Indirect Identification Research Articles

Spinal infections in children

This multicentre, retrospective study aimed to improve our knowledge of primary pyogenic spinal infections in children by analyzing a large consecutive case series. The medical records of children with such an infection, treated at four tertiary institutions between 2004 and 2014, were analyzed retrospectively. Epidemiological, clinical, paraclinical, radiological, and microbiological data were evaluated. There were 103 children, of whom 79 (76.7%) were aged between six months and four years. We confirmed a significant male predominance in the incidence of primary pyogenic spinal infections in children (65%). The lumbar spine was the most commonly affected region, and 27 infections (26.2%) occurred at L4/5. The white blood cell count was normal in 61 children (59%), and the CRP level was normal in 43 (42%). Blood cultures were performed in 95 children, and were positive in eight (8%). A total of 20 children underwent culture of biopsy or aspiration material, which was positive in eight (40%). Methicillin-sensitive Staphylococcus aureus (MSSA) and Kingella ( K.) kingae were the most frequently isolated pathogens. MSSA remains the most frequently isolated pathogen in children with primary pyogenic infection of the spine, but K. kingae should be considered as an important pathogen in children aged between six months and four years. Therefore, an empirical protocol for antibiotic treatment should be used, with consideration being made for the triphasic age distribution and specific bacteriological aetiology. In the near future, the results of polymerase chain reaction assay on throat swabs may allow the indirect identification of K. kingae spondylodiscitis in young children and thus aid early treatment. However, these preliminary results require validation by other prospective multicentre studies. Cite this article: Bone Joint J 2018;100-B:542-8.

PH Change in Culture Medium Induces Reorganization of Intranuclear Actin in Two-Cell Mouse Embryos

Actin is a permanent component of the cell nucleus involved in many nuclear processes. However, some nuclear functions of actin remain insufficiently explored. The role played by various extracellular stimuli in regulation of nuclear actin still remains enigmatic. Deviation of basic parameters of culture medium from optimal values is a member of the group of extracellular stimuli that are very important for mammalian embryos cultured in vitro. Change in culture medium pH from the level optimal for embryo homeostasis is one such signals. The purpose of this study was to investigate the intranuclear actin distribution in nuclei of two-cell mouse embryos under stress conditions induced by changes in extracellular pH. The pattern of actin localization has been tracked after short-term culturing of the embryos at optimal (pH 7.2), increased (pH 7.8), or decreased (pH 6.5) pH conditions. Analysis was carried out with confocal microscopy using methods of direct fluorescent and indirect immunofluorescent identification of actin. It has been shown that the change of culture medium pH from the optimum value is the signal that alters intranuclear actin distribution in nuclei of the embryonic cells. Culture of two-cell mouse embryos in suboptimal pH conditions (pH 6.5 and pH 7.8) induced alterations in the intranuclear actin localization, which, in particular, were expressed in accumulation of monomeric actin and the appearance of phalloidin-stainable actin in the nuclei. These changes, in our opinion, show some signs of similarity with stress-induced changes in nuclear-actin distribution, which, as has been reported earlier by a number of researchers, have been observed in the nuclei of somatic cells.

Hidden information retrieval and evaluation method and tools utilising ontology reasoning applied for financial fraud analysis.

The paper summarizes a semantic association evaluation and reasoning method, utilising domain and problem solving ontologies. The method combines algorithms for data aggregation and logic reasoning utilising concrete financial data. As an outcome method supports suspicious behaviour recognition of money loundering schemes. These scenarios and schemes are implemented by the analysts using ontology-based constructs. Provided tools cover all stages of data processing starting from structural data extraction and migration, aggregation to reasoning using logic (DL and FOL) constructs. Advances in automatic reasoning and the availability of semantic processing tools encourage analysts to extend existing link analysis methods towards contextual data processing. To demonstrate presented method, a proof of concept environment IAFEC Ontology Toolkit has been described. It delivers initial financial fraud identification schemes (rules) based on set of problem solving ontologies. The novelty in such approach comes from incorporating heterogeneous types of data, which usually are processed by graph methods. The semantic tool, extend capabilities of graph-based (homogeneous) approach by delivering context-aware indirect association identification, and inference path explanation and inspection capabilities. Presented material describes the method and analytical algorithms, which demonstrate description logic reasoning and graph-based semantic association identification and ranking. Developed method has been implemented, as a Protégé OWL 5.0 environment extension, supplemented with web-services delivering distributed data processing, aggregation (not available in ontology languages). The environment provides declarative processing capabilities enabling analysts to design configurable processing flow, and new financial fraud identification schemes.

