1. Sera from individuals acutely ill with lobar pneumonia possess the capacity to precipitate in high titre a non-protein somatic fraction derived from pneumococci (Fraction C). Following crisis the reaction is no longer demonstrable. 2. Sera obtained from cases of pneumococcus pneumonia during illness and convalescence have been tested for antibodies specifically reactive with three chemically distinct constituents of Pneumococcus. The results, when correlated with the course of disease, demonstrate differences in the occurrence of each qualitatively distinct antibody. 3. The precipitation of pneumococcus Fraction C is not limited to the sera of individuals ill with pneumococcus infection. But in the few other cases available for comparative tests, definite reactions have been obtained only in streptococcus and staphylococcus infections and in acute rheumatic fever.

The results described in this article were obtained by the injection of concentrated and partially purified preparations derived from broth cultures of hemolytic streptococci into the pleural cavity of selected patients who were suffering from different types of diseases that gave rise to pleural exudations. The possibility has been explored of utilizing two of the defined properties elaborated by hemolytic streptococci that have the unique capacity of causing rapid lysis of the solid elements (fibrin and nucleoprotein) that are significant parts of exudates. In a companion article, Christensen (1) has described additional steps in the purification of the materials employed and has given quantitative methods of measurement of various increments concerned in the fibrinolytic system, including trypsin inhibitor and specific antibodies, which have been employed in this study.In the study of patients it was first necessary to: (a) develop the investigation within nontoxic but effective ranges of doses of the material employed, and (b) determine whether or not the enzymatic activities of the streptococcal products were effectively operative when introduced directly into the site of the disease in the patients. This article is essentially limited to findings that are pertinent to the two aspects of the study mentioned above.

The findings presented in this communication demonstrate the capacity of broth cultures of hemolytic streptococci to liquefy rapidly the clotted fibrin of normal human plasma. The experiments have been carried out in such a manner as to emphasize the rapidity with which active cultures transform solid clot into a completely liquid state, and to bring out other special characteristics of the fibrinolysis by hemolytic streptococci which differ in some respects from the orderly digestion of solid protein material by proteolytic enzymes. The observations contained in this report are chiefly limited to a consideration of the presence of fibrinolytic substances in cultures and the conditions of fibrin coagulation which influence the occurrence of liquefaction. Additional lines of investigation, suggested by the results, are not yet complete. Consequently the present communication makes only brief mention of some of the results which will be presented in detail in subsequent publications.The experimental conditions under which the clot-dissolving property of cultures is most strikingly demonstrable consist in mixing the cultures with plasma or fibrinogen before inducing clot formation. By this procedure the organisms and their products are disseminated within the body of the clot as it forms, thus affording maximum surface contact between the active bacterial agent and the fibrin substrate. Under these conditions the quantity of plasma clot employed in the experiments is liquefied in a few minutes, whereas the same amount of plasma, clotted before the addition of cultures, requires several hours incubation to effect the same degree of dissolution.The strains of Streptococcus hemolyticus employed in the tests have 485

The findings presented in this communication demonstrate the capacity of broth cultures of hemolytic streptococci to liquefy rapidly the clotted fibrin of normal human plasma. The experiments have been carried out in such a manner as to emphasize the rapidity with which active cultures transform solid clot into a completely liquid state, and to bring out other special characteristics of the fibrinolysis by hemolytic streptococci which differ in some respects from the orderly digestion of solid protein material by proteolytic enzymes. The observations contained in this report are chiefly limited to a consideration of the presence of fibrinolytic substances in cultures and the conditions of fibrin coagulation which influence the occurrence of liquefaction. Additional lines of investigation, suggested by the results, are not yet complete. Consequently the present communication makes only brief mention of some of the results which will be presented in detail in subsequent publications.The experimental conditions under which the clot-dissolving property of cultures is most strikingly demonstrable consist in mixing the cultures with plasma or fibrinogen before inducing clot formation. By this procedure the organisms and their products are disseminated within the body of the clot as it forms, thus affording maximum surface contact between the active bacterial agent and the fibrin substrate. Under these conditions the quantity of plasma clot employed in the experiments is liquefied in a few minutes, whereas the same amount of plasma, clotted before the addition of cultures, requires several hours incubation to effect the same degree of dissolution.The strains of Streptococcus hemolyticus employed in the tests have 485

