Systemic lupus erythematosus with a protein-losing enteropathy

Anasarca with pronounced hypoalbuminemia developed in a young woman 15 months after the onset of a mild, arthralgic type of systemic lupus erythematosus (SLE) without evidence of active nephritis. Investigation indicated a gastrointestinal rather than a renal site for protein loss. A full clinical remission was achieved with low-dose corticosteroid therapy.     

An alternative simple solution algorithm of an inventory model with fixed and variable lead time crash costs under unknown demand distribution

Inventory models with controllable lead time both for known and unknown demand distributions have been proposed in the literature. A model is useless unless it is formulated correctly and feasible. A simple solution procedure of a model also plays an important role in its application. This article highlights an erroneous formulation of an inventory model developed with fixed and variable lead time crash costs under unknown demand distribution, and also demonstrates its infeasibility. To attain feasibility we extend the model to include a constraint. Then, we present an alternative simple solution technique of the modified model and carry out a comparative study on a numerical example to show its potential significance.     

Concurrent engineering: A compromising approach to develop a feasible and customer-pleasing product

To develop a customer-pleasing and economically and technically feasible product, it is necessary to utilize the best possible knowledge of the market, the customers, the core product technology, and the cost implications of design alternatives. It requires the concurrent involvement of team members from merchandizing, product development, and purchasing and production-engineering departments of the enterprise. The merchandizing department identifies customer needs however, considering only customers’ requirements, without technical information it is not possible to develop a feasible product. Conversely, the function-oriented designers in the product development department determine the subsystems’ weight, which are technically feasible but may ignore the qualitative issues desired by the customers. To identify the economic feasibility of the product, the purchasing and production-engineering departments calculate the estimated cost by evaluating the cost implications of the design alternatives. Therefore, to produce an economically and technically feasible product with customer pleasing quality, a trade-off among these three sets of weights is essential. Here, we propose an optimization model that assimilates three sets of weights of the subsystems to a final one. The resultant set of weights will represent the effects of concurrent cooperation among merchandizing, product development, purchasing and production-engineering departments of the enterprise.     

Orchestration of neutrophil movement by intestinal epithelial cells in response to Salmonella typhimurium can be uncoupled from bacterial internalization

Intestinal epithelial cells respond to Salmonella typhimurium by internalizing this pathogen and secreting, in a polarized manner, an array of chemokines which direct polymorphonuclear leukocyte (PMN) movement. Notably, interleukin-8 (IL-8) is secreted basolaterally and directs PMN through the lamina propria, whereas pathogen-elicited epithelial chemoattractant (PEEC) is secreted apically and directs PMN migration across the epithelial monolayer to the intestinal lumen. While most studies of S. typhimurium pathogenicity have focused on the mechanism by which this bacterium invades its host, the enteritis characteristically associated with salmonellosis appears to be more directly attributable to the PMN movement that occurs in response to this pathogen. Therefore, we sought to better understand the relationship between S. typhimurium invasion and epithelial promotion of PMN movement. First, we investigated whether S. typhimurium becoming intracellular was necessary or sufficient to induce epithelial promotion of PMN movement. Blocking S. typhimurium invasion by preventing, with cytochalasin D, the epithelial cytoskeletal rearrangements which mediate internalization did not reduce the epithelial promotion of PMN movement. Conversely, bacterial attainment of an intracellular position was not sufficient to induce model epithelia to direct PMN transmigration, since neither basolateral invasion by S. typhimurium nor apical internalization of an invasion-deficient mutant (achieved by inducing membrane ruffling with epidermal growth factor) induced this epithelial cell response. These results indicate that specific interactions between the apical surface of epithelial cells and S. typhimurium, rather than simply bacterial invasion, mediate the epithelial direction of PMN transmigration. To further investigate the means by which S. typhimurium induces epithelia to direct PMN movement, we investigated whether the same signaling pathways regulate secretion of IL-8 and PEEC. IL-8 secretion, but not PEEC secretion, was activated by phorbol myristate acetate and blocked by an inhibitor (mg-132) of the proteosome which mediates NF-kappabeta activation. Further, secretion of IL-8, but not PEEC, was activated by an entry-deficient (HilDelta) S. typhimurium mutant or by basolateral invasion of a wild-type strain. Together, these results indicate that distinct signaling pathways mediate S. typhimurium invasion, induction of IL-8 secretion, and induction of PEEC secretion in model intestinal epithelia.     

