Autoimmune Gastrointestinal Paralysis: Failure of Conventional Treatment without Immunomodulation.

The treatment of the rare enteric nervous system (ENS) manifestations of paraneoplastic syndromes, which are most frequently associated with small cell lung cancer (SCLC), is poorly understood and described. Patients with neuroendocrine-derived tumors can develop B-cell reactivity towards the tumor with cross-reactivity for neurons located in the submucosal and myenteric ganglia of the ENS. The ensuing autoimmune neuritis causes aperistalsis and severe gastrointestinal (GI) dysfunction. Immune-directed therapy is not the standard of care but may be paramount for patient recovery. Our patient, a 63-year-old man with recent symptoms of esophageal dysmotility and newly diagnosed SCLC was hospitalized with nausea, emesis, and constipation. After an extensive work-up that included laparoscopy and celiotomy with bowel resection, we diagnosed what we refer to as Autoimmune Paraneoplastic Chronic Intestinal Pseudoobstruction (AP-CIPO). Unlike the few clinically similar reports, SCLC and AP-CIPO were diagnosed in our patient within weeks of each other, which presented the dilemma of treating the two processes simultaneously. In this report, we review the relevant literature and describe our patient's course. We believe standard chemotherapy is not effective treatment for AP-CIPO. Based on evidence discussed herein, we suggest initiating autoimmune-directed therapy before or simultaneous with cancer-directed therapy.

Analysis of Porphyra membrane transporters demonstrates gene transfer among photosynthetic eukaryotes and numerous sodium-coupled transport systems.

Membrane transporters play a central role in many cellular processes that rely on the movement of ions and organic molecules between the environment and the cell, and between cellular compartments. Transporters have been well characterized in plants and green algae, but little is known about transporters or their evolutionary histories in the red algae. Here we examined 482 expressed sequence tag contigs that encode putative membrane transporters in the economically important red seaweed Porphyra (Bangiophyceae, Rhodophyta). These contigs are part of a comprehensive transcriptome dataset from Porphyra umbilicalis and Porphyra purpurea. Using phylogenomics, we identified 30 trees that support the expected monophyly of red and green algae/plants (i.e. the Plantae hypothesis) and 19 expressed sequence tag contigs that show evidence of endosymbiotic/horizontal gene transfer involving stramenopiles. The majority (77%) of analyzed contigs encode transporters with unresolved phylogenies, demonstrating the difficulty in resolving the evolutionary history of genes. We observed molecular features of many sodium-coupled transport systems in marine algae, and the potential for coregulation of Porphyra transporter genes that are associated with fatty acid biosynthesis and intracellular lipid trafficking. Although both the tissue-specific and subcellular locations of the encoded proteins require further investigation, our study provides red algal gene candidates associated with transport functions and novel insights into the biology and evolution of these transporters.

Biodosimetry Assessment Tool (BAT) software-dose prediction algorithms.

PURPOSE: Medical management of suspected radiation casualties requires use of multiparameter biodosimetry because no single biodosimetric measurement is sufficiently robust. This report describes the design and algorithms used in a radiation exposure assessment software application that serves as a diagnostic utility for triage and medical treatment formulation, as well as to convey psychological reassurance, for early-phase assessment of radiation exposures, and for surge response assessment for mass radiological casualties. METHODS: The Armed Forces Radiobiology Research Institute's Biological Dosimetry Research Program developed the integrated multiparameter Biodosimetry Assessment Tool computer program using Microsoft Visual Basic 6 with various second party plug-ins and add-ons. Dose-predicting algorithms were adopted by analyzing data from merged databases of human radiation exposure incidents and normal controls (non-irradiated) volunteers. The results are summarized in user-friendly screens. SUMMARY: BAT algorithms are presented and compared to other previously published dose assessment algorithms based on biological indicators (i.e., onset of vomiting, lymphocyte depletion kinetics). These new algorithms are incorporated into a computer-based program that assists responders and medical providers in recording relevant diagnostic information and assessing significant radiation exposures. It promotes early-phase (<10 d) data collection after a radiation exposure incident and provides data templates for entry of diagnostic information using multiparameter indices. It allows for recording of relevant clinical information and summarizes diagnostic information such as estimated multiparameter doses. Data can be printed and archived in accordance with civilian and military guidelines.

Overview of hazard assessment and emergency planning software of use to RN first responders.

There are numerous software tools available for field deployment, reach-back, training and planning use in the event of a radiological or nuclear terrorist event. Specialized software tools used by CBRNe responders can increase information available and the speed and accuracy of the response, thereby ensuring that radiation doses to responders, receivers, and the general public are kept as low as reasonably achievable. Software designed to provide health care providers with assistance in selecting appropriate countermeasures or therapeutic interventions in a timely fashion can improve the potential for positive patient outcome. This paper reviews various software applications of relevance to radiological and nuclear events that are currently in use by first responders, emergency planners, medical receivers, and criminal investigators.