Can polarity-inverted membranes self-assemble on Titan?

The environmental and chemical limits of life are two of the most central questions in astrobiology. Our understanding of life's boundaries has implications on the efficacy of biosignature identification in exoplanet atmospheres and in the solar system. The lipid bilayer membrane is one of the central prerequisites for life as we know it. Previous studies based on molecular dynamics simulations have suggested that polarity-inverted membranes, azotosomes, made up of small nitrogen-containing molecules, are kinetically persistent and may function on cryogenic liquid hydrocarbon worlds, such as Saturn's moon Titan. We here take the next step and evaluate the thermodynamic viability of azotosome formation. Quantum mechanical calculations predict that azotosomes are not viable candidates for self-assembly akin to lipid bilayers in liquid water. We argue that cell membranes may be unnecessary for hypothetical astrobiology under stringent anhydrous and low-temperature conditions akin to those of Titan.

Nurse-led patient-centered self-management support improves HbA1c in patients with type 2 diabetes-A randomized study.

OBJECTIVES: The aim of this study was to evaluate the effect of a patient-centered self-management support, in type 2 diabetes (T2D) with regard to metabolic changes. METHODS: 182 patients were randomized into group intervention (GI), individual intervention (II) or internal controls (IC). An external control (EC) group was recruited from another county council. The intervention consisted of six sessions that featured themes, which regarded different views of their illness experiences. Data were collected in 2010 and 2011. RESULTS: HbA1c was significantly decreased at 12-month follow-up with 5mmol/mol in the GI and 4mmol/mol in the II. In the IC group, the HbA1c was close to baseline. The EC group had increased HbA1c, though not significantly. When the HbA1c difference at baseline was adjusted, there was a significant difference between intervention groups and the EC-group. CONCLUSION: Patient-centered self-management support, led by nurses, can lower HbA1c among patients with type 2 diabetes. PRACTICE IMPLICATIONS: It is possible to train diabetes specialist nurses in clinical patient-centered care, and simultaneously influence patients' metabolic balance positively.

Medical intelligence in Sweden. Vitamin B12: oral compared with parenteral?

BACKGROUND: Sweden is the only country in which oral high dose vitamin B12 has gained widespread use in the treatment of deficiency states. OBJECTIVE: The aim of the study was to describe prescribing patterns and sales statistics of vitamin B12 tablets and injections in Sweden 1990-2000.Design, setting, and sources: Official statistics of cobalamin prescriptions and sales were used. RESULTS: The use of vitamin B12 increased in Sweden 1990-2000, mainly because of an increase in the use of oral high dose vitamin B12 therapy. The experience, in statistical terms a "total investigation", comprised 1,000,000 patient years for tablets and 750,000 patient years for injections. During 2000, 13% of residents aged 70 and over were treated with vitamin B12, two of three with the tablet preparation. Most patients in Sweden requiring vitamin B12 therapy have transferred from parenteral to oral high dose vitamin B12 since 1964, when the oral preparation was introduced. CONCLUSION: The findings suggest that many patients in other post-industrial societies may also be suitable for oral vitamin B12 treatment.

Attitudes and behaviours in smoking cessation among general practitioners in Finland 2001.

OBJECTIVES: To investigate whether smoking by general practitioners (GPs) and gender influence smoking cessation advice. METHODS: A self-administered questionnaire, originally developed by the WHO and modified according to the Finnish health care system was sent by mail to physicians who were members of the Finnish Medical Association (FMA). Participants were restricted to those who were living in Finland and were younger than 65 years. Numbers of participants was 3,057 and the response rate 69%. RESULTS: Smoking male GPs gave less smoking cessation advice only to patients with a stomach ulcer or patients using oral contraceptive pills compared with their non-smoking colleagues. Male GPs gave less smoking cessation advice to pregnant patients or patients using contraceptive pills than female GPs. Female smoking GPs less likely advised patients who were pregnant or who were using oral contraceptive pills to stop smoking than non-smoking female GPs (p <0.001). The percentage of GPs who have never distributed smoking cessation information was lower in men (41%) than in women (45%; p-value: 0.052). CONCLUSION: Minor differences in anti-smoking advice to patients between smoking and non-smoking general practitioners were found. The little involvement of GPs in health promotion activities regarding tobacco control is of concern.

Ultrasound diagnosis and guided biopsy in renal actinomycosis.

We report the case of a 45-year-old man with 3 months malaise, in whom ultrasound showed an atypical tumour of the right kidney. Ultrasound-guided fine needle biopsy led to a diagnosis of renal actinomycosis.

[Localized gene of the rare "Norrland disease". CDA-III blood disease with dominant heredity]. / Sällsynt "Norrlandssjukdom" genlokaliserad. CDA-III blodsjukdom med dominant ärftlighetsgång.

The article consists in a review of available knowledge of the rare blood disorder, congenital dyserythropoietic anaemia, type III (CDA-III), a disease characterised by autosomal dominant heredity, and mild to moderate haemolytic anaemia. The gene causing CDA-III has been localised on chromosome 15q22. Most patients are adapted to their disease, and have few or no overt manifestations. Bone marrow examination yields a characteristic picture of erythroid hyperplasia and multinucleate erythroblasts. A Swedish family affected with CDA-III has been reported to be characterised by a high prevalence of monoclonal gammopathy and angioid streaks, a triad suggested by the authors to represent a hitherto unreported syndrome.

Has PET/CT a role in the characterization of indeterminate lung lesions on staging CT in colorectal cancer? A prospective study.

