A history-taking system that uses continuous speech recognition

Q-MED is an automated history-taking system that uses speaker-independent continuous speech as its main interface modality. Q-MED is designed to allow a patient to enter her basic symptoms by engaging in a dialog with the program. Error-recovery mechanisms help to eliminate findings resulting from misrecognitions or incorrect parses. An evaluation of the natural language parser that Q-MED uses to map user utterances to findings showed an overall semantic accuracy of 87 percent; Q-MED asks more specific questions to capture findings that were not volunteered, or that were unable to be parsed in their initial, open-ended form.

Proteolytic removal of core histone amino termini and dephosphorylation of histone H1 correlate with the formation of condensed chromatin and transcriptional silencing during Tetrahymena macronuclear development

During the sexual cycle in Tetrahymena, the germ-line micronucleus gives rise to new macro- and micronuclei, whereas the former somatic macronucleus ceases transcription, becomes highly condensed, and is eventually eliminated from the cell. With polyclonal antibodies specific for acetylated forms of histone H4, immunofluorescent analyses have demonstrated that transcriptionally active macronuclei stain positively at all stages of the life cycle except during conjugation, when parental macronuclei become inactive and are eliminated from the cell. In this report using affinity-purified antibodies to either the acetylated or unacetylated amino-terminal domain of H4, immunofluorescent analyses suggest that the acetylated amino-terminal tails of H4 are proteolytically removed in "old" macronuclei during this period. This suggestion was further confirmed by biochemical analysis of purified old macronuclei that revealed several polypeptides with molecular mass 1-2 kD less than that of intact core histones. These species, which are unique to old macronuclei, are not newly synthesized and fail to stain with either acetylated or unacetylated H4 antibodies. Microsequence analysis clearly shows that these polypeptides are proteolytically processed forms of core histones whose amino-terminal "tails" (varying from 13 to 21 residues) have been removed. During the same developmental period, histone H1 is dephosphorylated rapidly and completely in old macronuclei. These results strongly suggest that the developmentally regulated proteolysis of core histones and dephosphorylation of histone H1 participate in a novel pathway leading to the formation of highly condensed chromatin and transcriptional silencing during Tetrahymena macronuclear development.

Prediction of response to interferon in patients with chronic active hepatitis C, and evidence that this improves hepatic metabolic function

We sought to ascertain whether response to alpha interferon treatment could be predicted among patients with chronic active hepatitis C, and whether antipyrine clearance estimations would determine changes in liver function with this disease. The patients came from a randomized controlled trial, with patients who were initially untreated eventually being offered interferon treatment. Among 28 patients treated with interferon 18 (64%) responded with normalization of serum aminotransferase levels. Responders were less likely to have acquired hepatitis C by blood transfusion and more likely to have acquired it by intravenous drug abuse (P less than 0.05). All 13 patients with less severe chronic active hepatitis responded to interferon but only 5 of 15 patients with progressive fibrosis or cirrhosis responded (P less than 0.01). During 8-39 (median 19) months of observation of 16 untreated patients, there was a significant fall in antipyrine clearance (Cl-Ap) but no change in serum albumin. Among interferon-treated patients, Cl-Ap improved in 9 of 16 compared with 1 of 14 controls observed for the same time period (P less than 0.02). It is concluded that Cl-Ap is a sensitive test for detecting changes in liver function during chronic hepatitis. Without treatment, deterioration is evident at 18 months in 50% of patients with chronic active hepatitis C. Conversely, normalization of serum aminotransferase levels by interferon is associated with improvement of Cl-Ap.(ABSTRACT TRUNCATED AT 250 WORDS)

Can the response to interferon treatment be predicted in patients with chronic active hepatitis C?

Twenty-one of 40 patients with chronic non-A, non-B hepatitis (37 anti-HCV positive) were randomised to receive interferon alpha 2b (3 million units subcutaneously thrice weekly for 24 weeks) and then to be observed for six months. Among the other 19 patients (controls) randomised to be observed without treatment for 12 months, eight have subsequently been treated with interferon for six months. One treated patient and three controls were lost to follow-up. A return to normal serum alanine aminotransferase levels which lasted until the end of the treatment period occurred in 18 (64%) of the 28 patients given interferon (and in 13 of 21 (62%) randomised to treatment), but only in one of the 16 untreated controls (p less than 0.001). Multivariant analysis indicated that, compared with the ten nonresponders, the 18 patients who responded to interferon were more likely to have acquired infection by intravenous drug abuse than by blood transfusion (p less than 0.05), and were more likely to have histologically less severe chronic liver disease (p less than 0.01). Thus, all 13 patients with less severe liver disease histologically responded to interferon, but only five of 15 patients with cirrhosis or bridging fibrosis responded. Among 17 responders followed for more than four months, five (28%) are still in remission a median of 13 months (range four months to 24 months) after stopping interferon. The characteristics which favoured a response during treatment also appeared to distinguish those who experienced sustained post-treatment remission.(ABSTRACT TRUNCATED AT 250 WORDS)

