ALMA Observations of the Water Fountain Pre-Planetary Nebula IRAS 16342-3814: High-Velocity Bipolar Jets and an Expanding Torus.

We have mapped 12CO J=3-2 and other molecular lines from the "water-fountain" bipolar pre-planetary nebula (PPN) IRAS 16342-3814 with [Formula: see text] resolution using ALMA. We find (i) two very high-speed knotty, jet-like molecular outflows, (ii) a central high-density (> few × 106 cm-3), expanding torus of diameter 1300 AU, and (iii) the circumstellar envelope of the progenitor AGB, generated by a sudden, very large increase in the mass-loss rate to > 3.5 × 10-4M⊙ yr-1 in the past ~455 yr. Strong continuum emission at 0.89 mm from a central source (690 mJy), if due to thermally-emitting dust, implies a substantial mass (0.017 M⊙) of very large (~mm-sized) grains. The measured expansion ages of the above structural components imply that the torus (age~160 yr) and the younger high-velocity outflow (age~110 yr) were formed soon after the sharp increase in the AGB mass-loss rate. Assuming a binary model for the jets in IRAS 16342, the high momentum rate for the dominant jet-outflow in IRAS 16342 implies a high minimum accretion rate, ruling out standard Bondi-Hoyle-Lyttleton wind accretion and wind Roche lobe overflow (RLOF) models with white-dwarf or main-sequence companions. Most likely, enhanced RLOF from the primary or accretion modes operating within common envelope evolution are needed.

Lesiones gástricas premalignas en familiares en primer grado de pacientes con cáncer gástrico evaluados en la consulta de gastroenterología de dos hospitales universitarios de Caracas / Premalignant gastric lesions in first-degree relatives of gastric cancer patients evaluated in the gastroenterology at two university hospitals in Caracas

Las alteraciones morfológicas de la mucosa gástrica que predisponen al desarrollo de cáncer gástrico son atrofia, metaplasia y displasia. Diversos factores etiológicos han sido estudiados, destacándose el parentesco en primer grado con una probabilidad de presentar cáncer gástrico 2 veces más que la población general. Diagnosticar lesiones gástricas premalignas en familiares de pacientes con cáncer gástrico, evaluados en las consultas de Gastroenterología del Hospital Vargas de Caracas y Hospital Militar "Dr. Carlos Arvelo". Se realizó un estudio descriptivo, prospectivo, longitudinal, desde Octubre 2008 a Mayo 2009. Se incluyeron 75 individuos con edades comprendidas entre 18 y 80 años, familiares en primer grado de pacientes con cáncer gástrico, a los cuales se les practicó endoscopia digestiva superior con toma de biopsia. En 51 pacientes femeninos (68%) y 24 (32%) masculinos, se encontraron los siguientes hallazgos endoscópicos: endoscopia normal 52%, gastropatía crónica 33%, úlcera gástrica 5,33%, pólipos gástricos 3,33% y úlcera duodenal 1,33%. El estudio histológico determinó que la atrofia estuvo presente en 25 pacientes (33,3%), metaplasia intestinal en 17 pacientes (22,67%), displasia en 4 pacientes (5,33%), la mitad de ellas de alto grado y 1 (1,33%) indefinido para displasia. Conclusión y recomendación: En el grupo estudiado se encontró un 42,6% de lesiones gástricas premalignas, de las cuales el 5,33% correspondió a displasia, ninguno de estos con lesiones endoscópicas de malignidad; lo que nos hace recomendar de rutina en todos los servicios de gastroenterología del país un programa de pesquisa en familiares en primer grado de pacientes de cáncer gástrico...

