Perinuclear antineutrophil cytoplasmic antibodies in patients with Crohn's disease define a clinical subgroup

BACKGROUND & AIMS: Antineutrophil cytoplasmic antibodies (ANCA) have been consistently detected in a subgroup of patients with Crohn's disease (CD). This study was designed to determine whether serum ANCA expression in patients with CD characterizes an identifiable clinical subgroup. METHODS: The study population consisted of 69 consecutive patients with an established diagnosis of CD as determined by a combination of characteristic clinical, radiographic, endoscopic, and histopathologic criteria. Sera from the patients were analyzed for the presence of ANCAs using the fixed neutrophil enzyme-linked immunosorbent assay (ELISA) assay. Perinuclear ANCA (pANCA)-positive and cytoplasmic ANCA (cANCA)-positive results by ELISA were confirmed by indirect immunofluorescence staining. Clinical profiles of the ANCA-positive patients with CD were compared with those of patients with CD not expressing ANCA (ANCA-negative). RESULTS: pANCA-positive patients with CD have endoscopically and/or histopathologically documented left-sided colitis and symptoms of left-sided colonic inflammation, clinically reflected by rectal bleeding and mucus discharge, urgency, and treatment with topical agents. One hundred percent of patients with CD expressing pANCA had "UC-like" features. CONCLUSIONS: In patients with CD, serum pANCA expression characterizes a UC-like clinical phenotype. Stratification of CD by serum pANCA provides evidence of heterogeneity within CD and suggests a common intestinal mucosal inflammatory process among a definable subgroup of patients with CD and UC expressing this marker.     

Proteomic studies in animal models of diabetes

The aim of this review is to provide an overview of proteomic studies in animal models of diabetes and to give some insight into the different methods available today in the rapidly developing field of proteomics. A summary of 31 papers published between 1997 and 2007 is presented. For instance, proteomics has been used to study the development of both type 1 and type 2 diabetes, diabetic complications in tissues like heart, kidney and retina and changes after treatment with anti-diabetic drugs like peroxisome proliferator-activated receptors agonists. Together, these studies give a good overview of a number of experimental approaches. Proteomics holds the promise of providing major contributions to the field of diabetes research. However, to achieve this, a number of issues need to be resolved. Appropriate data representation to facilitate data comparison, exchange, and verification is required, as well as improved statistical assessment of proteomic experiments. In addition, it is important to follow up the results with functional studies to be able to make biologically relevant conclusions. The potential of proteomics to dissect complex human disorders is now beginning to be realized. In the future, this will result in new important information concerning diabetes.     

Laparoscopic vs. open wedge biopsy of the liver

The number of people smoking free-base cocaine, or "crack," has increased dramatically in recent years. Concomitantly, the literature describing complications of such use has grown as well. Adverse pulmonary effects are being increasingly noted, such as respiratory symptoms, pulmonary hemorrhage, pulmonary edema, asthma, and pulmonary barotrauma. These and other pulmonary effects are reviewed.     

After-hours telephone coverage: the application of an area-wide telephone triage and advice system for pediatric practices

BACKGROUND: After-hours telephone calls are a stressful and frustrating aspect of pediatric practice. At the request of private practice pediatricians in Denver, a metropolitan area-wide system was created to manage after-hours pediatric telephone calls and after-hours patient care. This system, the After-Hours Program (AHP), uses specially trained pediatric nurses with standardized protocols to provide after-hours telephone triage and advice for the patients of 92 Denver pediatricians, representing 56 practices. OBJECTIVES: This report describes the AHP, presents data from 4 years' experience with the program, and describes results of our evaluation of the following aspects of the program: subscribing physician satisfaction, parent satisfaction, the accuracy and appropriateness of telephone triage, and program costs. METHODS: After-Hours Program records (including quality assurance data) for all 4 years of operation were retrospectively reviewed, tabulated, and analyzed. The results of two subscribing physician surveys and one parent caller satisfaction survey are presented. A retrospective review of after-hours patient care encounter forms assessed the necessity for after-hours visits triaged by the AHP. An analysis of the total cost of this program to 10 randomly selected subscribing physicians was conducted using current AHP data and a survey of the 10 physicians. RESULTS: In 4 years, 107,938 calls have been successfully managed without an adverse clinical outcome. Minor errors in using protocols occurred in one call out of 1450 after-hours calls. After-hours phoen calls necessitated an after-hours patient visit 20% of the time and generated one after-hours hospital admission out of every 88 calls. Just over half of the patients were managed with home care advice only, and 28% were given home care advice after-hours and seen the next day in the primary physician's office. Of all patients directed by the telephone triage nurses to be seen after hours, 78% were determined to have a condition necessitating after-hours care. Data are presented regarding call volumes by time of day, day of week, patient age, and patient's initial complaint. The 6 most common complaints accounted for more than one half of the calls, and 38 complaints accounted for more than 95% of all after-hours calls. Utilization by subscribing physicians is described. Satisfaction among subscribing pediatricians was 100%, and among parents was 96% to 99% on a variety of issues. The total cost to participating Denver pediatricians (which includes revenues "given up" as a result of not seeing patients after hours) ranged from 1% to 12% of their annual net income, depending on a variety of factors. CONCLUSIONS: Large-scale after-hours telephone coverage systems can be effective and well-received by patients, parents, and primary physicians. Data presented in this report can assist in planning the training of personnel who provide after-hours telephone advice and triage. Controversies associated with this type of program are discussed. Suggestions are made regarding the direction of future programs and research.     