Timing of the appearance of ubiquitinated histones in developing new macronuclei of Tetrahymena thermophila

Vegetative cells of the ciliated protozoan Tetrahymena thermophila contain a transcriptionally active macronucleus and a transcriptionally inert micronucleus. During vegetative growth, macronuclear histones H2A and H2B and micronuclear H2A are ubiquitinated. Despite differences in function, macro- and micro-nuclei are related. During conjugation (the sexual phase of the life cycle in Tetrahymena), postzygotic division products of micronuclei give rise to new micro- and macro-nuclei. Using an anti-ubiquitin antibody in Western blotting experiments, we determined the levels of ubiquitinated histones in new macro- and micro-nuclei at various times during conjugation. Very soon after the second postzygotic division (approximately 8 h) when new macronuclei begin to synthesize RNA, ubiquitinated H2B and polyubiquitinated H2A are present. At this time micronuclei have only low levels of ubiquitinated H2A. During later stages of conjugation (15 h), the level of polyubiquitinated H2A decreases, while ubiquitinated H2B increases in developing new macronuclei, attaining levels of ubiquitinated H2B approaching that of parental macronuclei. Ubiquitinated histones are not detectable in the 15-h micronuclei. These results show that ubiquitination of H2B coincides with the transformation of an inert germinal nucleus into that of a transcriptionally active somatic nucleus, suggesting that ubiquitinated H2B has a role in maintaining the transcriptionally active chromatin state.

A free-text processing system to capture physical findings: Canonical Phrase Identification System (CAPIS)

The task of gathering detailed patient information from free-text medical records presents a significant barrier to clinical research. In this paper, we describe a prototype system for extracting physical examination findings from dictated admission summaries. Our computer program applies a concept-based free-text processing algorithm that identifies user-selected target physical examination findings. We are using the extraction system to enrich an existing clinical database. The system was evaluated by comparing the physical examination findings extracted by our computer program with findings extracted by an independent investigator. Our prototype system was able to recall 92 percent (sensitivity) of the relevant physical findings, with a precision of 96 percent (positive predictive value).

A free-text processing system to capture physical findings: Canonical Phrase Identification System (CAPIS)

The task of gathering detailed patient information from free-text medical records presents a significant barrier to clinical research. In this paper, we describe a prototype system for extracting physical examination findings from dictated admission summaries. Our computer program applies a concept-based free-text processing algorithm that identifies user-selected target physical examination findings. We are using the extraction system to enrich an existing clinical database. The system was evaluated by comparing the physical examination findings extracted by our computer program with findings extracted by an independent investigator. Our prototype system was able to recall 92 percent (sensitivity) of the relevant physical findings, with a precision of 96 percent (positive predictive value).

The role of fibre optics in gastroenterology

Diagnostic fibre optic endoscopy has a well established role in clinical gastroenterology. The authors highlight the expanding therapeutic applications of this technology.

Delayed onset PTSD among Israeli veterans of the 1982 Lebanon War

This is an exploratory study of the nature, course and rates of delayed post-traumatic stress disorder (PTSD). We reviewed 150 medical files of Israeli soldiers who sought help between 6 months and 5 years after the 1982 Lebanon War. Results indicated that only 10% of the cases were truly examples of delayed PTSD; in a large proportion of the cases, help-seeking rather than onset was delayed.

Antibodies specific to acetylated histones document the existence of deposition- and transcription-related histone acetylation in Tetrahymena

In this study, we have constructed synthetic peptides which are identical to hyperacetylated amino termini of two Tetrahymena core histones (tetra-acetylated H4 and penta-acetylated hv1) and used them to generate polyclonal antibodies specific for acetylated forms (mono-, di-, tri-, etc.) of these histones. Neither of these antisera recognizes histone that is unacetylated. Immunoblotting analyses demonstrate that both transcription-related and deposition-related acetate groups on H4 are recognized by both antisera. In addition, the antiserum raised against penta-acetylated hv1 also recognizes acetylated forms of this variant. Immunofluorescent analyses with both antisera demonstrate that, as expected, histone acetylation is specific to macronuclei (or new macronuclei) at all stages of the life cycle except when micronuclei undergo periods of rapid replication and chromatin assembly. During this time micronuclear staining is also detected. Our results also suggest that transcription-related acetylation begins selectively in new macronuclei immediately after the second postzygotic division. Acetylated histone is not observed in new micronuclei during stages corresponding to anlagen development and, therefore, histone acetylation can be distributed asymmetrically in development. Equally striking is the rapid turnover of acetylated histone in parental macronuclei during the time of their inactivation and elimination from the cell. Taken together, these data lend strong support to the idea that modulation of histone acetylation plays an important role in gene activation and in chromatin assembly.