Morphological alterations of the gastric mucosa that predispose to the development of gastric cancer are atrophy, metaplasia and dysplasia. Various etiologic factors have been studied, especially in first degree relatives,with a probability of gastric cancer double than that of the general population. To diagnose premalignant gastric lesions in relatives of patients with gastric cancer evaluated in the Gastroenterology consultation of "Hospital Vargas de Caracas", and "Hospital Militar Dr. Carlos Arvelo". A descriptive, prospective, longitudinal study was made, from October 2008 to May 2009. We included 75 individuals aged 18 to 80 years in first degree relatives of patients with gastric cancer, who underwent upper gastrointestinal endoscopy with biopsy guided. We found 51 (68%) female and 24 (32%) male, with these endoscopic findings: normal in 52% of the patients, with chronic gastropathy 37, 33%, gastric ulcer in 5,3%, gastric polyps in 3,33% and duodenal ulcer in 1,33%. The histological study found that atrophy was present in 25 (33.3%) patients, intestinal metaplasia in 17 (22, 67%) and dysplasia in 4(5, 33%) and 1(1,33%) indefinite to dysplasia. In this group of patients it was found a 42.6% of premalignant gastric lesions, of which 5.33% corresponded to dysplasia. Neither one had endoscopic malignant lesions. We recommend as a routine in all Gastroenterology Divisions in the country a program of screening in first degree families of patients of gastric cancer...

A template for the future: digitizing and databasing a taxonomic illustration collection.

This is the first iconographic taxonomic database intended as an everyday tool for the practising taxonomist, that allows access to the original drawings used to describe species. We demonstrate the system with water mites (Acari, Parasitengona, Hydrachnidia) but it may be used with any other plant or animal group. Query by genus or species leads to the original drawings and any additional images associated to that particular name. At present, the database includes images from more than 4,000 species (around 38,000 illustrations) and is easily expandable. Copyright does not allow the database to be used in an open WWW context, but it can be an extremely useful tool in private taxonomic applications.

UV circular polarisation in star formation regions: the origin of homochirality?

Ultraviolet circularly polarised light has been suggested as the initial cause of the homochirality of organic molecules in terrestrial organisms, via enantiomeric selection of prebiotic molecules by asymmetric photolysis. We present a theoretical investigation of mechanisms by which ultraviolet circular polarisation may be produced in star formation regions. In the scenarios considered here, light scattering produces only a small percentage of net circular polarisation at any point in space, due to the forward throwing nature of the phase function in the ultraviolet. By contrast, dichroic extinction can produce a fairly high percentage of net circular polarisation ( approximately 10%) and may therefore play a key role in producing an enantiomeric excess.

Bronquiolitis respiratoria como causa de fibrosis pulmonar (BR-FP): estudio histopatológico y ultraestructural de tres casos / Respiratory bronchiolitis with cause of pulmonary fibrosis (BR-FP): study histopathologic and structure of three cases

La bronquiolitis respiratoria es una lesión que se desarrolla en los pulmones de pacientes fumadores. Recientemente ha sido señalado que esta enfermedad puede evolucionar hacia la fibrosis pulmonar y se denomina Bronquiolitis Respiratoria-Fibrosis pulmonar. Histologicamente: La lesión se caracteriza por fibrosis peribronquiolar con macrófagos alveolares con un pigmento citoplasmático, finamente granular PAS positivo y Azul de Prusia débilmente positivo localizados en los espacios bronquiolares y alveolares, enfisema centrolobulillar e hiperplasia de neumocitos tipo II. A la ultraestrctura se observa en el citoplasma de los macrófagos alveolares intraluminales, fagolisosomas complejos que contienen un material amorfó electro-denso y particulas electrón lúcidas en forma de agujas conocidas como "inclusiones del fumador". Estudiamos tres (3) biopsias pulmonares con diagnóstico clínico de Enfermedad Pulmonar Intersticial. A través del estudio morfológico correlacionado con la clínica y la radiología concluimos que se trataba de una BR-FP. Enfatizamos la importancia de los criterios diagnósticos morfológicos y el diagnóstico diferencial de esta entidad, ya que se describe que tiene buena respuesta a la terapia con esteroides y al cese del hábito de fumar, por lo cual se considera de mejor pronóstico que otras enfermedades pulmonares intersticiales

Circular polarisation in star-forming regions: possible implications for homochirality.

