Evaluation of the Marburg Heart Score and INTERCHEST score compared to current telephone triage for chest pain in out-of-hours primary care.

INTRODUCTION: Chest pain is a common and challenging symptom for telephone triage in urgent primary care. Existing chest-pain-specific risk scores originally developed for diagnostic purposes may outperform current telephone triage protocols. METHODS: This study involved a retrospective, observational cohort of consecutive patients evaluated for chest pain at a large-scale out-of-hours primary care facility in the Netherlands. We evaluated the performance of the Marburg Heart Score (MHS) and INTERCHEST score as stand-alone triage tools and compared them with the current decision support tool, the Netherlands Triage Standard (NTS). The outcomes of interest were: C­statistics, calibration and diagnostic accuracy for optimised thresholds with major events as the reference standard. Major events are a composite of all-cause mortality and both cardiovascular and non-cardiovascular urgent underlying conditions occurring within 6 weeks of initial contact. RESULTS: We included 1433 patients, 57.6% women, with a median age of 55.0 years. Major events occurred in 16.4% (n = 235), of which acute coronary syndrome accounted for 6.8% (n = 98). For predicting major events, C­statistics for the MHS and INTERCHEST score were 0.74 (95% confidence interval: 0.70-0.77) and 0.76 (0.73-0.80), respectively. In comparison, the NTS had a C-statistic of 0.66 (0.62-0.69). All had appropriate calibration. Both scores (at threshold ≥ 2) reduced the number of referrals (with lower false-positive rates) and maintained equal safety compared with the NTS. CONCLUSION: Diagnostic risk stratification scores for chest pain may also improve telephone triage for major events in out-of-hours primary care, by reducing the number of unnecessary referrals without compromising triage safety. Further validation is warranted.

Estimation of a general time-dependent Hamiltonian for a single qubit.

The Hamiltonian of a closed quantum system governs its complete time evolution. While Hamiltonians with time-variation in a single basis can be recovered using a variety of methods, for more general Hamiltonians the presence of non-commuting terms complicates the reconstruction. Here using a single trapped ion, we propose and experimentally demonstrate a method for estimating a time-dependent Hamiltonian of a single qubit. We measure the time evolution of the qubit in a fixed basis as a function of a time-independent offset term added to the Hamiltonian. The initially unknown Hamiltonian arises from transporting an ion through a static laser beam. Hamiltonian estimation allows us to estimate the spatial beam intensity profile and the ion velocity as a function of time. The estimation technique is general enough that it can be applied to other quantum systems, aiding the pursuit of high-operational fidelities in quantum control.

Quantum optics. Quantum harmonic oscillator state synthesis by reservoir engineering.

The robust generation of quantum states in the presence of decoherence is a primary challenge for explorations of quantum mechanics at larger scales. Using the mechanical motion of a single trapped ion, we utilize reservoir engineering to generate squeezed, coherent, and displaced-squeezed states as steady states in the presence of noise. We verify the created state by generating two-state correlated spin-motion Rabi oscillations, resulting in high-contrast measurements. For both cooling and measurement, we use spin-oscillator couplings that provide transitions between oscillator states in an engineered Fock state basis. Our approach should facilitate studies of entanglement, quantum computation, and open-system quantum simulations in a wide range of physical systems.

An elderly woman with obstructed obturator hernia: a less common variety of external abdominal hernia.

Obturator hernia is a type of external abdominal hernia. Site of hemiation is the obturator canal, which is the superolateral aspect of the obturator foramen. The herniation sac exits the pelvis near the obturator nerve and vessels. Herniated loops of small bowel extend between the pectineus and obturator muscles. In this report, we present a case of obstructed obturator hernia.

The relationship between previous tertiary education and course performance in first year medical students at Newcastle University, Australia.