Cloning and functional expression of a human liver organic cation transporter

OBJECTIVE: The triglyceride-lowering effects of omega-3 fats and HDL cholesterol-raising effects of exercise may be appropriate management for dyslipidemia in NIDDM. However, fish oil may impair glycemic control in NIDDM. The present study examined the effects of moderate aerobic exercise and the incorporation of fish into a low-fat (30% total energy) diet on serum lipids and glycemic control in dyslipidemic NIDDM patients. RESEARCH DESIGN AND METHODS: In a controlled, 8-week intervention, 55 sedentary NIDDM subjects with serum triglycerides > 1.8 mmol/l and/or HDL cholesterol < 1.0 mmol/l were randomly assigned to a low-fat diet (30% daily energy intake) with or without one fish meal daily (3.6 g omega-3/day) and further randomized to a moderate (55-65% VO2max) or light (heart rate < 100 bpm) exercise program. An oral glucose tolerance test (75 g), fasting serum glucose, insulin, lipids, and GHb were measured before and after intervention. Self-monitoring of blood glucose was performed throughout. RESULTS: In the 49 subjects who completed the study, moderate exercise improved aerobic fitness (VO2max) by 12% (from 1.87 to 2.07 l/min, P = 0.0001). Fish consumption reduced triglycerides (0.80 mmol/l, P = 0.03) and HDL3 cholesterol (0.05 mmol/l, P = 0.02) and increased HDL2 cholesterol (0.06 mmol/l, P = 0.01). After adjustment for age, sex, and changes in body weight, fish diets were associated with increases in GHb (0.50%, P = 0.05) and self-monitored glucose (0.57 mmol/l, P = 0.0002), which were prevented by moderate exercise. CONCLUSIONS: A reduced fat diet incorporating one daily fish meal reduces serum triglycerides and increases HDL2 cholesterol in dyslipidemic NIDDM patients. Associated deterioration in glycemic control can be prevented by a concomitant program of moderate exercise.     

It is time to move from the nursing process to critical thinking

As we reflect on the concept of critical thinking in perioperative nursing practice, we should ask ourselves whether we think critically. If not, we must learn the principles of critical thinking and apply them in our clinical practice settings. Our perioperative nurse managers and directors must demonstrate critical thinking in leading other nurses in the delivery of quality, cost-effective, service-oriented patient care. They also must identify peers who use critical thinking skills to support and sustain them in their quest.     

Protective effect of amiloride against reperfusion damage as evidenced by inhibition of accumulation of free fatty acids in working rat hearts

To examine whether amiloride protects against ischemia-induced or reperfusion-induced damage to the heart, mechanical and metabolic studies were performed in the isolated, working rat heart. Ischemia decreased both mechanical function and the tissue levels of high-energy phosphates and increased the tissue levels of free fatty acids (FFAs). Reperfusion restored the levels of high-energy phosphates but further increased FFA accumulation. For this reason, accumulation of FFAs was used as an indicator of both ischemia-induced and reperfusion-induced damage. Drugs were added to the perfusion solution 5 min before ischemia until the end of ischemia (pre) or until 10 min after reperfusion (pre + post). Diltiazem (1 or 5 mumol/L pre) decreased the mechanical function of the non-ischemic heart and attenuated both ischemia-induced and reperfusion-induced accumulation of FFAs. Amiloride (50 mumol/L pre) did not affect the mechanical function of the non-ischemic heart or attenuate ischemia-induced or reperfusion-induced FFA accumulation effectively. However, amiloride (50 mumol/L pre + post) did markedly attenuate the reperfusion-induced accumulation of FFAs. In conclusion, diltiazem attenuates both ischemia-induced and reperfusion-induced myocardial damage, probably through its energy-sparing effect as a result of a decrease in mechanical function before ischemia. In contrast, amiloride attenuates only the reperfusion-induced myocardial damage through mechanisms other than the energy-sparing effect.     

马尔克海的眼睛

West 8是一个国际性的城市设计和景观设计事务所,由Adriaan Geuze于1987年成立。在过去20年West 8已经成长为一个由景观建筑师和工程师组成的国际领先的实践性公司。     

A Comparative Study of the Mechanical Properties of Jute Fiber and Yarn Reinforced Concrete Composites

ABSTRACT

A relatively better performance of jute fiber and yarn reinforced concrete composites can open up a wide access to application of natural resources in concrete strengthening. In order to achieve this goal, an experimental investigation on the flexural, compressive and tensile strengths of Jute Fiber Reinforced Concrete Composites (JFRCC) and Jute Yarn Reinforced Concrete Composites (JYRCC) has been conducted. To draw a specific conclusion, the mix ratios of 1:1.5:3 and 1:2:4 (by volume) of concrete have been maintained with incorporation of jute fiber and yarn in concrete mortar having different cut lengths with distinct volumetric ratios. Finally, a comparison of the JFRCC and JYRCC strength increments with respect to the plain concrete has been investigated. A significant increment of compressive, flexural and tensile strength was observed only for a short cut length having a low volumetric ratio, where JYRCC increment value was always found progressive. A far more regular arrangement and adequate mixture of JYRCC was also visualized compare to JFRCC in concrete mortar. All the principal increment values were found only in case of JYRCC with a mix ratio of 1:1.5:3. So, it can be concluded that the presence of jute yarn and more cement content can strengthen the concrete to a great extent.