Our discovery of high degrees of circular polarisation in some star-forming regions provides an attractive mechanism for the origin of homochirality. The largest degrees of circular polarisation, so far observed at near-infrared wavelengths, are thought to arise from the scattering of stellar radiation from aligned dust grains and are calculated to extend down to UV wavelengths. The extent of the region where circularly polarised light (CPL) of a single handedness originates is very large, and it is likely that the whole of a planetary system would see a single handedness of CPL also. We present the observational data, models of the scattering that leads to the production of CPL, and a model for the origin of homochirality. We also discuss briefly future laboratory and space-based experiments.

Near-Infrared Imaging Polarimetry of the GG Tauri Circumbinary Ring.

We present 1 µm Hubble Space Telescope/near-infrared camera and multiobject spectrometer resolved imaging polarimetry of the GG Tau circumbinary ring. We find that the ring displays east-west asymmetries in surface brightness as well as several pronounced irregularities but is smoother than suggested by ground-based adaptive optics observations. The data are consistent with a 37 degrees system inclination and a projected rotational axis at a position angle of 7 degrees east of north, determined from millimeter imaging. The ring is strongly polarized, up to approximately 50%, which is indicative of Rayleigh-like scattering from submicron dust grains. Although the polarization pattern is broadly centrosymmetric and clearly results from illumination of the ring by the central stars, departures from true centrosymmetry and the irregular flux suggest that binary illumination, scattering through unresolved circumstellar disks, and shading by these disks may all be factors influencing the observed morphology. We confirm a approximately 0&farcs;25 shift between the inner edges of the near-infrared and millimeter images and find that the global morphology of the ring and the polarimetry provide strong evidence for a geometrically thick ring. A simple Monte Carlo scattering simulation is presented that reproduces these features and supports the thick-ring hypothesis. We cannot confirm filamentary streaming from the binary to the ring, also observed in the ground-based images, although it is possible that there is material inside the dynamically cleared region that might contribute to filamentary deconvolution artifacts. Finally, we find a faint fifth point source in the GG Tau field that, if it is associated with the system, is almost certainly a brown dwarf.

Circular polarization in star-formation regions: implications for biomolecular homochirality.

Strong infrared circular polarization resulting from dust scattering in reflection nebulae in the Orion OMC-1 star-formation region has been observed. Circular polarization at shorter wavelengths might have been important in inducing chiral asymmetry in interstellar organic molecules that could be subsequently delivered to the early Earth by comets, interplanetary dust particles, or meteors. This could account for the excess of L-amino acids found in the Murchison meteorite and could explain the origin of the homochirality of biological molecules.

[Pulmonary alveolar proteinosis: ultrastructural study of 4 cases]. / Proteinosis alveolar pulmonar: estudio ultraestructural de cuatro casos.

Pulmonary Alveolar Proteinosis (PAP) is a rare and diffuse lung disease characterized by the abnormal deposition of PAS positive, lipoproteinaceous material in the alveolar spaces. It has been related, mainly, to alterations in the immune state and to secondary infections. We studied four cases of PAP diagnosed by light microscopy. In two cases we were able to demonstrate disseminated Histoplasmosis related to immunodeficiency states (AIDS and malnutrition), one case with Pneumocystis carinii infection and AIDS, and one case with no related pathology. Granular and electron dense material, concentric myelin figures, and variable-sized osmiophilic bodies were observed by electron microscopy. We found yeast-like structures, trophozoites and cysts in the alveolar spaces, in the Histoplasmosis and Pneumocystic carinii infection cases, respectively. In one of our cases, the circulating neutrophils showed crystalloid inclusions in the nucleus. PAP should be considered in the differential diagnoses of patients with pulmonary infiltrates.

Systems of the future needed today.

Finding the right software for groups requires investigating a practice's quantifiable and qualitative needs, determining goals and translating the needs into system requirements. Software packages don't generally fill all the needs of a practice, therefore it is important to identify vendors who know about health care management and are willing to work with the practice to maintain an edge in business. Look for vendors who continually upgrade their products, service the practice's needs and anticipate future requirements. Quantifiable needs may include tracking patients and patient visits, referring physicians and payers, as well as billing. Qualitative needs include lifestyle (how many hours or days the practice will be open, covering physicians access) and computer usage patterns. Translating the needs into system requirements involves close work with the vendor to customize the software in order to fulfill practice information demands.