AIM: The purpose of this study was to identify the relationship between previous tertiary education background and the performance of first year medical students at Newcastle University, Australia. Specifically, we examined degree type (i.e. arts, science, allied health, nursing or other professional backgrounds), level of degree completion (fully or partially completed ), academic achievement ( grade point average) and whether or not students had postgraduate qualifications. The relationship between age and gender was also examined. METHOD: All students admitted to the medical course from 1990 to 1998 with previous tertiary education experience who entered via the "standard" entry pathway and sat the end of year examinations were eligible for the study (N=303). The outcome measures were the results of first assessment ("satisfactory" versus "not satisfactory") and final assessment of the first year ("satisfactory" versus "not satisfactory"). Logistic regression was used to examine the relationship between predictor variables and outcomes. RESULTS: In relation to first assessment results, students with a nursing and arts background were significantly more likely to receive a "not satisfactory" assessment (RR=3.9, 95% CI: 1.6- 7.7; RR=2.9, 95% CI: 1.2-6.8, respectively), as were females (RR=1.8, 95% CI: 1.1-3.5) and students with a grade point average of less than a distinction average (RR=2.8, 95% CI: 1.6-5.2). At final assessment, students with a nursing background and those with a less than distinction average were more likely to receive a "not satisfactory" result (RR=20.7, 95% CI: 3.5-123.9 and RR=4.0, 95% CI: 1.2-13.9, respectively); consequently, they were required to repeat first year. CONCLUSION: Our research suggests that there are some medical student groups who encounter more academic difficulties than others in first year. Identifying these students can assist medical schools to focus academic support appropriately.

Assessment of community mental health care in the Federation of Bosnia-Hercegovina (FBH) after the 1992-95 war.

Bosnia-Hercegovina is in the process of reforming its health care system. One realises that this is a complex matter that will cost a great deal of time and effort. The findings suggest that the highest priority now is the development of the 'mental health strategic and action 'plan', which includes (as a component of the overall PHC strategy) legislation, financing mechanisms, a clear statute for the CMHCs and staff, and to define the relationship with other PHC services. In addition, it is recommended that the authorities should take a more decisive co-ordinating and leading role. To this end, a special Mental Health Task Force assisted by a professional advisory group on mental health and/or professional consultants could be established. In order to realise a real cost-effective community-based care, it is inevitable to allocate enough funds to these primary mental health care services and initiatives such as sheltered living and family support initiatives (eventually to reallocate funds from expenditures on hospital-based care). A mental health reform does not happen in a vacuum and therefore can not be accomplished without 'negotiating' with other sectors/ministries, e.g., Ministries of Finances, Social Affairs/Displaced Persons and Refugees, International Trade and Economy. A multi-sector approach is considered indispensable. Overall management of CMHCs should be strengthened. In addition, it is important that CMHCs exchange information and promote standardised protocols and procedures to enhance comparability and structured referral. The planned Management Information System is a good example, but should be implemented as soon as possible in all CMHCs. Other initiatives to improve professional networking might include (community mental health) newsletters, round table conferences, etc. Further skills training of CMHC staff and management might be difficult to define as long as it is not clear what practical skills are required. Technical Assistance to the (mental) health sector should primarily focus on the overall framework and policy. Training should be tailored to the actual needs and focus primarily on local capacity building via training-of-trainers. Health prevention and promotion, i.e. information provision to the general public and community participation in terms of support for self-help groups and consumer groups, deserve more attention than it has received so far.

Determinants of smoking behaviour among adolescents in Semarang, Indonesia.

OBJECTIVES: To determine the smoking prevalence and to examine the determinants of smoking behaviour among male adolescents in Semarang, Indonesia. DESIGN: A random sample of schools in Semarang (population 1.5 million) was obtained using a stratified sampling procedure (strata based on type of school and district). A total of 149 schools were selected (response rate 72%). Within the schools 186 classes were selected, targeting the 11, 13, 15, and 17 year olds. An anonymous, self administered questionnaire was filled in by all students present at the day of the survey (total sample size 6276). OUTCOME MEASURES: Smoking prevalence, exposure to family and peer smoking, and other variables that may be related to smoking. Logistic regression was used to examine the determinants of smoking behaviour. Only male students were included in the analysis. RESULTS: Smoking increased dramatically between the ages of 11 and 17, from 8.2% to 38.7%. The variance explained by the regression model increased from 19.8% for 11 year olds to 53% for 17 year olds. The smoking behaviour of best friends was the most powerful determinant of smoking, and this was consistent across the age groups. Best friends' attitudes towards smoking and older brothers' smoking behaviour were also important determinants of smoking. CONCLUSIONS: Smoking prevalence among male adolescents in Semarang, Indonesia is high. Effective smoking prevention programmes should take into account the dominant influence of peers in the onset and maintenance of smoking behaviour. In general, school related items had a less important role in predicting smoking behaviour than expected.

