[Prognosis and therapy of inflammatory rheumatic diseases : Impact of renal manifestations]. / Prognose und Therapie von entzündlich-rheumatischen Erkrankungen : Einfluss der Nierenbeteiligung.

BACKGROUND: Inflammatory rheumatic diseases and their treatment cause various renal manifestations requiring modification of treatment. OBJECTIVES: Discussion of renal manifestations in selected rheumatic diseases, including their impact on general prognosis and therapy. MATERIALS AND METHODS: Basic literature and expert opinions are analyzed and discussed. RESULTS: Inflammatory rheumatic diseases and their treatment cause various renal manifestations, including glomerular, tubular, interstitial, and vascular damage. The type of damage determines both, associated clinical symptoms (i.e. hematuria, proteinuria, loss of kidney function) and the renal and overall survival as will be discussed here for rheumatoid arthritis, systemic lupus erythematosus, scleroderma, Sjögrens syndrome, cryoglobulinemia and ANCA-associated vasculitis. CONCLUSION: Renal manifestations are generally indicators of high disease activity and usually require more intensive treatment of the underlying rheumatic disease. Early and rigorous treatment, which has to be adapted to renal function, is capable of improving renal and overall survival in many of the affected patients.

Functional analysis of TamA, a coactivator of nitrogen-regulated gene expression in Aspergillus nidulans.

The tam A gene of Aspergillus nidulans encodes a 739-amino acid protein with similarity to Uga35p/Dal81p/DurLp of Saccharomyces cerevisiae. It has been proposed that TamA functions as a co-activator of AreA, the major nitrogen regulatory protein in A. nidulans. Because AreA functions as a transcriptional activator under nitrogen-limiting conditions, we investigated whether TamA was also present in the nucleus. We found that a GFP-TamA fusion protein was predominantly localised to the nucleus in the presence and absence of ammonium, and that AreA was not required for this distribution. As the predicted DNA-binding domain of TamA is not essential for function, we have used a number of approaches to further define functionally important regions. We have cloned the tamA gene of A. oryzae and compared its functional and sequence characteristics with those of A. nidulans tamA and S. cerevisiae UGA35/DAL81/DURL. The Aspergillus homologues are highly conserved and functionally interchangeable, whereas the S. cerevisiae gene does not complement a tamA mutant when expressed in A. nidulans. Uga35p/Dal81p/DurLp was also found to be unable to recruit AreA. The sequence changes in a number of tamA mutant alleles were determined, and altered versions of TamA were tested for tamA complementation and interaction with AreA. Changes in most regions of TamA appeared to destroy its function, suggesting that the overall conformation of the protein may be critical for its activity.

A descriptive analysis of air medical directors in the United States.

INTRODUCTION: The purpose of this study was to describe the characteristics and functions of U.S. physician air medical directors. METHODS: This descriptive study included physician directors of U.S. rotor-wing and fixed-wing air medical services. Data were obtained using a standardized survey in regard to the training, education, and roles/responsibilities of directors of critical care air medical services (AMSs). RESULTS: Data from 153 of 276 surveys (55.4%) were analyzed and reported in this study. Air medical directors' residency training varied, but emergency medicine was the most frequently reported training type (38.0%). Most directors reported less than 5 years of job experience in AMS (57.3%), had neither residency/fellowship-based flight experience (63.9%) nor practical flight experience (60.5%), and performed director functions on a part-time basis (93.2%). The six most commonly reported medical director activities were medical protocol development (87.6%), quality improvement activities (86.3%), medical crew training (80.4%), administrative negotiations (79.1%), on-line medical control (71.9%), and personnel hiring (59.5%). The three most common sources of continuing education for medical directors were literature review (95.8%), attendance at medical conferences (79.2%), and participation in professional organizations (59.7%). CONCLUSION: These data describe the characteristics of U.S. air medical directors and identify physician contributions to patient care in the aviation environment.

Integrating emergency medicine residents into a well-established helicopter program.

INTRODUCTION: The institution of an emergency medicine residency in a university-affiliated Level 1 trauma center in July 1993 provided a challenge to develop a curriculum and on-line learning experience for emergency medicine residents in a well-established helicopter program. The purpose of this study was to survey flight crew members, emergency medicine at tending physicians, and emergency medicine residents on the anticipated roles and educational experience of integrating the emergency medicine residents from a new emergency medicine residency into the flight crew of a well-established helicopter program. METHODS: A survey consisting of multiple choice, Likert scale, and open-ended questions was distributed to flight crew members (RN, RT, pilots, communication specialists, EM attendings, and EM residents [n=72]). RESULTS: 92% of surveys were returned. These surveys identified specific issues of concern and those areas believed to be of academic importance for the emergency medicine residents. CONCLUSIONS: The results of this study allowed for the creation and implementation of a progressive flight experience for EM residents that incorporates increasing responsibility on the flight crew as experience is gained.