An "infobutton" for enabling patients to interpret on-line Pap smear reports.

We describe the development of a prototype application that would allow patients with little or no medical background to understand their Pap smear reports. This information button, or "infobutton", is attached to on-line text reports describing Pap smear results present in a medical record system intended for patient access (PatCIS). The infobutton application generates an explanation of terms present in the report and a list of questions related to the terms in the report, which link to publicly accessible resources on the Web.

Combining laboratory data sets from multiple institutions using the logical observation identifier names and codes (LOINC).

A standard set of names and codes for laboratory test results is critical for any endeavor requiring automated data pooling, including multi-institutional research and cross-facility patient care. This need has led to the development of the logical observation identifier names and codes (LOINC) database and its test-naming convention. This study is an expansion of a pilot study using LOINC to exchange laboratory data between Columbia University Medical Center in New York and Barnes Hospital at Washington University in St. Louis, where we described complexities and ambiguities that arose in the LOINC coding process (D.M. Baorto, J.J. Cimino, C.A. Parvin, M.G. Kahn, Proc. Am. Med. Inf. Assoc. 1997). For the present study, we required the same two medical centers to again extract raw laboratory data from their local information system for a defined patient population, translate tests into LOINC and provide aggregate data which could then be used to compare laboratory utilization. Here we examine a larger number of tests from each site which have been recoded using an updated version of the LOINC database. We conclude that the coding of local tests into LOINC can often be complex, especially the 'Kind of Property' field and apparently trivial differences in choices made by individual institutions can result in nonmatches in electronically pooled data. In the present study, 75% of failures to match the same tests between different institutions using LOINC codes were due to differences in local coding choices. LOINC has the potential to eliminate the need for detailed human inspection during the pooling of laboratory data from diverse sites and perhaps even a built-in capability to adjust matching stringency by selecting subsets of LOINC fields required to match. However, a quality standard coding procedure is required and examples highlighted in this paper may require special attention while mapping to LOINC.

Survival of FimH-expressing enterobacteria in macrophages relies on glycolipid traffic.

Strains of Escherichia coli persist within the human gut as normal commensals, but are frequent pathogens and can cause recurrent infection. Here we show that, in contrast to E. coli subjected to opsonic interactions stimulated by the host's immune response, E. coli that bind to the macrophage surface exclusively through the bacterial lectin FimH can survive inside the cell following phagocytosis. This viability is largely due to the attenuation of intracellular free-radical release and of phagosome acidification during FimH-mediated internalization, both of which are triggered by antibody-mediated internalization. This different processing of non-opsonized bacteria is supported by morphological evidence of tight-fitting phagosomes compared with looser, antibody-mediated phagosomes. We propose that non-opsonized FimH-expressing E. coli co-opt internalization of lipid-rich microdomains following binding to the FimH receptor, the glycosylphosphatidylinositol-linked protein CD48, because (1) the sterol-binding agents filipin, nystatin and methyl beta-cyclodextrin specifically block FimH-mediated internalization; (2) CD48 and the protein caveolin both accumulate on macrophage membranes surrounding bacteria; and (3) antibodies against CD48 inhibit FimH-mediated internalization. Our findings bring the traditionally extracellular E. coli into the realm of opportunistic intracellular parasitism and suggest how opportunistic infections with FimH-expressing enterobacteria could occur in a setting deprived of opsonizing antibodies.

Using Logical Observation Identifier Names and Codes (LOINC) to exchange laboratory data among three academic hospitals.

Using a standard set of names and codes to exchange electronic laboratory data would facilitate multiinstitutional research and data pooling. This need has led to the development of the Logical Observation Identifier Names and Codes (LOINC) database and its test naming convention. We conducted a study which required 3 academic hospitals (in 2 separate medical centers) to extract raw laboratory data from their local information system for a defined patient population, translate tests into LOINC, and provide aggregate data which could then be used to compare laboratory utilization. We found that the coding of local tests into LOINC can often be complex, especially the "Kind of Property" field, and apparently trivial differences in choices made by individual institutions can result in nonmatches in electronically pooled data. In our study, 72-86% of the failures of LOINC to match the same tests between different institutions were due to differences in local coding choices. LOINC has tremendous potential to eliminate the needing for detailed human inspection during the pooling of laboratory data from diverse sites, and perhaps even a built-in capability to adjust matching stringency by selecting subsets of LOINC fields required to match. However, a quality, standard coding procedure at all sites is critical.

Astrocyte process growth induction by actin breakdown.

cAMP analogues such as dibutyryl cAMP (dBcAMP) have been shown to induce the formation of processes in cultured primary astrocytes. We observe that the processes form by elongation as well as the previously reported retraction of cytoplasm around cytoskeletal elements. The most prominent cytoskeletal change that occurs in response to dBcAMP is a rearrangement of actin filaments characterized by a loss of cortical F-actin staining and the appearance of actin filament staining at the tips of the processes. If cortical actin filaments are disrupted with dihydrocytochalasin B, processes form that are similar to those induced by dBcAMP suggesting that the disruption of the cortical actin network is the pivotal step in process formation. Reorganization of the actin filament network in response to cAMP is accompanied by a decrease in phosphate incorporation into the regulatory light chain of myosin (MLC). Two selective inhibitors of MLC kinase (MLCK), ML-9 and KT5926, as well as a calmodulin antagonist (W7), which would also inhibit MLCK activation, all induce astrocytic process growth implicating MLCK as a control point in process initiation. We also found that dBcAMP and ML-9 both cause a decrease in the phosphate content of actin depolymerizing factor, suggesting that this protein and myosin light chain are the effectors of actin cytoskeleton reorganization and process growth.