The clinical complexity of splenic vein thrombosis

Upper gastrointestinal hemorrhage secondary to splenic vein thrombosis is a curable form of localized portal hypertension when treated with splenectomy. A high index of suspicion is necessary in order to promptly diagnose and treat this underrecognized condition that is most commonly caused by inflammation or neoplasm of the pancreas. The triad of isolated gastric varices, splenomegaly, and normal hepatic function is classic; it is not uncommon, however, for patients to have only some or even none of these conditions. Mesenteric angiography with venous phase imaging is the gold standard of diagnosis. Ultrasound and CT may identify splenic vein thrombosis, but are most helpful in delineating concomitant upper abdominal pathology. Early recognition and intervention allow associated underlying conditions to be treated under the same anesthetic with minimal morbidity and mortality.     

Transport is the primary determinant of glycine content in retinal neurons

This study demonstrates that in mammalian and nonmammalian species it is possible to deplete selectively and reversibly retinal glycinergic neurons of their content of glycine by exposure to sarcosine, a competitive inhibitor of glycine transporter 1 (glyt-1). This observation was used as a tool to test the hypothesis that uptake of glycine rather than de novo synthesis is the main determinant of glycine content in retinal neurons. Isolated retinae were depleted of immunocytochemically detectable pools of glycine. Thereafter retinae were exposed either to physiological medium containing glycine or to medium lacking glycine but containing precursors for the synthesis of glycine. Retinae exposed to glycine-containing medium rapidly recovered their content of glycine, whereas retinae exposed to medium lacking glycine but containing serine, a substrate for synthesis of glycine, showed only a slow recovery of immunoreactivity for glycine in a few amacrine cells. These data indicate that uptake of glycine is the primary determinant of glycine content in most retinal glycinergic neurons. The origins of the extracellular pools of glycine remain to be identified; however, it is suggested that such glycine may be derived from the vitreous humor and that in turn this glycine may be derived from the peripheral circulation.     

B lymphocytes are critical antigen-presenting cells for the initiation of T cell-mediated autoimmune diabetes in nonobese diabetic mice

Nonobese diabetic (NOD) mice genetically deficient in B lymphocytes (NODJg mu(null)) are resistant to T cell-mediated autoimmune insulin-dependent diabetes mellitus (IDDM). Ig infusions from diabetic NOD donors did not abrogate IDDM resistance in NODJg mu(null) mice. However, T cell responses to the candidate pancreatic beta cell autoantigen glutamic acid decarboxylase (GAD), but not the control Ag keyhole limpet hemocyanin, were eliminated in NODJg mu(null) mice. To initially test whether they contribute to IDDM as APC, NOD B lymphocytes were transferred into NODJg mu(null) recipients. B lymphocytes transferred into unmanipulated NODJg mu(null) recipients were rejected by MHC class I-restricted T cells. Stable T and B lymphocyte repopulation was achieved in irradiated NODJg mu(null) mice reconstituted with syngeneic bone marrow admixed with NOD B lymphocytes. IDDM susceptibility was restored in NODJg mu(null) mice reconstituted with syngeneic marrow plus B lymphocytes, but not with syngeneic marrow only. T cell responses to GAD were restored only in NODJg mu(null) mice reconstituted with syngeneic marrow plus B lymphocytes. Hence, B lymphocytes appear to contribute to IDDM in NOD mice as APC with a preferential ability to present certain beta cell Ags such as GAD to autoreactive T cells.     

Implementation of Quality Criteria in Tendering and Regulating Infrastructure Management Contracts

In recent years, several public authorities have been making advances in developing bidding terms for contracts regulating the management of infrastructure. Up to now these bidding terms have focused on granting the contract to the bidder who, having agreed to comply with the requirement of a specified level of quality, as stipulated in the contract, submits the lowest tender in terms of price. As a result, the experience of implementing quality-related incentives for the management of infrastructure has been scarce. This paper demonstrates that, if infrastructure quality is verifiable and the social benefit derived from it is measurable, there is a better way both to tender and to regulate those contracts, based on a combination of price and quality standards. In addition, the paper proposes a new procurement procedure to encourage bidders to provide better quality levels. The last part of the paper provides a practical example of how to calculate a quality index for contracts regulating the management of infrastructure. The paper ends with a set of conclusions related to the advantages of the new tendering mechanism and its possible application.