12-O-tetradecanoylphorbol-13-acetate (TPA) stimulates the adipose conversion of piglet preadipocytes in primary culture.

The effects of 12-O-tetradecanoylphorbol-13-acetate (TPA) were analyzed on the proliferation and differentiation of cultured porcine preadipocytes. In both chemically-defined and serum-containing media, short term treatment (2 days), either during the growth phase or from confluence, significantly enhanced cell proliferation, as assessed by tritiated thymidine incorporation and protein content assay. Addition of TPA during the growth phase in serum-free medium had no effect on lipoprotein lipase (LPL), glycerol 3-phosphate dehydrogenase (GPDH) and malic enzyme (ME) activities after 14 days of culture. By contrast, similar treatments in serum-containing medium significantly increased all these enzyme activities. Addition of TPA from confluence in both media stimulated LPL activity on day 14 as well as ME activity on day 17. These results were confirmed by morphologic studies. In conclusion, this study demonstrates that a short stimulation of the protein kinase C pathway can enhance the differentiation of porcine preadipocytes. Such a positive effect is however dependent on the time of TPA addition as well as the culture conditions, indicating a complex regulation of the protein kinase C pathway in this cell type.

An anti-adipocyte monoclonal antibody is cytotoxic to porcine preadipocytes in vitro and depresses the development of pig adipose tissue.

A mouse monoclonal antibody of the IgG2b subclass was raised against porcine adipocyte plasma membranes. This antibody did not cross-react in immunocytofluorescence with any tested cell-type or tissue other than porcine adipocytes. Complement-mediated cytotoxicity was demonstrated in primary cultures of porcine stromal-vascular cells. When the antibody and complement were added to already differentiated cultures, the treatment resulted in elimination of lipid-filled preadipocytes, whereas an early treatment of cultures prevented the appearance of these cells. In vivo, injection of newborn pigs with 1 mg/kg of monoclonal antibody on d 2 and 5 of life produced a more than 20% reduction of subcutaneous and leaf fat lipids at 35 d of age, whereas the lipid content of the longissimus muscle remained unaffected. These results demonstrate that early systemic treatment of pigs with a specific anti-adipocyte antibody reduces the fat mass. In addition to their potential in vivo use, monoclonal antibodies directed against adipose determinants may be useful tools for studying adipocyte lineage.

The cellularity of developing adipose tissues in Pietrain and Meishan pigs.

The development of external, internal, inter- and intramuscular adipose tissues was compared in Pietrain (lean) and Meishan (obese) pigs during their growth, at 0, 7, 30 and 90 days of age. Up to 1 month of age, the total lipid content of external and internal adipose tissues as well as mean adipocyte diameter increased similarly in both breeds of pigs. The percentage of plurilocular adipocytes decreased in both breeds; it remained higher in Meishan up to 30 days of age, which would indicate a delayed maturity of adipose tissue in this pig. Adipocyte hypertrophy characterizing the Meishan pig starts between 1 and 3 months of age. At 90 days, adipocyte diameters were about 50% higher in Meishan than in Pietrain. Muscle lipid content was higher in Pietrain than in Meishan until 1 month of age, whereafter it became lower than that of Meishan. Intramuscular adipocytes appeared later than those of other tissues in both breeds and were larger in Meishan than in Pietrain.

Effects of acute or chronic administration of tumor necrosis factor on rat adipose tissue development.

Because tumor necrosis factor (TNF) inhibits adipose cell differentiation in vitro and affects lipid metabolism in vivo, we treated adult or newborn rats for 1 wk with daily intraperitoneal injections (100 U/g of body weight) or continuous intraperitoneal diffusion (3500 U/h) of human recombinant TNF. Three weeks after the end of treatment, the long-term effect of the cytokine was examined on adipose tissue development. Control and TNF-injected rats did not differ in growth or development of perirenal, retroperitoneal and epididymal adipose tissues. Nevertheless, the size distribution of epididymal adipocytes of adult injected rats presented a slight shift towards larger values in the cytokine group. When TNF was administered chronically, the cytokine exerted an anorectic effect, which was alleviated after the end of treatment. The weights of the excised adipose tissues were depressed (P < .025) by TNF administration. Part of this effect was due to the induced anorexia. The size distributions of the epididymal adipocytes of pair-fed and TNF-treated rats were both shifted to smaller (P < 0.01) values than for the controls. The ratio of triglycerides over total lipids was, however, reduced by TNF specifically, but only at the retroperitoneal (P < .05) and not the epididymal site. These results indicate that in contrast to acute treatment, chronic TNF treatment slightly inhibited adipose tissue development in vivo; however, most of this effect was attributable to the associated anorexia.