Testing a potential alternative to traditional identification procedures: Reaction time-based concealed information test does not work for lineups with cooperative witnesses

Direct eyewitness identification is widely used, but prone to error. We tested the validity of indirect eyewitness identification decisions using the reaction time-based concealed information test (CIT) for assessing cooperative eyewitnesses’ face memory as an alternative to traditional lineup procedures. In a series of five experiments, a total of 401 mock eyewitnesses watched one of 11 different stimulus events that depicted a breach of law. Eyewitness identifications in the CIT were derived from longer reaction times as compared to well-matched foil faces not encountered before. Across the five experiments, the weighted mean effect size d was 0.14 (95% CI 0.08–0.19). The reaction time-based CIT seems unsuited for testing cooperative eyewitnesses’ memory for faces. The careful matching of the faces required for a fair lineup or the lack of intent to deceive may have hampered the diagnosticity of the reaction time-based CIT.

Cystic fibrosis transmembrane regulator haplotypes in households of patients with cystic fibrosis

IntroductionNearly 2000 mutations in the cystic fibrosis transmembrane regulator (CFTR) gene have been reported. The F508del mutation occurs in approximately 50–65% of patients with cystic fibrosis (CF). However, molecular diagnosis is not always possible. Therefore, silent polymorphisms can be used to label the mutant allele in households of patients with CF. ObjectiveTo verify the haplotypes of four polymorphisms at the CFTR locus in households of patients with CF for pre-fertilization, pre-implantation, and prenatal indirect mutation diagnosis to provide better genetic counseling for families and patients with CF and to associate the genotypes/haplotypes with the F508del mutation screening. MethodsGATT polymorphism analysis was performed using direct polymerase chain reaction amplification, and the MP6-D9, TUB09 and TUB18 polymorphism analyses were performed using restriction fragment length polymorphism. ResultsNine haplotypes were found in 37 CFTR alleles, and of those, 24 were linked with the F508del mutation and 13 with other CFTR mutations. The 6 (GATT), C (MP6-D9), G (TUB09), and C (TUB18) haplotypes showed the highest prevalence (48%) of the mutant CFTR allele and were linked to the F508del mutation (64%). In 43% of households analyzed, at least one informative polymorphism can be used for the indirect diagnostic test. ConclusionCFTR polymorphisms are genetic markers that are useful for identifying the mutant CFTR alleles in households of patients with CF when it is not possible to establish the complete CFTR genotype. Moreover, the polymorphisms can be used for indirect CFTR mutation identification in cases of pre-fertilization, pre-implantation and prenatal analysis.

Sensitive detection of level anticrossing spectra of nitrogen vacancy centers in diamond

We report a study of the magnetic field dependence of photoluminescence of ${\mathrm{NV}}^{\ensuremath{-}}$ centers (negatively charged nitrogen vacancy centers) in diamond single crystals. In such a magnetic field dependence characteristic sharp features are observed, which are coming from level anticrossings (LACs) in a coupled electron-nuclear spin system. For studying such LAC lines we use sensitive lock-in detection to measure the photoluminescence intensity. This experimental technique allows us to obtain new LAC lines. Additionally, a remarkably strong dependence of the LAC lines on the modulation frequency is found. Specifically, upon decrease of the modulation frequency from 12 kHz to 17 Hz the amplitude of the LAC lines increases by approximately two orders of magnitude. To take a quantitative account for such effects, we present a theoretical model, which describes the spin dynamics in a coupled electron-nuclear spin system under the action of an oscillating external magnetic field. Good agreement between experiments and theory allows us to conclude that the observed effects are originating from coherent spin polarization exchange in a coupled spin system comprising the spin-polarized ${\mathrm{NV}}^{\ensuremath{-}}$ center. Our results are of great practical importance allowing one to optimize the experimental conditions for probing LAC-derived lines in diamond crystals comprising ${\mathrm{NV}}^{\ensuremath{-}}$ centers and for indirect detection and identification of other paramagnetic defect centers.

