Automation of an extracorporeal support system with adaptive fuzzy controllers.

For patients suffering from cardiogenic shock cardiopulmonary resuscitation may not be sufficient to restore normal heart function. However, their chances of survival may be increased with the use of an extracorporeal support system. With this system the patient's organs are perfused while being transported to the nearest hospital for proper treatment. In the automation of an extracorporeal support system the patient's vital signals are constantly monitored and proper adjustments are performed to improve organ perfusion. In this paper, an adaptive fuzzy controller is proposed that uses the knowledge and expertise of a perfusionist as a starting point and reference for regulation. Furthermore it is able to adapt to the patient's specific reactions by manipulating the rule base of the fuzzy controller. The performance of the adaptive fuzzy controller is tested with a simulation model of the cardiovascular system.

Observation of negative absolute resistance in a Josephson junction.

We experimentally demonstrate the occurrence of negative absolute resistance (NAR) up to about -1 Omega in response to an externally applied dc current for a shunted Nb-Al/AlO_{x}-Nb Josephson junction, exposed to a microwave current at frequencies in the GHz range. The realization (or not) of NAR depends crucially on the amplitude of the applied microwave current. Theoretically, the system is described by means of the resistively and capacitively shunted junction model in terms of a moderately damped, classical Brownian particle dynamics in a one-dimensional potential. We find excellent agreement of the experimental results with numerical simulations of the model.

Pulsed-field separation of particles in a microfluidic device.

We demonstrate the proof-of-principle of a new separation concept for micrometer-sized particles in a structured microfluidic device. Under the action of externally applied, periodic voltage-pulses two different species of like-charged polystyrene beads are observed to simultaneously migrate into opposite directions. Based on a theoretical model of the particle motion in the microdevice that shows good agreement with the experimental measurements, the underlying separation mechanism is identified and explained. Potential biophysical applications, such as cell sorting, are briefly addressed.

Moving backward noisily.

We discuss the fundamental physical differences and the mathematical interconnections of counterintuitive transport and response properties in Brownian motion far from equilibrium. After reviewing the ubiquity of such effects in physical and other systems, we illustrate the general properties on paradigmatic models for both individually and collectively acting Brownian particles.

Malignancies in inflammatory bowel disease: fact or fiction?

BACKGROUND: The association between ulcerative colitis (UC), Crohn disease (CD) and colorectal cancer (CRC) has been confirmed in several studies. The aim of this study was critical analysis of the relation between IBD and malignancy. METHODS: Review of the literature. RESULTS: In UC, the extent of the disease, its duration and start at a young age are risk factors for the development of CRC. Primary sclerosing cholangitis and colonic strictures are additional risk factors for development of CRC. The relation between azathioprine or 6-MP and the development of lymphomas is a subject of debate. The administration of anti-TNF-alpha has produced some concern about the development of lymphomas in CD. However, at present there is no evidence of lymphomas caused by anti-TNF-alpha in CD. On the contrary, some drugs seem to have a preventive effect on CRC development in UC. 5-aminosalicylic acid in particular and to a lesser extent sulphasalazine have prevented the development of CRC significantly in retrospective studies. In CD, there is no strong relationship between the disease and the development of CRC or other malignancies. Only the development of small-bowel carcinoma is reported with a much higher frequency. CONCLUSIONS: There is a correlation with UC and the development of CRC. For CD, this correlation is less firmly established. There is a possible, but not proven, relation between AZA/6-MP use and the development of lymphoma in IBD. There is also a probable relationship between CD and the development of small-bowel carcinoma. In some retrospective studies, the use of 5-aminosalicylic or sulphasalazine has been shown to prevent the development of CRC in UC.

Sickle cell-like crisis and bone marrow necrosis associated with parvovirus B19 infection and heterozygosity for haemoglobins S and E.

In the literature, heterozygosity for haemoglobins S and E is known as a clinically benign condition. Nevertheless, we present a case of double heterozygosity manifesting as an infarctive sickle cell-like crisis with acute chest syndrome and reversible bone marrow necrosis. Importantly, these complications were associated with serologically documented parvovirus B19 infection. Reviewing the literature, this case emphasizes a specific role of parvovirus B19 as a precipitating cause. Furthermore, it demonstrates how important the consideration of haemoglobin disorders can be even outside of the historically known areas.

Involvement of spinal nerves in neurofibromatosis.

Spinal tumors are a frequent form of manifestation of neurofibromatosis. Out of 171 patients, who have been operated on over a ten years period on spinal tumors, 7 patients had neurofibromatosis (4.1%). A total of 9 operations were performed, removing 20 spinal tumors. Three patients had multiple neurofibromas. Half of the neurofibromas had a dumbbell configuration with a larger extraspinal extension. In three patients a family history of neurofibromatosis and typical dermatological signs were evident. Two cases will be selected and the basic concept regarding treatment and the risks involved will be discussed.