A prospective comparison of the effects of placebo, ranitidine and highly selective vagotomy on 24 h ambulatory intragastric pH in patients with duodenal ulcer.

Twenty-four hour ambulatory intragastric pH (24 h IGpH) recording, a highly reproducible technique, was used to compare the effects of ranitidine and highly selective vagotomy (HSV) in 20 patients who had been referred for surgical treatment of duodenal ulcer. The 24 h IGpH was recorded when they were taking either placebo or ranitidine 300 mg at 10 pm, and again 4 to 13 weeks after elective HSV. Median 24 h IGpH and 24 h hydrogen ion activity (24 h [H+]) were calculated for each patient. Median (quartile) 24 h IGpH was 1.4 (1.3-1.6) with placebo, 2.2 (1.8-2.7) after ranitidine and 2.6 (1.8-3.7) after HSV. IGpH was significantly higher after both ranitidine (P less than 0.0001) and HSV (P less than 0.0001) than after placebo, but IGpH after ranitidine did not differ from IGpH after HSV (0.5 greater than P greater than 0.4). HSV reduced 24 h [H+] by a median 68 per cent (quartiles, 47-82 per cent) whereas ranitidine reduced it by only 50 per cent (34-69 per cent, 0.1 greater than P greater than 0.05). The 24 h pH recording was then analysed as two distinct periods; 'daytime' (8 am to midnight) and 'night-time' (midnight to 8 am). HSV reduced daytime [H+] by a median 77 per cent (59-93 per cent) whereas ranitidine reduced it by only 30 per cent (13-45 per cent, P less than 0.0001). HSV reduced night-time [H+] by a median 57 per cent (40-83 per cent) but ranitidine reduced it by a median 92 per cent (78-98 per cent, P less than 0.01). Thus, HSV inhibits gastric acidity more during the day than at night, whereas ranitidine given at 10 pm effectively suppresses night-time acidity but is much less effective in suppressing daytime acidity. However both HSV and ranitidine will heal more than 90 per cent of duodenal ulcers. Hence, contrary to Dragstedt's teaching, suppression of nocturnal acidity is not of crucial importance for the healing of duodenal ulcers.

Blind total gastrectomy for massive bleeding from the stomach.

The source of massive haemorrhage from the stomach cannot always be identified even with the use of fibreoptic endoscopy and angiography. Six patients with massive, continuing, non-variceal haemorrhage from the stomach are described in whom total gastrectomy was eventually required. Three patients were shown to have bled from submucosal arteriovenous malformations, two from erosive gastritis and one from a vessel in an ulcer at the oesophagogastric junction. One patient died as a result of surgery and another died later of disseminated malignant disease. The functional results in the remaining patients were surprisingly good and rebleeding has not occurred. Total gastrectomy is a satisfactory 'last resort' treatment for life-threatening gastric haemorrhage for which no cause can be found.

Controlled trial of transcutaneous electrical nerve stimulation (TENS) for postoperative pain relief following inguinal herniorrhaphy.

We have evaluated the effect of transcutaneous electrical nerve stimulation (TENS) on postoperative pain following inguinal herniorrhaphy in a prospective randomized controlled trial. Forty male patients undergoing unilateral inguinal herniorrhaphy for the first time were randomized to receive either active or inactive TENS. Electrical stimulation was delivered by electrodes placed along either side of the wound following operation. An identical apparatus, which did not deliver an electrical current, was applied to control patients. Pain was assessed over the first 3 postoperative days by visual analogue pain scores, expiratory peak flow rates and analgesic requirements. There was no difference between the two groups for pain scores, peak flow rates or analgesic requirements and we conclude that TENS as used in this trial does not reduce postoperative pain. However, TENS had considerable patient appeal and many patients believed that it was effective.

Nocturnal gastric acid secretion: its importance in the pathophysiology and rational therapy of duodenal ulcer.