Role of FKBP51 in the modulation of the expression of the corticosteroid receptors in bovine thymus following glucocorticoid administration

The aim of this work was to study the transcriptional effects of glucocorticoids on corticosteroid hormone receptors, prereceptors (11β-hydroxysteroid dehydrogenase 1 and 2, 11β-HSD1 and 2), and chaperones molecules regulating intracellular trafficking of the receptors (FKBP51 and FKBP52) in thymus of veal calves. Moreover, the expression of FKBP51 and FKBP52 gene were investigated in beef cattle thymus. In the cervical thymus of veal calves, dexamethasone administration in combination with estradiol decreased FKBP51 expression (P < 0.01). The same treatment increased mineralocorticoid receptor (MR) (P < 0.01) and 11β-HSD1 expression (P < 0.05) compared to control group in the cervical thymus of veal calves. The thoracic thymus of veal calves treated with dexamethasone and estradiol showed a decrease of FKBP51 (P < 0.05), FKBP52 (P < 0.05), glucocorticoid receptor (P < 0.05), and MR expression (P < 0.05) compared to control group in the thoracic thymus of veal calves. The gene expression of FKBP51 decreased both in cervical (P < 0.01) and thoracic thymus (P < 0.01) of beef cattle treated with dexamethasone and estradiol. In addition, also prednisolone administration reduced FKBP51 expression in the cervical thymus (P < 0.01) and in the thoracic thymus of beef cattle (P < 0.01). The gene expression of FKBP52 increased only in the cervical thymus following dexamethasone administration (P < 0.01). The decrease of FKBP51 gene expression in thymus could be a possible biomarker of illicit dexamethasone administration in bovine husbandry. Moreover, so far, an effective biomarker of prednisolone administration is not identified. In this context, the decrease of FKBP51 gene expression in thymus of beef cattle following prednisolone administration could play an important role in the indirect identification of animals illegally treated with prednisolone.

An experimental study on the direct & indirect dynamic identification of an over-constrained 3-DOF decoupled parallel mechanism

This paper provides the state of the art of obtaining the dynamic model of an over-constrained 3-DOF translational parallel mechanism, namely, Tripteron, by performing system identification concept in which friction is taken into account. To this end, as the first step, in order to circumvent the problem of being over-constrained, i.e., inconsistent numbers of equations and unknown parameters in the dynamic model, some modifications on the kinematic arrangement of the constituted limbs are applied, in such a way that preserve the degrees-of-freedom performed by the mechanism under study, the so-called Tripteron with three translational degrees-of-freedom. Then, in order to have a close-to-reality dynamic model, the model is combined with the model of the linear module friction. Afterward, by using the practical data, the optimum values for the uncertain parameters of the inverse dynamic and friction models are obtained by a white-box identification approach based on Genetic algorithm. In addition, in order to propose a less complex model, a model based on the polynomial regressors of position, velocity, acceleration and applied torque of each axis is proposed. Finally, by proposing some criterion, the paper concludes by a comprehensive discussion on the performance of the obtained models.

Indirect closed-loop systems identification of distributed systems

In many cases it is impossible to remove the feedback during systems identification as it will make the system unstable. This paper presents an identification method for spatially interconnected distributed systems with identical subsystems operating in closed-loop feedback control. The proposed method takes into consideration the boundary conditions. The approach provides parameters estimate with minimum bias for unstable plant models when there is additive colored noise in output data. This yields consistent parameters estimate and, compared with other techniques to identify such systems under similar situations, takes far less time. The method is illustrated for two-dimensional systems (one for time and one for space), but is equally applicable for systems having more dimensions in space. The proposed technique is for general two-dimensional systems which may be causal, semi-causal (spatially interconnected systems) or non-causal. The effectiveness of the approach is demonstrated with a simulation example.

Nonlinear indirect identification method for cement composite-to-concrete bond

In the application of cement composites as Externally Bonded Reinforcement (EBR) for concrete structures, debonding is reported to be a common and undesired failure mode. This paper presents an indirect bond identification method that incorporates the nonlinear material behaviour of cement composites. The extended nonlinear indirect method is compared with a linear method by means of virtual and laboratory experiments. The virtual experiments allow omitting measurement scatter and hence quantify the error inherent to the theoretical assumptions. The laboratory experiments validate the use of the indirect method on real slip measurements. The results show that incorporating the cement composite’s nonlinear secant modulus as a function of the occurring strain is essential to accurately determine the cement composite – concrete bond from experiments.