The evolution of spondyloarthropathies in relation to gut histology. I. Clinical aspects.

OBJECTIVE: To study prospectively the clinical evolution of different forms of spondyloarthropathy (SpA) (excluding inflammatory bowel disease, IBD): reactive arthritis, undifferentiated SpA, and ankylosing spondylitis (AS). METHODS: Ileocolonoscopy was performed on 217 patients with SpA (149 men, 68 women). They also underwent clinical, laboratory, and radiological examinations. Two to 9 years later, 123 patients (84 men, 39 women) who had been regularly monitored were reviewed and given the same examinations. For the remaining 94 patients clinical data were obtained by telephone. RESULTS: At the time of clinical review, 53 (43%) of the regularly monitored patients were in clinical remission. The remission rate was higher in patients with non-ankylosing spondylitis SpA (non-As-SpA) than in patients with AS (19%). Fourteen patients with non-AS-SpA had developed AS; 4 of them also had IBD. IBD was also found in 4 patients with AS and in 3 patients from the telephone group. The prevalence of HLA-B27 was significantly higher in all SpA subgroups, while HLA-BW62 was elevated in the undifferentiated SpA. At review, HLA-B27 was significantly more prevalent in patients with persistent locomotor inflammation compared to patients in clinical remission, while HLA-BW62 was predominant in the latter group. CONCLUSION: Patients with SpA, especially those with non-AS-SpA, have a good longterm prognosis. However, patients with non-AS-SpA may develop AS. Six percent of the patients with SpA in whom manifestations of IBD are absent will develop this disease. This confirms the hypothesis that some of these patients with SpA initially have a form of subclinical Crohn's disease, of which locomotor inflammation is the only clinical expression. HLA-B27 positivity predisposes to a more severe course of locomotor inflammation, while HLA-BW62 has a protective effect but is associated with gut inflammation.

The evolution of spondyloarthropathies in relation to gut histology. II. Histological aspects.

OBJECTIVE: To study prospectively the clinical evolution of different forms of spondyloarthropathy (SpA) in relation to the type of gut histology in ileocolonoscopic biopsy specimens. METHODS: Ileocolonoscopy was performed in 217 patients with SpA (149 men, 68 women). Three types of gut histology (normal gut histology and acute and chronic inflammatory gut lesions) were found. Clinical, laboratory, and radiological examinations were performed at start and 2 to 9 years later in 123 patients who were regularly monitored. For the remaining 94 patients clinical data were obtained by telephone. RESULTS: Of the 123 patients monitored regularly, 40 (32%) had normal gut histology, and 28 (23%) had acute and 55 (45%) chronic inflammatory gut lesions. Acute lesions were preferentially found in patients with non-ankylosing spondylitis SpA (non-AS-SpA). In the groups with normal gut histology and with chronic gut inflammation, patients with ankylosing spondylitis (AS) and non-AS-SpA were present in equal numbers. At review, clinical evolution was identical in the 3 histological subgroups. Eight patients developed idiopathic inflammatory bowel disease (IBD), one with initially acute gut inflammation, 7 with initially chronic gut inflammation. All had active AS at review. Fourteen patients with non-AS-SpA developed AS; 13 of them had initially presented inflammatory gut lesions. Three patients in the telephone group also developed IBD; all had active AS at review and initially presented chronic inflammatory gut lesions. Persistently high inflammatory serum variables, HLA-B27 negativity in the presence of sacroiliitis or AS, and inflammatory gut lesions at the first ileocolonoscopy indicate patients with SpA are at risk for developing IBD. CONCLUSION: Gut inflammation, mainly subclinical, could be demonstrated in 68% of patients with SpA. Acute gut inflammation was predominant in patients with reactive arthritis (ReA). The evolution to clinical remission was not influenced by the presence or the type of gut inflammation at start. Patients with non-AS-SpA with inflammatory gut lesions have greater risk of developing AS. One patient with Yersinia induced ReA developed AS and IBD. In total, 11 patients (66%) developed IBD, all initially presenting inflammatory gut lesions. Ten had chronic gut lesions, suggesting this type of gut inflammation is related to the inflammation of Crohn's disease. This type of gut inflammation, the persistence of high inflammatory serum variables, and the absence of HLA-B27 in patients with AS are risk factors for developing IBD.

