Group III to IV (21 vs 6%, P = 0.09), which is of unclear etiology and warrants further study. In patients with blunt TBI, there is no significant difference in mortality between the super geriatric age group (age older than 80 years) and the younger pediatric, adult, and geriatric age groups. Resource use therefore should not be limited to patients older than 80 years with TBI.

THE CONCENTRATION OF LEAD IN PLASMA, WHOLE BLOOD AND ERYTHROCYTES OF INFANTS AND CHILDREN

PEDIATRICS ◽  
1958 ◽  
Vol 21 (5) ◽  
pp. 793-797
Author(s):  
Morton J. Robinson ◽  
Felix E. Karpinski ◽  
Heinrich Brieger
Keyword(s):  
Lead Poisoning ◽  
Whole Blood ◽  
Newborn Infants ◽  
Infants And Children ◽  
Age Group ◽  
Group Iii ◽  
Group I ◽  
History Of ◽  
Group Ii

The concentration of lead in the blood of 103 infants and children without history of pica or lead poisoning, ranging in age from 5 hours to 13 years, was studied. The children were divided into three groups according to age: Group I, 5 hours to 6 months of age; Group II, 6.1 months to 4 years of age; Group III, older than 4 years. The values obtained in Group I were significantly lower than those obtained in Groups II and III. Groups II and III showed approximately the same content of lead in whole blood and erythrocytes. The median values in Group I were 0.015 mg/ 100 ml of whole blood and 0.034 mg/100 ml of erythrocytes. In the combined Groups II and III median values in whole blood were 0.027 mg/100 ml, and in erythrocytes 0.065 mg/100 ml. The range in Group I was 0.005-0.031 mg/100 ml of whole blood and 0.010-0.090 mg/100 ml of erythrocytes. In the two groups more than 6 months of age, the range for whole blood was found to be 0.003-0.054 mg/100 ml, and for erythrocytes 0.003-0.144 mg/100 ml; 90% of the values were between 0.015 and 0.040 mg/100 ml (whole blood), and between 0.028 and 0.103 mg/100 ml (erythrocytes). Significant amounts of bead were found in the whole blood (0.007-0.028 mg/100 ml), and erythrocytes (0.010-0.044 mg/100 ml) of newborn infants.

Ultrastructural Lesions Produced by Alcohol and Sucrose in the Heart and Liver of C57BL Mice

1970 ◽  
Vol 28 ◽  
pp. 208-209
Author(s):  
K.K. SEKHRI ◽  
C.S. ALEXANDER ◽  
H.T. NAGASAWA
Keyword(s):  
Osmium Tetroxide ◽  
Male Mice ◽  
Alcohol Group ◽  
Group Iii ◽  
Group I ◽  
C57bl Mice ◽  
Group Ii

C57BL male mice (Jackson Lab., Bar Harbor, Maine) weighing about 18 gms were randomly divided into three groups: group I was fed sweetened liquid alcohol diet (modified Schenkl) in which 36% of the calories were derived from alcohol; group II was maintained on a similar diet but alcohol was isocalorically substituted by sucrose; group III was fed regular mouse chow ad lib for five months. Liver and heart tissues were fixed in 2.5% cacodylate buffered glutaraldehyde, post-fixed in 2% osmium tetroxide and embedded in Epon-araldite.

Heterogeneity and Immunochemical Properties of Anti-β2-glycoprotein I Autoantibodies

1998 ◽  
Vol 80 (09) ◽  
pp. 393-398 ◽  
Author(s):  
V. Regnault ◽  
E. Hachulla ◽  
L. Darnige ◽  
B. Roussel ◽  
J. C. Bensa ◽  
...  
Keyword(s):  
Fluid Phase ◽  
Anticardiolipin Antibodies ◽  
Dual Reactivity ◽  
Group Iii ◽  
Important Group ◽  
Epitope Specificity ◽  
Glycoprotein I ◽  
Group I ◽  
Group Ii ◽  
Sufficient Concentration

SummaryMost anticardiolipin antibodies (ACA) associated with antiphospholipid syndrome (APS) are directed against epitopes expressed on β2-glycoprotein I (β2GPI). Despite a good correlation between standard ACA assays and those using purified human β2GPI as the sole antigen, some sera from APS patients only react in the latter. This is indicative of heterogeneity in anti-β2GPI antibodies. To characterize their reactivity profiles, human and bovine β2GPI were immobilized on γ-irradiated plates (β2GPI-ELISA), plain polystyrene precoated with increasing cardiolipin concentrations (CL/β2GPI-ELISA), and affinity columns. Fluid-phase inhibition experiments were also carried out with both proteins. Of 56 selected sera, restricted recognition of bovine or human β2GPI occurred respectively in 10/29 IgA-positive and 9/22 IgM-positive samples, and most of the latter (8/9) were missed by the standard ACA assay, as expected from a previous study. Based on species specificity and ACA results, IgG-positive samples (53/56) were categorized into three groups: antibodies reactive to bovine β2GPI only (group I) or to bovine and human β2GPI, group II being ACA-negative, and group III being ACA-positive. The most important group, group III (n = 33) was characterized by (i) binding when β2GPI was immobilized on γ-irradiated polystyrene or cardiolipin at sufficient concentration (regardless of β2GPI density, as assessed using 125I-β2GPI); (ii) and low avidity binding to fluid-phase β2GPI (Kd in the range 10–5 M). In contrast, all six group II samples showed (i) ability to bind human and bovine β2GPI immobilized on non-irradiated plates; (ii) concentration-dependent blockade of binding by cardiolipin, suggesting epitope location in the vicinity of the phospholipid binding site on native β2GPI; (iii) and relative avidities approximately 100-fold higher than in group III. Group I patients were heterogeneous with respect to CL/β2GPI-ELISA and ACA results (6/14 scored negative), possibly reflecting antibody differences in terms of avidity and epitope specificity. Affinity fractionation of 23 sera showed the existence, in individual patients, of various combinations of antibody subsets solely reactive to human or bovine β2GPI, together with cross-species reactive subsets present in all samples with dual reactivity namely groups III and II, although the latter antibodies were poorly purified on either column. Therefore, the mode of presentation of β2GPI greatly influences its recognition by anti-β2GPI antibodies with marked inter-individual heterogeneity, in relation to ACA quantitation and, possibly, disease presentation and pathogenesis.

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