Mathematical Methods for Indirect Visualization of the Electronic Structure of Diamond

modeling of continuous frequency spectrum of the imaginary part of a complex electronic polarizability. An important part of the method used is the indirect visualization of electron atomic structure of the unit cell of the diamond. This visualization of the structural features of the crystal parsed performed by the spatial geometric modeling nodal points of its nuclear atomic skeleton, surrounded by electron shells of a certain configuration. For indirect identification of necessary geometrical parameters include relatively simple computational methods that rely on the use of a small number of easily generated experimental data. In turn, the definition of geometric parameters of the electronic configuration of particulate matter can be realized by optimizing the frequency characteristics of an elastic electronic polarization. It is proposed to use the original “cybernetic” model of these processes, created on the basis of the classical theory of the polarization of the preconditions given explicit allocation of causality, objectively existing in the traditional description of the Lorentz local field strength. Findings: The article presents the results of simulation of continuous frequency spectrum of the imaginary part of a complex electronic polarizability of the diamond based on the consideration of physical models, which were calculated in the framework of the described techniques. Comparing the data of physical experiment, the traditional interpretation of covalent diamond connection with the results of a computational experiment, it should be noted that the use of the existing model does not allow to achieve high-quality real-compliance and the model spectra. The differences lie in the presence of the physical characteristics of a complex dual-output, and on the simulated curve - single output. In addition, the use of core-electron interpretation electronic diamond configuration does not allow to achieve high-quality real-compliance and the model spectra, obtained on the basis of a simulation of the spectrum. In this case, the differences lie in the displacement of the simulated electron emission caused by the polarization of core-electron pairs in the region of deep electronic resonances. However, the authors proposed a modified model of the carbon of the diamond connection allows you to get it close enough to the dielectric characteristics of the data of physical experiment. Thus, a modified model of the structure of the internal structure of the material allows for the most precise study of its optical properties. Improvements: Practical use the mathematical techniques of mediated visualization of the electronic structure of the diamond should be useful for the further evolution of the theoretical foundations of modern nanotechnology.

Escherichia coli Proteome Microarrays Identified the Substrates of ClpYQ Protease

Proteolysis is a vital mechanism to regulate the cellular proteome in all kingdoms of life, and ATP-dependent proteases play a crucial role within this process. In Escherichia coli, ClpYQ is one of the primary ATP-dependent proteases. In addition to function with removals of abnormal peptides in the cells, ClpYQ degrades regulatory proteins if necessary and thus let cells adjust to various environmental conditions. In E. coli, SulA, RcsA, RpoH and TraJ as well as RNase R, have been identified as natural protein substrates of ClpYQ. ClpYQ contains ClpY and ClpQ. The ATPase ClpY is responsible for protein recognition, unfolding, and translocation into the catalytic core of ClpQ. In this study, we use an indirect identification strategy to screen possible ClpY targets with E. coli K12 proteome chips. The chip assay results showed that YbaB strongly bound to ClpY. We used yeast two-hybrid assay to confirm the interactions between ClpY and YbaB protein and determined the Kd between ClpY and YbaB by quartz crystal microbalance. Furthermore, we validated that YbaB was successfully degraded by ClpYQ protease activity using ClpYQ in vitro and in vivo degradation assay. These findings demonstrated the YbaB is a novel substrate of ClpYQ protease. This work also successfully demonstrated that with the use of recognition element of a protease can successfully screen its substrates by indirect proteome chip screening assay.

Bacterial diseases of wheat caused by Xanthomonas sp. in the Southern Ural: Identification issues

The identification of pathogenic agents isolated from infected wheat seeds and plants, collected in the Southern Ural and characterized by an atypical manifestation of bacterial infection (yellow leaf tips), has been carried out by direct microbiological and molecular methods. In addition, an indirect identification by the hypersensitive reaction (HR) approach has been performed simultaneously with the pathogenicity assessment of isolates using an indicator plant Plectranthus australis R. Br. Isolated samples have been microbiologically identified as Xanthomonas sp. According to the results of the PCR identification with species-specific primers, isolated samples represent Xanthomonas translucens; the reliability of the obtained results is corroborated by the hypersensitive reaction approach used also to assess the pathogenicity of isolates. Winter wheat, especially cv. Pionerskaya 23, where both X. translucens and Pantoea agglomerans were found, suffered more severe symptoms than spring wheat that was only affected by strains of X. translucens. To improve the reliability of the primary diagnostics of a bacterial character of seed infection, the provoking of the pathogen development by temperature or pH stress is proposed.