The evolution of spondyloarthropathies in relation to gut histology. III. Relation between gut and joint.

OBJECTIVE: To study prospectively the clinical evolution of different forms of spondyloarthropathy (SpA) in relation to the evolution of gut histology in consecutive ileocolonoscopic biopsy specimens. METHODS: Ileocolonoscopy was performed in 49 patients with SpA (34 men, 15 women). They also underwent clinical, laboratory, and radiological examinations. Two to 9 years later, a 2nd and sometimes a 3rd or 4th ileocolonoscopy was performed, and the other examinations were repeated. RESULTS: At first ileocolonoscopy, 34 patients (69%) showed inflammatory gut lesions. At the 2nd ileocolonoscopy, 16 patients (32%) were in clinical remission; none were found to have inflammatory gut lesions. Of the 33 patients with persistent locomotor inflammation, 14 had persistent inflammatory gut lesions, predominantly the chronic type. Of these 14 patients, 6 had developed inflammatory bowel disease (IBD). None of the 15 patients with an initially normal gut histology had gut inflammation at 2nd examination. Of the 9 with initially acute lesions, 3 developed chronic lesions (1 Crohn's disease). Initial chronic lesions in 25 patients persisted in 9, of whom 5 had developed IBD. Seven of the 19 patients with non-SpA ankylosing spondylitis (non-AS-SpA) developed ankylosing spondylitis (AS); all had initially presented inflammatory gut lesions, which persisted at 2nd examination. In the 11 patients with more than 2 consecutive ileocolonoscopies, clinical remission was always associated with normal gut histology, and flares of the joint disease were related temporally to the reappearance of gut inflammation. CONCLUSION: This study demonstrates the close relationship between gut and locomotor inflammation in SpA. Clinical remission was always associated with normal gut histology, whereas active locomotor inflammation was usually associated with the presence of gut inflammation. Absence of gut inflammation in the SpA is a good prognostic indicator, since gut inflammation or IBD never develops in these patients. Evolution of non-AS-SpA to full blown AS or of uncomplicated SpA to a form of IBD was always associated with gut inflammation at disease onset.

Prevention of the cytotoxic effect of IL-1 by human lysozyme on isolated rat islets.

Macrophages are present in the initial phase of the autoimmune process involved in the destruction of the endocrine pancreas in IDDM via the secretion of cytokines such as IL-1 beta. Macrophages also secrete lysozyme. Besides its action on the bacterial cell wall, lysozyme has an important physiological and immunological role. Human lysozyme is an in-situ modulator of the inflammatory reactions. We investigate the protective role of human lysozyme in vitro against the cytotoxic effect of IL-1 beta or of IL-1 beta combined with IFN-gamma on isolated rat islets. Precultured newborn rat islets were incubated with human or chicken lysozyme (50.000 U/ml) over 3 days. Human IL-1 beta (100 U/ml) or IL-1 beta (5 U/ml) + INF-gamma (100 U/ml) was added for the last 2 days and tritiated thymidine for the last 24 hrs. In another set of experiments, islets were exposed simultaneously to human lysozyme and IL-1 beta. Only pretreatment with human lysozyme abolished the lowering of the labelling index of the islet cell induced by IL-1 beta or by IL-1 beta and INF-gamma. Pycnotic nuclei were abundant in islets treated with IL-1 alone while they were not when islets were pretreated with human lysozyme. Chicken lysozyme had no protective effect in the same protocol. Human lysozyme was not protective when applied simultaneously with IL-1. Pretreatment of the islets by human lysozyme does not prevent the reduction of the insulin secretion induced by IL-1 beta. Human and chicken lysozyme differ further in their action when tested on fibroblasts proliferation. Only human lysozyme stimulates the latter. In conclusion, only human lysozyme seems to have a protective effect against the cytotoxicity of IL-1 in combination or not with IFN-gamma on islet cells in vitro. Moreover, to be protected, the islets have to be pretreated with lysozyme before the IL-1 application. Our in vitro results imply that natural aspecific immunity and its relation to the secretory function of the macrophage might be crucial for the prevention of the initial assault responsible for the onset of the immune process leading to insulin dependent diabetes.