Lipoprotein lipase: a source of free fatty acids in bronchoalveolar lining fluid

Long-chain free fatty acids (FFAs) in pulmonary bronchoalveolar lavage fluid (BALF) are antimicrobial agents that may participate in lung defenses. FFAs may also participate in synthetic and metabolic activities of bronchoalveolar lining cells. In evaluating the origins of FFAs, we found that rat triglyceride lipase activity was readily detectable in rat BALF. This activity appeared to be caused mainly by lipoprotein lipase (LPL), because it was inhibited by protamine, a high salt concentration, or specific anti-LPL antibody. LPL activity was detected in BALF from guinea pigs, humans, and rabbits, but rats had significantly more LPL activity than the other species. LPL activity in rat BALF was enhanced by heat-inactivated serum, but LPL-mediated hydrolysis of triglycerides in BALF proceeded at 37 degrees C in vitro even without serum. The possibility that BALF contained an intrinsic LPL activating factor(s) was suggested by the fact that concentrated, heat-inactivated lavage was 85% as effective as heat-inactivated serum in enhancing the LPL activity of fresh BALF. Macrophages are the likely source of LPL in BALF, and we confirmed that rat resident alveolar macrophages produce LPL in culture in a time-dependent fashion. It was concluded that FFAs in BALF were produced by the hydrolysis of triglycerides by LPL.

Effect of diclofenac sodium (Voltaren) on spermatogenesis of infertile oligospermic patients

The effect of the prostaglandin synthesis inhibitor diclofenac sodium (Voltaren) on spermatogenesis in infertile oligospermic patients has been studied. Diclofenac sodium was given orally at a daily dose of 100 mg for 30 days. Seminal fluid parameters were evaluated. Group II with high levels of seminal prostaglandin showed a statistically significant increase in the number and motility of spermatozoa (p less than 0.01), whilst no significant variations were observed in patients of group I with normal values of seminal prostaglandin.

Deaths as a result of a combination of codeine and glutethimide

Toxicological findings are described in 16 medical examiner cases directly related to the combination of codeine and glutethimide. The cases described represent a six-month period, July through December 1982, showing the epidemic rate of abuse of this drug combination, most prominent in the Newark, NJ area since the late 1970s. Concentrations of codeine and glutethimide, measured by gas liquid chromatography (GLC), in the blood averaged 0.62 and 4.07 mg/L, respectively. Similarly determined urine concentrations averaged 38.06 and 12.68 mg/L, respectively. Specific concentrations of each drug in most cases were in the high therapeutic range, suggesting a possible toxic synergistic effect.

Effects of antibiotics on polymorphonuclear leukocyte chemiluminescence and chemotaxis

Polymorphonuclear leukocyte chemiluminescence and chemotaxis assays were performed on cells obtained from normal individuals and patients with defined defects in chemotaxis or chemiluminescence. After in-vitro pre-incubation with trimethoprim/sulphamethoxazole, its separate components, clindamycin and cefotaxime, normal cells showed some enhancement in chemotaxis and significant increase in chemiluminescence. There was an even more marked increase in chemotaxis when these antibiotics were incubated with cells from patients with leukocyte chemotaxic defects. When the cells from patients with chemiluminescence defects were pre-incubated with these antibiotics, there was also substantial enhancement in chemiluminescence.

Histo-mechanical aspects of carpal tunnel syndrome

Carpal tunnel syndrome is a result of median nerve compression within the carpal canal. Factors associated with the appearance of carpal tunnel syndrome can be related to the bony architecture of the carpal canal, to its contents and to systemic disease. The purpose of this work is to see if changes in the elasticity of the transverse carpal ligament may cause carpal tunnel syndrome.

Value of concomitant sympathectomy in aortoiliac reconstruction. Results of a prospective, randomized study

The efficacy of concomitant lumbar sympathectomy in improving results of aortoiliac reconstruction was assessed by a prospective, randomized study of 51 patients undergoing operation for occlusive or aneurysmal disease. Sympathectomy was performed on 50 limbs, while 52 extremities served as controls. Sympathectomy resulted in a significant reduction in foot vascular resistance determined by plethysmography. However, the procedure had no effect on leg circulation, assessed by ankle/arm pressure indices determined by Doppler ultrasound. In the sympathectomy group, there were three early postoperative amputations for ischemia, despite patent grafts. In the control group, there was one late graft occlusion, caused by progressive atherosclerotic disease. Although sympathectomy may improve pedal circulation, the procedure does not appear to improve the results of aortoiliac reconstruction.