Frequency domain indirect identification of AMB rotor systems based on fictitious proportional feedback gain

It is very difficult to directly identify an unstable system with uncertain dynamics from frequency domain input-output data. Hence, in these cases, closed-loop frequency responses calculated using a fictitious feedback could be more identifiable than open-loop data. This paper presents a frequency domain indirect identification of AMB rotor systems based on a Fictitious proportional feedback gain (FPFG). The closed-loop effect due to the FPFG can enhance the detectability of the system by moving the system poles, and significantly weigh the target mode in the frequency domain. The effectiveness of the proposed identification method was verified through the frequency domain identification of active magnetic bearing rotor systems.

UnMarginalizing Workers: How Big Data Drives Lower Wages and How Reframing Labor Law Can Restore Information Equality in the Workplace

While there has been a flurry of new scholarship on how employer use of data analysis may lead to subtle but potentially devastating individual discrimination in employment systems, there has been far less attention to the ways the deployment of big data may be driving down wages for most workers, including those who manage to be hired. This article details the ways big data can and in many cases is actively being deployed to lower wages through hiring practices, in the ways raises are now being offered, and in the ways workplaces are organized (and disorganized) to lower employee bargaining power — and how new interpretations of labor law are beginning to and can in the future reshape the workplace to address these economic harms.Data analysis is increasingly helping to lower wages in companies beginning in the hiring process where pre-hire personality testing helps employers screen out employees who will agitate for higher wages and organize or support unionization drives in their companies. For employees who are hired, companies have massively expanded data-driven workplace surveillance that allows employers to assess which employees are most likely to leave and thereby limit pay increases largely to them, lowering wages over time for workers either less able to find new employment because of their age or less inclined in general to risk doing so. Data analysis and so-called “algorithmic management” has also allowed the centralized monitoring of far flung workers organized nominally in subcontractors or as individual contractors, while traditional firms such as in retail implement data-driven scheduling that resembles the “on-demand” employment of independent contractors. All of this shifts risk and “downtime” costs to employees and lowers their take-home pay, even as the fragmenting of the workplace makes it harder for workers to collectively organize for higher wages. The article addresses how we should rethink and interpret existing labor law in each of these aspects of the employment process. The NLRB can reasonably construe many pre-hire employment tests as violating federal labor law’s prohibition of screening out union sympathizers, much as the EEOC has found many personality tests violate the Americans with Disabilities Act by allowing indirect identification of people with mental illness. Similarly, since big data analysis can reveal pro-union sympathies of current employees, under existing prohibitions of “polling” employees for their views, a reasonable extension of the law would be to prohibit sharing any personal data collected by management that might reveal protected conduct or union sympathies with line managers or outside management consultants involved in advising in labor campaigns. The Board can also level the informational playing field by making both hiring algorithms and those determining pay increases more available during collective bargaining. The Board is already moving to expand its “joint employer” doctrine to allow workers to challenge the fragmented workplace increasingly driven by algorithmic management and a clear recognition that algorithms establish exactly the control of nominally independent contractors or subcontractor’s workers that entitle them to collective bargaining rights with a central employer, strengthening worker bargaining power.Such a “collective action” approach to the problem is far more likely to succeed than other proposals focused on strengthening individual worker privacy or anti-discrimination rights in the workplace in regards to data-driven decision-making. As scholars have noted, disadvantaged groups under the civil rights laws may have sharply different preferences in wage versus benefit packages, so a process that increases informational resources for all workers and allows them to negotiate together for the mix of wages, benefits, work conditions and other “public goods” in the workplace, including privacy protections, will better reflect the overall interests of employees than in either a classic economic model based on a marginal worker’s “exit” or a “rights consciousness” litigation approach to rein in individual employment harms. In making this overall argument, the article partially addresses the debate on why wages have stagnated and even fallen below productivity gains over the last four decades as the deployment of data technology has played a significant and growing role in helping employers extract a disproportionate share of employee productivity gains to the benefit of management and shareholders.

New technologies in immunohaematology.

