Evolution of a legacy system to a Web patient record server: leveraging investment while opening the system

A layered system is under development to enhance our legacy system as a backend in a WEB-enabled system. Each layer of the system has defined functionality, leverages the investment in the layer below, and follows the strategy of reducing support requirements for workstations. The mainframe system provides administrative integration of sub-systems, security, and the central data repository for most information. The second layer is a graphical user interface (GUI) to the system for Windows platforms. Support needs are limited by relying chiefly on X-terminals and application servers. The "Intranet" layer is a WEB Server building upon the second layer gateways to provide platform-independent access to selected information and images. The fourth layer, under evaluation, will extend access to the central data repository for Internet users of web browsers that support private-key/public-key encryption.

Effect of mosquito age and reproductive status on melanization of sephadex beads in Plasmodium-refractory and -susceptible strains of Anopheles gambiae

Malaria-refractory and -susceptible strains of the mosquito vector, Anopheles gambiae, differ in their response to negatively-charged Sephadex CM-25 beads. CM-25 beads elicit a much stronger melanization reaction in refractory mosquitoes than in susceptible mosquitoes. Light microscopic and scanning electron microscopic studies documented a progression from early stages with small spots of melanin adhering to CM-25 beads to late stages where spots had grown and coalesced to form a dark dense capsule. This reaction occurred maximally during the first 18 hr after inoculation; female mosquitoes aged 3-5 days showed 48% of beads heavily melanized by 18 hr postinoculation in the refractory strain and 0-10% in the susceptible strain. Female mosquito age and reproductive status strongly affected the ability to melanize beads. All of the beads were completely melanized in the refractory strain on the day immediately following eclosion (Day 0); thereafter these levels decreased steadily until the last time point on Day 7, when only 23% of beads were melanized in this strain. In the susceptible strain, 53% of beads were heavily melanized on Day 0 and 0-10% were melanized at all other times. At Day 1 and 2 after blood feeding, 85 and 88% of beads, respectively, were heavily melanized in refractory females in comparison with control mosquitoes of the same age which heavily melanize 23-58% of the beads. Blood feeding had little effect on the ability to melanize beads in the susceptible strain.

Chronic innominate artery dissection after blunt thoracic trauma: case report

Blunt innominate chest trauma is relatively rare, with only 70 cases being reported in the surgical literature since 1960. This report describes a 20-year-old male who sustained a blunt chest injury that resulted in an innominate artery dissection. The patient's clinical course and management are discussed, as well as a review of the surgical literature.

A phylogenetic analysis of the genus Nocardia with 16S rRNA gene sequences

Partial sequences of the 16S rRNA genes of the type strains of nine species of the genus Nocardia were determined following the isolation and cloning of the amplified genes. These sequences were aligned with the sequences of representatives of the genera Corynebacterium, Gordona, Mycobacterium, Rhodococcus, and Tsukamurella, and phylogenetic trees were inferred by using the Fitch-Margoliash and neighbor-joining methods. The genus Nocardia formed a distinct clade that was most closely associated with the genus Rhodococcus. The average level of sequence similarity found among the type strains of the Nocardia species was 97.2 +/- 0.7%. Two sublines were recognized within the Nocardia clade; one encompassed Nocardia asteroides and related species, and the other encompassed Nocardia otitidiscaviarum and allied taxa. Separation of the two sublines is based on differences in helix 37-1. The results of isoprenoid quinone analyses provided evidence that nocardiae can be distinguished from all other actinomycete taxa on the basis of their characteristic menaquinone profiles. Nocardiae typically contain hexahydrogenated menaquinones with eight isoprene units in which the two end units are cyclized.

Transfer of Nocardia amarae Lechevalier and Lechevalier 1974 to the genus Gordona as Gordona amarae comb. nov

The taxonomic status of Nocardia amarae strains was examined using chemical, microbiological and nucleic acid sequencing methods. It was evident from the results of this and previous studies that Nocardia amarae has properties that are at variance with its classification in the genus Nocardia but consistent with its transfer to the genus Gordona. It is proposed that Nocardia amarae Lechevalier and Lechevalier 1974 be transferred to the genus Gordona as Gordona amarae comb. nov.

Dobutamine echocardiography and resting-redistribution thallium-201 scintigraphy predicts recovery of hibernating myocardium after coronary revascularization

The value of dobutamine echocardiography and resting thallium-201 scintigraphy to predict reversal of regional left ventricular wall motion dysfunction after revascularization in patients with chronic coronary artery disease was assessed. Improvement in wall motion during dobutamine echocardiography and normal or mildly decreased uptake on thallium-201 scanning are strong predictors of reversible left ventricular dysfunction. Dobutamine echocardiography and resting thallium-201 scanning are simple and safe methods of assessing hibernating myocardium.