BackgroundMany patients with axSpA experience work disability (WD: not working due to axSpA) which is preceded by impairment whilst working (presenteeism), absenteeism, and overall work productivity loss (WPL). Studies addressing these and health-related factors are few, with only one done in a UK sample.ObjectivesTo determine key factors associated with absenteeism, presenteeism, WPL, and daily activity impairment (other than employed work) in UK patients with axSpA using standardized measures.MethodsIn a cross-sectional, observational study, during visits to the Royal National Hospital for Rheumatic Diseases axSpA clinic, 490 patients completed validated questionnaires for: (1) Work productivity using the Work Productivity and Impairment questionnaire (WPAI) which produces 4 measures: absenteeism, presenteeism, WPL and activity impairment; (2) Health-related disease factors using: BASDAI, BASFI, BASMI, Jenkins Sleep scale, Patient Global Assessment (PGA) for disease activity, back pain at night, back pain at any time, EQ-5D for mobility, self-care ability, usual daily activities, pain/discomfort, anxiety/depression, EQ-VAS for Health State Today, FACIT for fatigue in the last week scale, and the Margolis Pain Diagram. Statistics package STATA V. 13.1 was used for analyses. Univariate and multivariate linear and logistic regression were applied to determine associations between WPAI measures and health-related factors.ResultsOf 490 patients, 301 (61%) provided WPAI measurements, 261 (53%) were in employment, 76% were male, 87% HLA-B27+, mean (±SD) years (i) age of first symptoms 21.5 (8.8), (ii) age at diagnosis 30.8 (11.7), (iii)disease duration 21.7 (13.0), and 29% were receiving biologics. Mean scores: BASDAI 3.8 (2.2), BASFI 4.0 (2.7), BASMI 3.8 (2.1), Jenkins 13.0 (2.7), PGA 3.9 (2.6), PGA night pain 3.3 (2.6), PGA pain anytime 3.6 (2.6), FACIT 34 (12), EQ-VAS 63 (22), Margolis pain 8.7 (6.9). Mean WPAI scores for absenteeism were=5.1% (19.2), presenteeism=22% (24.3), WPL=23.2% (25.7), activity impairment=34.8% (27.3).WPAI outcomeNVariable*OR/Coefficient (95% CI)P*Absenteeism301FACIT−0.68 (0.56, 0.82)<0.001Smoking – Non10.07 Smoking – Ex0.82 (0.24, 2.74)<0.001 Smoking – Current2.86 (1.07, 7.64)Category – Radiographic1 Category – Non6.07, (1.83, 20.1)Presenteeism301FACIT−3.1 (−4.7, −1.6)<0.001BASDAI3.0 (1.1, 5.0)0.002BASFI1.6 (0.0, 3.3)0.04Duration diagnosis (yrs)−2.0 (−4.2, 0.3)0.08WPL301FACIT−3.9 (−5.5, −2.3)<0.001BASDAI3.0 (1.0, 4.9)0.003BASFI1.6 (0.1, 3.2)0.05Activity Impairment301FACIT−3.9 (−4.7, −3.1)<0.001Smoking – Non00.02 Smoking – Ex−4.4 (−7.6, −1.2)<0.001 Smoking – Current−0.8 (−4.8, 3.2)0.003BASFI4.4 (3.6, 5.2)<0.001EQ-VAS−1.2 (−2.0, −0.4)PGA disease activity1.7 (0.8, 2.5)ConclusionsWork productivity and activity impairment are associated with fatigue, disease activity, and functional ability in UK patients with axSpA. The strong association of fatigue with work disability and activity impairment emphasize the need to measure and better understand the impact of fatigue in axSpA.Disclosure of Inter...