Goodpasture syndrome involving overlap with Wegener's granulomatosis and anti-glomerular basement membrane disease

A 68-year-old Caucasian woman presented to the hospital with nodular pulmonary infiltrates and acute renal failure. Wegener's granulomatosis was initially considered to be most likely because of the presence of increased serum levels of c-anti-neutrophil cytoplasmic antibodies (c-ANCA). A consultation through the Internet after a renal biopsy demonstrated crescentic, necrotizing glomerulonephritis and linear deposits of immunoglobulin G (IgG) and complement C3, typical of anti-glomerular basement membrane (GBM) disease. Hemodialysis was instituted; however, the patient suddenly developed a massive cerebral hemorrhage and died before full therapy could take effect. Postmortem analysis of the patient's sera revealed high titers of IgG against the alpha 3 NC1 domain of type IV collagen. Serologic evidence of both p-ANCA and anti-GBM antibodies are becoming more frequently recognized in the setting of rapidly progressive glomerulonephritis. The patient reported here had the unusual combination of c-ANCA antibodies with anti-GBM disease, and this association raises complex questions regarding the pathogenesis of this type of renal injury.     

The m1 muscarinic acetylcholine receptor transactivates the EGF receptor to modulate ion channel activity

Intracellular tyrosine kinases link the G protein-coupled m1 muscarinic acetylcholine receptor (mAChR) to multiple cellular responses. However, the mechanisms by which m1 mAChRs stimulate tyrosine kinase activity and the identity of the kinases within particular signaling pathways remain largely unknown. We show that the epidermal growth factor receptor (EGFR), a single transmembrane receptor tyrosine kinase, becomes catalytically active and dimerized through an m1 mAChR-regulated pathway that requires protein kinase C, but is independent of EGF. Finally, we demonstrate that transactivation of the EGFR plays a major role in a pathway linking m1 mAChRs to modulation of the Kv1.2 potassium channel. These results demonstrate a ligand-independent mechanism of EGFR transactivation by m1 mAChRs and reveal a novel role for these growth factor receptors in the regulation of ion channels by G protein-coupled receptors.     

What is driving health system change?

Socially amoral economic forces now drive health system change. The authors, assisted by a panel of experts on employers, health plans, providers, and consumers, discuss current drivers such as (1) employers' price-focused purchasing, without good quality/value measures; (2) health plans' growing successes and market clout; (3) providers declining prospects and fears about their future; and (4) consumers' worries about less choice. Future influences will include Medicare reforms, better information, and pro-consumer regulation of managed care, as well as rising social distress. The health system's future is now open for resolution in an evolving, imperfect market.     

Vector characterization of photodetectors, photoreceivers, andoptical pulse sources by time-domain pulse response measurements

Deconvolution of measurement system effects from pulse response measurements is demonstrated to yield reproducible, accurate characterization of the impulse response (and vector frequency response) of a photodetector or photoreceiver, as well as the intensity waveform of an optical pulse. Calibration is based on a <3-ps FWHM (full width at half maximum) optical pulse and a 50-GHz 3-dB bandwidth electrical sampling system. Vector characterization of a photodetector/photoreceiver to >40 GHz and an optical pulse source to >30 GHz are demonstrated. Calibration and effects of noise are discussed     

A New Approach to Solving Applied Location/AIIocation Problems

Abstract: Facility location and customer allocation problems are pervasive in industry and in the private sector. In this paper, we outline a new approach to solving these problems that avoids the need to resort to integer programming techniques. The approach exploits the mathematical structure of the problem as well as characteristics frequently found in applied location/allocation problems. Using this approach, large scale problems are readily solvable on personal computers. We illustrate the approach on a small example and provide computational results based on a real-world application of the technique. Extensions to include additional problem features are also discussed.     

Internal mammary vein to coronary artery anastomotic fistula

Two patients are presented where internal mammary artery grafting was performed for the relief of symptomatic coronary artery disease. At follow-up the internal mammary artery was occluded and a communication between the internal mammary vein and the native coronary artery was demonstrated. These patients were characterised by the early recurrence of angina or the appearance of a continuous murmur. Both patients were treated by re-operation with ligation of the arterio-venous fistula and saphenous vein grafting.     

How office space affects programming productivity

The relationship between office size and noise level is one of the most significant, yet least investigated, factors affecting software productivity. According to Tom DeMarco and Tim Lister (1992), US programmers with more than 80 square feet of private, noise-free office space consistently outperform programmers who occupy two- or three-person cubicles. The result was the Santa Teresa Programming Laboratory in San Jose, California, which opened in 1978. The author discusses some requirements of an optimal programming office environment. He considers the effectiveness of home working     

Using neural networks to learn hand-eye co-ordination

The work presented in this paper shows how the association of proprioceptive and exteroceptive stimuli can enable a Kohonen neural network, controlling a robot arm, to learn hand-eye co-ordination so that the arm can reach for and track a visually presented target. The approach presented in this work assumes no a priorimodel of arm kinematics or of the imaging characteristics of the cameras. No explicit representation, such as homogeneous transformations, is used for the specification of robot pose, and camera calibration and triangulation are done implicitly as the system adapts and learns its hand-eye co-ordination by experience. This research is validated on physical devices and not by simulation.