Rapid characterisation and identification of mycobacteria using fluorogenic enzyme tests

Sixty representatives of selected Mycobacterium and Nocardia species were examined for their ability to cleave 79 fluorogenic synthetic enzyme substrates based on the fluorophores 7-amino-4-methylcoumarin and 4-methylumbelliferone. The resultant data were analysed using the simple matching coefficient and clustering achieved using the unweighted pair group method with arithmetic averages algorithm. Clusters corresponding to the validly described species Mycobacterium bovis, M. chelonae, M. chitae, M. farcinogenes, M. fortuitum, M. peregrinum, M. senegalense, M. smegmatis, Nocardia asteroides, and N. farcinica were circumscribed at or above the 83% similarity level. Fluorogenic probes prepared from 7-amino-4-methylcoumarin and 4-methylumbelliferone provide a rapid means of detecting taxonomically useful enzymes in small amounts of whole mycobacteria and nocardiae.

Rapid identification of streptomycetes by artificial neural network analysis of pyrolysis mass spectra

An artificial neural network was trained to distinguish between three putatively novel species of Streptomyces using normalised, scaled prolysis mass spectra from three representative strains of each of the taxa, each sampled in triplicate. Once trained, the artificial neural network was challenged with spectral data from the original organisms, the 'training set', from additional members of the putative novel taxa and from over a hundred strains representing six other actinomycete genera. All of the streptomycetes were correctly identified but many of the other actinomycetes were mis-identified. A modified network topology was developed to recognise the mass spectral patterns of the non-streptomycete strains. The resultant neural network correctly identified the streptomycetes, whereas all of the remaining actinomycetes were recognised as unknown organisms. The improved artificial neural network provides a rapid, reliable and cost-effective method of identifying members of the three target streptomycete taxa.

Artificial neural network analysis of pyrolysis mass spectrometric data in the identification of Streptomyces strains

Sixteen representatives of three morphologically distinct groups of streptomycetes were recovered from soil using selective isolation procedures. Duplicated batches of the test strains were examined by Curie-point pyrolysis mass spectrometry and the first data set used for conventional multivariate statistical analyses and as a training set for an artificial neural network. The second set of data was used for 'operational fingerprinting' and for testing the artificial neural network. All of the test strains were correctly identified using the artificial neural network whereas only fifteen of the sixteen strains were assigned to the correct group using the conventional operational fingerprinting procedure. Artificial neural network analysis of pyrolysis mass spectrometric data provides a rapid, cost-effective and reproducible way of identifying and typing large numbers of microorganisms.

Prohormone processing in Xenopus oocytes: characterization of cleavage signals and cleavage enzymes

In this study, we characterize the sequences required for the cleavage of prohormones in Xenopus oocytes. We demonstrate that the yeast alpha-factor and the Aplysia egg-laying hormone (ELH) precursors are not cleaved in oocytes following simple pairs of basic residues, such as Lys-Arg, but that the ELH precursor is cleaved following the consensus sequence Arg-Xaa-(Lys/Arg)-Arg. This motif is conserved among precursors that are cleaved in virtually all mammalian cell types. Mutations that generate this sequence in the alpha-factor prohormone also result in efficient processing within oocytes. Cleavage at this consensus sequence may be due to the action of the Xenopus homologues of mammalian furin.

Isolation and functional expression of a mammalian prohormone processing enzyme, murine prohormone convertase 1

We have combined gene cloning with an assay for prohormone biosynthesis and processing in Xenopus oocytes to identify the genes that encode mammalian prohormone processing enzymes. The coinjection of RNA encoding murine prohormone convertase 1 (mPC1), a mammalian endoprotease, along with proopiomelanocortin RNA into an oocyte results in the appropriate cleavage after paired basic residues in the proopiomelanocortin polyprotein necessary to generate corticotropin. The ability of mPC1 to generate corticotropin, along with the observation that mPC1 is specifically expressed in endocrine and neuronal cells, suggests that the mPC1 gene encodes the endopeptidase responsible for the pathway of proopiomelanocortin cleavage observed in the anterior pituitary.

Is the anterior bone scan necessary in the diagnosis of osseous metastases?

Bone imaging studies of 1650 patients with known or strongly suspected extraosseous malignancies were reviewed to determine whether a completely negative posterior view was sufficient to exclude metastatic disease. Of 708 negative posterior images, 27 (3.4%) were positive for metastasis on anterior views. All of the anterior lesions were in the sternium, sternoclavicular joints and first four ribs. When the posterior view is positive, further views may be unnecessary. Negative or equivocal posterior images necessitate anterior views of the thoracic cage.