Prevalence of inflammatory rheumatic diseases in an adolescent urban student population, age 12 to 18, in Belgium.

In order to determine the prevalence of inflammatory rheumatic diseases in an urban secondary school student population, a questionnaire dealing with past or present joint, tendon, axial, gastrointestinal, ocular and dermatological symptoms was completed by 2,990 students of secondary schools in Antwerp and Ghent. The parents were asked to complete a questionnaire regarding the family medical history. From these 2,990 students, 524 were selected for further investigation by a rheumatology resident, who checked the answers to the first questionnaire and performed a clinical examination. Forty-one adolescents with a presumptive history or present symptoms of inflammatory rheumatic diseases were retained. These students were examined by the medial staff of the rheumatology department; if necessary, a complementary biochemical and radiological examination was performed. Five cases of definite juvenile chronic arthritis (JCA) (with polyarticular onset in 1 case and late pauciarticular onset in 4 cases) and 4 cases of presumptive late pauciarticular onset JCA were detected, resulting in a prevalence of 167 per 100,000 for definite JCA and of 301 per 100,000 for possible JCA. This prevalence rate is higher than that generally described. This method of investigation effectively allows the detection of milder and spontaneously remitting cases of JCA. It further enabled us to definite case and 4 presumptive cases of various previously undiagnosed forms of JCA.

Juvenile spondyloarthropathies in 1992.

There is some evidence that patients with late onset pauciarticular juvenile chronic arthritis (JCA) should be included among those with spondyloarthropathies, at least during the course of their disease, even if at the onset of the disease we prefer to label them as patients with JCA. The clinical symptoms which could allow us to classify them as spondyloarthritic are frequently absent at the onset of the disease. The gut seems to play a role in the pathogenesis of this form of JCA, though the exact mechanisms must be elucidated further.

Anthropometric and biochemical assessment of the nutritional state in depression: evidence for lower visceral protein plasma levels in depression.

Severe depression is characterized by anorexia and weight loss, symptoms that could endanger the patient's nutritional state. In order to investigate the nutritional state of depressed patients we determined the following in 113 healthy controls and depressed inpatients: (1) anthropometric variables such as body weight, ideal body weight (IBW), percentage of IBW, mean arm circumference, triceps skinfold thickness and arm muscle circumference, and (2) biochemical parameters such as albumin (Alb), prealbumin (Prealb), and transferrin (Tf). We were unable to detect any differences in the anthropometric parameters between healthy controls, minor and major depressed patients. Depressed patients exhibited significantly lower Alb and Tf levels than healthy controls. The drop in both plasma proteins was highly sensitive (72%) and specific (92%) for melancholia. These results may point towards the existence of a disorder in protein homeostasis or protein malnutrition without a marasmic component.

Influence of human recombinant interleukin-1 beta on human articular cartilage. Mitotic activity and proteoglycan metabolism.

The effects of human recombinant interleukin-1 beta (IL-1 beta) were investigated on recently isolated (1 to 3 weeks) and on well-established (older than 3 weeks) monolayer cultured human articular chondrocytes. IL-1 beta was found to depress 35S-proteoglycan synthesis rates and to enhance prostaglandin E2 (PGE2) production in these monolayer cultured chondrocytes. Induction of 35S-proteoglycan-degradative activity by these cells also occurred in IL-1 beta treated cultures. These "catabolin" -IL-1 activities were observed in recently isolated as well as in well-established "old" cultures. IL-1 beta increased 3H-thymidine incorporation rates in the "old" cultures. However, in recently isolated chondrocytes a dose-dependent reduction of the 3H-thymidine incorporation occurred. The depression of mitotic activity in these cells was partially abolished by indomethacin, indicating that this depression was a PGE2 effect. However, supplementing IL-1 beta with indomethacin did not raise the 3H-thymidine incorporation rates above the control levels. It can be concluded that IL-1 beta in itself is unable to induce proliferation in recently isolated cartilage cells. Our results suggest the possible existence of two different receptors for the different IL-1 beta activities. Hence, human articular chondrocytes respond differently to in vitro IL-1 beta exposure at different stages of differentiation.