Serum concentrations of soluble adhesion molecules in patients with colorectal cancer

The concentrations of the soluble adhesion molecules E-cadherin, E-selectin, intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) were investigated in 48 patients with colorectal cancer before treatment, and their relation to clinical, histological and routine laboratory parameters was examined. Data were collected on tumour stage at presentation, presence and sites of metastatic disease, tumour pathology and results of routine laboratory tests. Serum concentrations of ICAM-1 and VCAM-1 were significantly elevated in the patients with colorectal cancer in comparison with a group of healthy subjects (P < 0.00001). Levels of circulating ICAM-1 and VCAM-1 were increased both in patients with local and those with metastatic disease. Although elevated in some patients soluble E-cadherin and E-selectin concentrations were not significantly elevated compared with the control group (P = 0.71 and P = 0.052 respectively). The levels of circulating ICAM-1 were significantly correlated with those of VCAM-1 and E-selectin. A correlation was also found between the serum concentrations of E-selectin and ICAM-1 and alkaline phosphatase, total white cell count and platelet count. VCAM-1 was positively correlated with age and negatively with degree of tumour differentiation and haemoglobin concentration. The biological implications and possible clinical relevance of these findings are discussed.     

Automatic Detection of Stress States in Type 1 Diabetes Subjects in Ambulatory Conditions

Two levels of control are crucial to the robustness of an artificial β-cell, a medical device that would automatically regulate blood glucose levels in patients with type 1 diabetes. A low-level component would attempt to regulate blood glucose continuously, while a supervisory-level, or monitoring, component would detect underlying changes in the subject's glucose-insulin dynamics and take corrective actions accordingly. These underlying changes, or "faults," can include changes in insulin sensitivity, sensor problems, and insulin delivery problems, to name a few. A multivariate statistical monitoring technique, principal component analysis (PCA), has been applied to both simulated and experimental type 1 diabetes data. The objective of this study was to determine if PCA could be used to distinguish between normal patient data, and data for abnormal conditions that included a variety of "faults." The PCA results showed a high degree of accuracy; for data from nine type 1 diabetes subjects in ambulatory conditions, 33 of 37 total test days (89%), including fault days and normal days, were classified correctly. Thus, the proposed monitoring technique shows considerable promise for incorporation into an artificial β-cell.     

Imaging appearances of ileouterine fistula complicating recurrent adenocarcinoma of the rectum

Enterouterine fistulae are rare and nowadays are most commonly due to pelvic tumours. We review the literature and present the case of a woman who presented with an ileouterine fistula following surgery and radiotherapy for recurrent rectal adenocarcinoma. The presence of tumour within the fistula track may also have been a significant aetiological factor. Magnetic resonance imaging (MRI) is an excellent method to demonstrate the site and size of the track and has not, to date, been used to identify such a fistula.     

Effect of input excitation on the quality of empirical dynamic models for type 1 diabetes

Accurate prediction of future blood glucose trends has the potential to significantly improve glycemic regulation in type 1 diabetes patients. A model‐based controller for an artificial β‐cell, for example, would determine the most efficacious insulin dose for the current sampling interval given available input–output data and model predictions of the resultant glucose trajectory. The two inputs most influential to the glucose concentration are bolused insulin and meal carbohydrates, which in practice are often taken simultaneously and in a specified ratio. This linear dependence has adverse effects on the quality of linear dynamic models identified from such data. On the other hand, inputs with greater degrees of excitation may force the subject into extreme hypoglycemia or hyperglycemia, and thus may be clinically unacceptable. Inputs with good excitation that do not endanger the subject are shown to result in models that can predict glucose trends reasonably accurately, 1–2 h ahead. © 2009 American Institute of Chemical Engineers AIChE J, 2009     

The field assessment of a high temperature scale control additive and its effect on plant corrosion

Distillation of seawater, currently the only aćcepted, method, for the large scale production of fresh water from seawater, produces two serious problems that cannot be easily “engineered” out of the process. These are scale formation on heat transfer surfaces and corrosion of the plant constructional materials and are a direct result of the nature and chemical composition of seawater.Scale formation can he controlled by the use of additives or acid. However, where fuel costs are high, it is important for efficiency to operate distillation plants at as high a temperature as possible. Until recently high temperature operation has only been possible by the use of acid treatment, as additives based on polyphosphates do not work at temperatures greater than 90°C because of hydrolysis of the polyphosphate to inactive phosphate. Use of acid, unless very carefully controlled, can lead to serious corrosion of the plant. Ideally acid addition should be controlled to leave a residual alkalinity in the seawater feed of 10–20 ppm, which in practice is very difficult, because of the problems in accurately controlling the pH of a large flowing volume of seawater. If acid is underdosed, to avoid corrosion problems then scale formation will result.The result of a joint programme between CIBA-GEIGY (UK) LTD and the UKAEA has been the introduction of a high temperature scale control additive. Results of plant trials with this chemical will be described and calculation of fouling factors from plant operational data show its effectiveness in controlling alkaline scale formation.Simple laboratory tests have shown the likely benefits, in terms of lower corrosion rates, to be gained from the use of additives which result in high recirculating brine pH. These observations have been substantiated by plant experience.     

Characterization of the Rhizobium (Sinorhizobium) meliloti high- and low-affinity phosphate uptake systems

Genetic studies have suggested that Rhizobium (Sinorhizobium) meliloti contains two distinct phosphate (Pi) transport systems, encoded by the phoCDET genes and the orfA-pit genes, respectively. Here we present data which show that the ABC-type PhoCDET system has a high affinity for Pi (Km, 0.2 microM) and that Pi uptake by this system is severely inhibited by phosphonates. This high-affinity uptake system was induced under Pi-limiting conditions and was repressed in the presence of excess Pi. Uptake via the OrfA-Pit system was examined in (i) a phoC mutant which showed increased expression of the orfA-pit genes as a result of a promoter-up mutation and (ii) a phoB mutant (PhoB is required for phoCDET expression). Pi uptake in both strains exhibited saturation kinetics (Km, 1 to 2 microM) and was not inhibited by phosphonates. This uptake system was active in wild-type cells grown with excess Pi and appeared to be repressed when the cells were starved for Pi. Thus, our biochemical data show that the OrfA-Pit and PhoCDET uptake systems are differentially expressed depending on the state of the cell with respect to phosphate availability.     

Promoting healthy sexuality: guidelines for the school-age child and adolescent

The purpose of this article is to provide the clinician with practical information to promote the healthy sexuality of the school-age child through adolescence. Much of the current literature related to sexuality is problem-focused; this article focuses on sexuality from a health promotion viewpoint. The development of a healthy sexuality is a life-long process with different issues and problems pertaining to each age group. Issues common to the school-age child and adolescent include changing physical characteristics and body image concerns. A set of guidelines has been developed that can be used in the clinical setting. In order to follow a holistic approach to health promotion with these age groups, the clinician must address sexuality. These guidelines will provide the information the clinician will need to initiate a discussion about sexuality. Patient education guidelines are also presented that will help the parent, child, and adolescent in sexual issues and understanding. Suggested reading materials about sexuality are also presented.