Special Psychosocial Issues in Diabetes Management: Diabetes Distress, Disordered Eating, and Depression.

Diabetes distress, disordered eating, and depression are common but often poorly recognized conditions that are often mutually self-sustaining and can confound a primary care physician's approach to the treatment of type 2 diabetes. There are validated screening instruments and evidence-based treatments for each of these. In devising a treatment plan for patients with these conditions, it is important for the primary care physician to target key issues, such as encouraging family support, instilling self-efficacy, understanding the value of a supportive physician-patient relationship, choosing medications that have evidence-based support, and making referrals to appropriate behavioral health providers.

Chromatography modelling to describe protein adsorption at bead level.

Chromatographic modelling can be used to describe and further understand the behaviour of biological species during their chromatography separation on adsorption resins. Current modelling approaches assume uniform rate parameters throughout the column. Software and hardware advances now allow us to consider what can be learnt from modelling at bead level, enabling simulation of heterogeneity in bead and packed bed structure due to design or due to changes during operation. In this paper, a model has been developed to simulate at bead level protein loading in 1.5 µl microfluidic columns. This model takes into account the heterogeneity in bead sizes and the spatial variations of the characteristics of a packed bed, such as bed void fraction and dispersion, thus offering a detailed description of the flow field and mass transfer phenomena. Simulations were shown to be in good agreement with published experimental data.

Design and characterization of a microfluidic packed bed system for protein breakthrough and dynamic binding capacity determination.

A 1.5 microL ion exchange chromatography column to accommodate resins used for biopharmaceutical processing has been designed to produce breakthrough curves and to quantify dynamic and maximum protein binding capacities. Channels within a glass chip were fabricated using photolithography and isotropic etching. The design includes a 1 cm long microfluidic column in which compressible, polydispersed porous agarose beads (70 mum mean diameter) were packed using a keystone method where particles aggregate in a narrow channel. The depth of the column is such that two bead layers exist. The fabrication technique used forms Cartesian geometries as opposed to circular cross sections found in standard columns. The voidage was therefore higher than standard values when measured by 3D confocal microscopy. In conjunction with microscopic techniques, the column allows visualization of events within the bed such as adsorption profiles that would otherwise be difficult to observe. In this work, the binding of fluorescently labeled protein during isocratic loading was used to generate breakthrough from the microcolumn. Useful breakthrough curves were achieved using mobile phase velocities from 60 to 270 cm h(-1). Calculated dynamic binding capacities were compared well with previously published data on conventional scale columns. The microfluidic chromatography column described here thus allows study of process scale chromatography behavior at scales 20,000 times smaller than in current practice. The work described in this article is representative of the proof of principle of a potentially powerful tool for the generation of microfluidic process bed data for the biopharmaceutical industry.

Clinical significance of granuloma in Crohn's disease.

Crohn's disease (CD) is diagnosed from information obtained clinically, pathologically, and radiologically. One important pathologic finding is a granuloma, which is helpful when a positive diagnosis of CD will affect treatment. Whether the presence of a granuloma has any clinical implication is not clear. We conducted a retrospective study to determine whether a granuloma found on a biopsy sample is associated with disease severity, fistulizing or perianal disease, frequent relapses, and extraintestinal manifestations. Eighty-two patients were identified who had a biopsy or bowel resection for CD between 1990 and 1994 at a tertiary referral center; 21 (25.6%) had a granuloma. This group was compared with a group of 61 patients without a granuloma. Forty-five percent were male (n = 37), mean age at diagnosis was 42.6 years (median, 39.5 years), mean disease duration at presentation was 8.8 years (median, 4.8 years), and mean follow-up duration was 2 years (range, 1 day to 10.2 years). No significant differences were demonstrated between the two groups by the Fisher exact test with regard to fistulizing or perianal disease, oral aphthous ulcers, disease severity, axial or peripheral arthralgia, episcleritis, anterior uveitis, erythema nodosum, or pyoderma gangrenosum.