[Acute primary phase as an indicator of HIV-1 infection. The general symptoms and polymorphic exanthema with mouth mucosal involvement 2 to 6 weeks before seroconversion]. / Akute Primärphase als Indikator der HIV-1-Infektion. Allgemeine Symptomatik und polymorphes Exanthem mit Mundschleimhautbeteiligung 2-6 Wochen vor der Serokonversion.

The initial symptoms of an HIV-1 infection were observed in four patients. The following were characteristic for the acute primary phase: (a) initial maculopapular exanthema, especially of the trunk, with occasional transition into a papulovesical appearance; (b) involvement of the oral mucosa, often of aphthous character; and (c) general malaise with fever and lymphadenopathy. The observed cutaneous changes had, on one hand, features of a Coxsackie or mononucleosis exanthema, on the other of secondary syphilis. In three patients seroconversion occurred within 2-6 weeks, the fourth failed to return for follow-up. The listed acute primary symptoms can be used as the earliest indicators of an HIV-1 infection having occurred.

[Disseminated mucocutaneous Kaposi sarcoma in AIDS. Clinical and therapeutic experiences in 13 patients]. / Disseminiertes mukokutanes Kaposi-Sarkom bei AIDS. Klinische und therapeutische Erfahrungen an 13 Patienten.

Since 1980 a new epidemic form of disseminated mucocutaneous Kaposi's sarcoma (KS) with a progressive clinical course has been observed in populations at risk. Since 1982, 13 cases of AIDS-associated KS have been seen in our department; all of them were in young homosexual males with circulating HIV antibodies and a reduction in the ratio of T-helper to T-suppressor lymphocytes (0.05-1.3). Following systemic treatment with recombinant alpha A-interferon (rIFN-alpha A) over a period of 6 months (18 million IU/day for 3 months; later 18 million IU/3 X weekly) together with other concomitant measures (superficial X-ray radiation, argon laser radiation, surgical excision of isolated lesions) we registered complete remission of the remaining lesions in 2 cases, progression of the disease in 4 cases, and at least temporary stabilization of the disease in 7 cases. In 4 patients opportunistic infections occurred during rIFN treatment: Pneumocystis carinii pneumonia (PCP) with lethal outcome in 2 cases, atypical mycobacteriosis in 2 cases, and Legionella pneumoniae infection in 1 case. Two additional deaths were registered due to PCP appearing during the post-treatment period. Life-threatening virus infections were not observed during rIFN treatment. Out of 9 patients receiving prophylactic trimethoprim/sulfamethoxazole medication, only 1 developed allergic exanthema as a result of this drug combination. Occasionally, rIFN-induced leukopenia was seen and pronounced thrombocytopenia appeared in 1 patient during treatment. Overall, systemic rIFN therapy was well tolerated; its long-term administration in patients with AIDS-associated mucocutaneous KS seems to be well justified according to these preliminary observations.(ABSTRACT TRUNCATED AT 250 WORDS)

Lipid composition of functional domains of the lymphocyte plasma membrane.

Plasma membrane vesicles from calf T-lymphocytes were fractionated by affinity chromatography on Con A-Sepharose. One subfraction eluted freely from the affinity column (fraction 1), while a second one adhered specifically to the column (fraction 2). While both fractions were derived exclusively from the plasma membrane, fraction 2 carried the high-affinity receptor for the mitogen concanavalin A and was distinct from fraction 1 with respect to its polypeptide pattern and the content of some plasma membrane-associated enzymes, suggesting the existence of functional plasma membrane domains. These functionally distinct fractions showed different lipid composition. The adherent fraction was enriched in phosphatidylcholine, while the relative amount of phosphatidylethanolamine and phosphatidylserine was reduced. Furthermore, the relative amount of saturated fatty acids was enhanced in the phospholipids of the adherent plasma membrane fraction. This could be shown in total phospholipids, as well as in separated individual phospholipids. We could therefore demonstrate that lipid heterogeneity may exist in plasma membranes of cells without structural polarity. Similar results were obtained when T-lymphocytes were stimulated with the mitogen concanavalin A. The functional domain, consisting of the high-affinity concanavalin A receptor, several enzymes and distinct lipid compositional pattern, thus seems to constitute a relatively stable structural entity of the lymphocyte plasma membrane.

Does benzbromarone in therapeutic doses raise renal excretion of oxipurinol?

Twenty male hyperuricaemic patients with normal kidney function were studied and it was found that the serum concentrations and excretions rates in the 24-hour urine of allopurinol and oxipurinol do not differ significantly after 9 days of oral treatment with either 300 mg allopurinol or a combination of 300 mg allopurinol and 60 mg benzbromarone daily. The sum of the excretion rates of the two pyrazolopyrimidines in the 24-hour urine represents 80.9% and 77.1%, respectively of the daily dose of allopurinol given alone or in combination with benzbromarone. As expected, the hypouricaemic effect of the combined therapy turned out to be stronger than that observed after monotherapy with allopurinol, due to the uricosuric component of benzbromarone. The difference was found to be highly significant.