Since the discovery of the ABO system, numerous important innovations have contributed to a continuous, rapid evolution in the diagnostic methods for in vitro measurements of the antigen-antibody reaction, allowing a significant improvement in the compatibility between blood from donors and the recipients. Apart from the introduction of ABO typing, these methods include the determination of Rh type and phenotype, the direct and indirect antiglobulin tests, cross-matching and consequent identification of antigens and antibodies of clinical relevance, the use of low ionic strength additives and enzyme treatments, the development of monoclonal reagents and solid-phase and microcolumn platforms for performing the pre-transfusion tests. Since transfusion safety depends on a series of strictly inter-related processes1, among which pre-transfusion tests have a predominant role, in recent years some of the new technologies that integrate the classical techniques in immunohaematology have become valid instruments for improving the safety of transfusions. The aim of this review is to illustrate the principles and practical applications of these emerging techniques used in our laboratory to identify antigens and antibodies, in cases of red cell or platelet immunisation.

SERS Tags: The Next Promising Tool for Personalized Cancer Detection?

AbstractSurface‐enhanced Raman scattering (SERS) has been historically considered a tool for physical scientists. Recently, however, a new avenue has opened for the application of SERS in the medical field, mainly spurred by the implementation of SERS tags. SERS tags are employed for the indirect identification of target molecules, similarly to what fluorescent dyes do, but with several intrinsic advantages. They have proven very useful in in vivo, ex vivo, and in vitro identification of cancerous cells and tissues, with targeting selectivity that can be tuned to recognize individual markers. It has also been demonstrated for the first time that surgical outcomes may be improved via the use of SERS tags, leading to complete tumor resection. Herein, I will explain how SERS tags can aid in the identification of cancerous tissues at the single cell level and how they promise to render SERS a powerful tool for personalized cancer detection.

An indirect tire identification method based on a two-layered fuzzy scheme

While the heights and numbers of tires in the assembly line are changing, the traditional methods are difficult to identify the types of the tires, so an indirect tire identification method is proposed to identify the types of the tires, which uses the widths of the tires, the diameters and the shapes of the hubs to classify the tires. First, the tires are identified according to the widths and diameters by using the fuzzy C-means clustering algorithm. Second, the shapes of the hubs are used to distinguish the tires with similar dimensions. Finally, a two-layered fuzzy scheme is designed to identify the tires. Experimental results show that the two-layered fuzzy scheme is more effective than the fuzzy C-means clustering algorithm. And the proposed indirect tire identification method can achieve an accuracy of above 99.9% in the assembly line of tires.

Online Estimation of Linear Tooth Belt Drive System Parameters

Many control schemes rely on an analytical model of the servomechanism to be controlled, and hence, accurate knowledge about the position- and time-dependent parameter variability becomes crucial in many contexts, such as robust control methods. Although a properly designed robust controller can cope with a large parameter variation, real-time identification of the system parameter behavior could lead to several advantages by means of monitoring the varying dynamics, e.g., the predetermined uncertainty region around the nominal value. This paper addresses issues in online parameter estimation of a linear tooth belt drive with a limited stroke. Particular attention is paid to detecting the position-dependent changes in the system dynamics by using recursive least squares algorithm and exciting the system in different cart positions in order to identify the varying dynamics. The algorithm used is based on an indirect output-error identification scheme. The experimentally estimated parameters are compared with the corresponding two-mass model parameters. The results show an acceptable agreement and demonstrate the feasibility of the estimation method to estimate the parameters of a closed-loop controlled servomechanism with a limited stroke and time-varying parameters.

A Case of Fatal Cold Agglutinin Disease with Malaria

The authors report a case of a 55 yr old male who presented with fever, yellowish discoloration of the eyes and altered mental status to the Emergency Department. On examination, pallor, icterus and Splenomegaly were present. Hemoglobin (Hb) was 9.5 gm. % and peripheral smear revealed ring forms of Plasmodium vivax. Serum LDH and Serum bilirubin (Indirect and Direct) were high. This patient’s blood group couldn’t be found out correctly as there was spontaneous agglutination in all the test and control cells. Indirect Antiglobulin Test (IAT), antibody screening and antibody identification showed pan agglutination. Direct Antiglobulin Test was also positive. The specific but rare problems that can occur due to these pathologic cold agglutinins are to be kept in mind for the accurate diagnosis and early management of these patients.