Machine vision applied to vehicle guidance

Research on the semiautonomous operation of mobile robots in typical pathways is described. The image of the pathway will consist of two nearly vertical lines bounding a region with little texture (the pathway) after correction for perspective. In order to identify pathway boundaries, regions in the image space are examined using an edge detection algorithm, edges between regions are determined by the algorithm, and those corresponding to straight or nearly straight lines with large slope (path boundaries) are identified by means of the Hough transform. Once the path boundaries are identified, the horizontal distance from camera to road edge is determined. Next, a method to detect cubics in the roadway (i.e., obstacles) is presented. The region of interest in the roadway (from the camera to some predetermined distance in front of it) is known from the path boundary algorithm. The interior of this region is examined for edges. If edges are detected, it means that obstacles or shadows are present. A method to separate obstacles from shadows using stere vision is then presented.     

Office task effects on comfort and body dynamics in five dynamic office chairs

In the present study, we investigated the effect of office tasks on posture and movements in field settings, and the comfort rating for chair characteristics and correlation with type of task. The tasks studied were: computer work, telephoning, desk work and conversation. Postures, movements, chair part inclinations and comfort rating data were collected from 12 subjects. Computer work showed the lowest physical activity, together with upright trunk and head position and low backrest inclination. Conversation shows the highest activity of head legs and low back together with the highest cervical spine extension. In contrast, desk work provoked the most cervical spine flexion and showed the second lowest activity. The telephoning tasks showed medium activity and the highest kyphosis. Conversation showed the highest backrest inclination. Positive comfort relations were found for computer work and a "swing system" chair, for telephoning and an active longitudinal seat rotation, and for desk work and a chair with a three-dimensionally moveable seat.     

Personality-structure in different kinds of bronchial asthma (author's transl)

The "Giessen-Test" is a psychological test in form of a questionnaire, basing on self-assessment. It was applied in 63 patients with bronchial asthma in order to get their "self-images" and their "ideal-self-images". Except of higher values for depression the "self-images" of the asthmatics resembled very closely those of normals. The ideals ("ideal-self-image") of the patients were uncharacteristic and reflected general trends. In contrast to these findings eleven physicians had a negative conception of asthmatic patients ("foreign image"). Physicians assessed the asthmatics to be disliked ("negative social resonant"), obstinate ("dominant") and depressive. Patients with exogen-allergic asthma, intrinsic asthma and asthma of unknown origin differ from each other only within a few marks. These differences, however, are not sufficient, to allow to coordinate a specific personality-structure with one of the different kinds of asthma.     

Choroidal neovascular membrane in Best's vitelliform macular dystrophy

The right eye of a 9-year-old white boy with Best's vitelliform macular dystrophy had an intact egg-yolk lesion and a retinal pigment epithelial defect superiorly, suggesting an early pseudohypopyon stage. The disruptive phase of the left eye showed subretinal hemorrhages, a "signet ring," and a subretinal neovascular membrane.     

Si/SiGe resonant interband tunnel diode with f/sub r0/ 20.2 GHz and peak current density 218 kA/cm/sup 2/ for K-band mixed-signal applications

This letter presents the room-temperature high-frequency operation of Si/SiGe-based resonant interband tunnel diodes that were fabricated by low-temperature molecular beam epitaxy. The resulting devices show a resistive cutoff frequency f/sub r0/ of 20.2 GHz with a peak current density of 218 kA/cm/sup 2/, a speed index of 35.9 mV/ps, and a peak-to-valley current ratio of 1.47. A specific contact resistivity of 5.3/spl times/10/sup -7/ /spl Omega//spl middot/cm/sup 2/ extracted from RF measurements was achieved by Ni silicidation through a P /spl delta/-doped quantum well by rapid thermal sintering at 430/spl deg/C for 30 s. The resulting devices are very good candidates for RF high-power mixed-signal applications. The device structures presented here are compatible with a standard complementary metal-oxide-semiconductor or heterojunction bipolar transistor process.