The importance of nocturnal acid secretion has long been acknowledged. The aim of therapy at present is to control acid secretion throughout the entire 24-h period. However, the fact that in DU patients a 400-mg nighttime dose of cimetidine is more effective than a 200-mg one, along with the observation that poorly responsive patients also show little decrease in H+ activity, suggests that a larger single nocturnal dose is an effective primary treatment for DU patients. In studies investigating the effects of different regimens of H2 antagonists on 24-h H+ activity and nocturnal acid secretion in DU patients and healthy volunteers, 400 mg cimetidine twice daily was compared with 800 mg cimetidine at night, 150 mg ranitidine twice daily, 300 mg ranitidine at night, and placebo. In 12 DU patients no significant difference was observed between twice daily or nighttime cimetidine and twice daily or nighttime ranitidine in the reduction of 24-h H+ activity. Cimetidine at night was significantly more effective than the twice daily regimen in reducing nocturnal acid output. Ranitidine, 300 mg at night, decreased nighttime H+ activity more than 800 mg cimetidine at night, although no significant differences in overnight acid output were observed. In another study of four DU patients and four volunteers, 400 mg cimetidine twice daily was compared with 800 or 1200 mg cimetidine at night, 150 mg ranitidine at night, and placebo. All treatments were equally effective at night but had no effect during the day. Hence, early reports seem to confirm that daytime administration of H2 antagonists is unnecessary.

The educational value of being a house surgeon.

A time and motion study has been performed with four house surgeons. The results suggest that modern pre-registration housemen spend over 75% of their time in a hospital service role. There is only a small amount of supervised teaching in what is regarded as an educational post.

Epidemic hypochlorhydria.

During a study of gastric secretion four out of six previously healthy subjects developed hypochlorhydria after a transient illness with nausea, vomiting, and abdominal pain. Mean basal and peak acid outputs were 0 and 2.3 mmol (84 mg)/h one month after the onset of illness and 1.5 and 27.0 mmol/h (55 and 984 mg/h) at eight months' follow up. Two of the subjects were followed up at 18 months, when mean basal and peak acid outputs were 3.9 and 33.5 mmol/h (142 and 1221 mg/h). No endoscopic abnormality was seen at one and eight months, but biopsies showed active superficial gastritis, which resolved in one subject and became chronic in two. Schilling tests performed in three subjects at eight months showed diminished retention of vitamin B12. During hypochlorhydria a 24 hour intragastric analysis was performed for total and nitrate reducing bacteria, pH, and concentrations of nitrite and total and stable N-nitroso compounds. Of the 48 samples of gastric juice examined, 47 had bacterial growth of more than 10(6) organisms/ml and 46 had growth of nitrate reducing bacteria of more than 10(5) organisms/ml. Mean intragastric nitrite concentrations were 10 times higher than in a group of eight healthy controls. Both mean total and mean stable N-nitroso compound concentrations, however, were not appreciably different from those in controls. Although community transmission was a possibility, serological screening and electron microscopy of gastric biopsy specimens failed to show an infective cause. Transmission of an unidentified enteric pathogen via a contaminated pH electrode was therefore suspected. Thus gastric juice should not be returned to the stomach after contact with a contaminated glass electrode as this is a possible cause of atrophic gastritis.

Effect of no treatment, cimetidine 1 g/day, cimetidine 2 g/day and cimetidine combined with atropine on nocturnal gastric secretion in cimetidine non-responders.

We have studied nocturnal acid secretion in patients with duodenal ulcer who met predetermined criteria of poor clinical response to cimetidine. Different groups of patients were investigated receiving either no treatment, cimetidine 1 g/day, cimetidine 2 g/day or cimetidine 1 g/day combined with atropine 4.8 mg/day. The results were compared with those obtained from other patients with duodenal ulcer who were studied in our department but who were not classified as according to their clinical response to cimetidine. The results show that despite adequate absorption, cimetidine has a decreased effect at controlling acid secretion in the poor responders and that increasing the dose of drug does not improve response. Control of acid output was, however, dramatically improved when cimetidine was combined with atropine which suggests that patients who do not respond to H2-receptor blockade should be treated by a combination of cimetidine with an anticholinergic agent.