PURPOSE: CT has been found superior to chest x-ray to detect lung malignances. However, indeterminate lung lesions (ILL) are found in 4-42% by using CT in staging colorectal cancer (CRC) patients. Our aim was to examine the frequency of ILL on staging CT and the rate of the ILL being malignant, and to investigate if PET/CT was useful in pointing out the malignant cases. METHODS: A prospective analysis of 238 consecutive patients operated for CRC followed median 24 months. All the patients had a preoperative staging CT. Patients with ILL had a PET/CT scan performed 3 months postoperatively and low dose chest CT performed 6, 12, 18 and 24 months postoperatively. RESULTS: Twenty percent of the patients had ILL. Four of these patients (8.5%) had lung metastases detected median 9 months postoperatively, while 2 (4.3%) had other lung malignancies. One patient had TB. In patients with normal staging chest CT 10 of the 185 patients (5.4%) developed lung metastases detected median 16 months postoperatively. This was significantly later than in patients with ILL (p < 0.001), but with regard to the number of patients developing lung metastases no significant difference was found between the groups (p = 0.12). CONCLUSIONS: Even though a relative low number of ILL turn out to be malignant it seems advisable to use PET/CT scan in the follow-up to detect lung metastases as early as possible to better the prognosis. For the same reason all CRC patients should have chest CT included in their follow-up 6-12 months postoperatively.

Congenital dyserythropoietic anemia type III.

BACKGROUND AND OBJECTIVES: Congenital dyserythropoietic anemia type III (CDA-III) is a group of very rare disorders characterized by similar bone marrow morphology. The clinical picture is characterized by hemolytic anemia and dramatic bone marrow changes dominated by active erythropoiesis with big multinucleated erythroblasts. The aim of this review is to describe the clinical manifestations, laboratory findings, and management CDA-III. EVIDENCE AND INFORMATION SOURCES: The present review critically examines relevant articles and abstracts published in journals covered by the Science Citation Index and Medline. The authors have performed several studies on CDA-III. STATE OF ART AND PERSPECTIVES: The clinical and laboratory manifestations of CDA-III indicate that the gene responsible for it, which has been mapped to chromosome 15q22, is expressed not only in erythroblasts during mitosis but also in B-cells, and in cells of the retina. Preliminary results indicate genetic and phenotypic similarities between a Swedish and an American family, both with an autosomally dominant inherited form of CDA-III. It is possible that the genetic lesion is identical in these families, but the different phenotypes and modes of inheritance reported among some other cases of CDA-III are probably the results of other genetic lesions. At present, the function of the gene responsible for the Swedish (V sterbotten) variant of CDA-III (CDAN3) is unknown and it is an important goal to characterize and clone this gene in order to study its function.

Personal understandings of illness among people with type 2 diabetes.

BACKGROUND: Professionals and patients understand the experience of illness from different worlds. Professionals' explanatory models focus on aetiology, diagnosis, pathophysiology and treatment, while patients' explanatory models are more focused on consequences and influences on daily life. The differences between patients and professionals in their understanding often result in conflicting expectations about treatment, priorities and outcomes of care. AIM: The aim of this study was to describe personal understandings of illness among people with type 2 diabetes in Sweden. METHOD: A sample of 44 patients, 47-80 years, diagnosed with type 2 diabetes within the last 2 years, was recruited from four health care centres. Narrative thematic interviews were used covering the areas of developing, coping with and living with diabetes. Qualitative content analysis was performed. FINDINGS: The findings were formulated into six categories: image of the disease, meaning of the diagnosis, integration of the illness, space for the illness, responsibility for care and future prospects. CONCLUSIONS: The findings demonstrate that patients' personal understanding of illness is an important complement to the traditional professional view of diabetes. They could serve as a foundation for development of health history interviewing, as well as development of systems of documentation. Patients' personal understandings of diabetes in their daily lives are considered to be an important shared source of information for planning meaningful care.

The focus group: a tool for programme planning, assessment and decision-making--an American view.

The objective of this paper is to describe the focus group process used with hospital librarians in the National Network of Libraries of Medicine, Pacific Southwest Region (NN/LM/PSR), in order to illustrate how focus groups can be effectively used in the library setting to plan programmes around identified needs. This paper explores the focus group methodology, a qualitative research technique, by discussing why it is used and the process involved in its use. Aspects of the methodology that are discussed include participant selection, question development, data analysis, and use of results in programme planning. The focus group findings assisted NN/LM/PSR in understanding the needs of hospital librarians related to integrating electronic resources into library services. The focus group data were used to determine the forum, content and speakers for a day-long symposium and subsequent planning meeting. The use of the focus group technique to assess the needs of a specific group on a specific issue resulted in activities and programmes that met these needs successfully. Based on the experiences detailed in this paper, the authors are confident that focus groups are an effective tool for programme planning, needs assessment and decision-making for all types of libraries.

Serum thymidine kinase in congenital dyserythropoietic anaemia type III.

Serum thymidine kinase (TK) was determined in a family with congenital dyserythropoietic anaemia type III (CDA, type III). 20 patients and 10 of their healthy siblings were investigated. Elevated TK was found in all 20 patients (median 56.2 U) but their healthy siblings had normal values (median 2.65 U). We suggest that determination of TK should be used for discrimination between healthy siblings and individuals affected by CDA type III when bone marrow examination is not suitable.

Angioid streaks are part of a familial syndrome of dyserythropoietic anaemia (CDA III).

Congenital dyserythropoietic anaemia type III (CDA III) is a rare disease inherited in an autosomal dominant way and characterized by mild to moderate haemolytic anaemia. Most patients are adapted to their disease and have no or few complaints. Bone marrow examination shows a characteristic picture with erythroid hyperplasia and multinucleate erythroblasts. 20% of patients in a Swedish family affected with the CDA III condition have monoclonal gammopathy or multiple myeloma. By linkage and recombination analysis in the same family, the gene linked to the CDA III condition (CDAN3) has been located to chromosome 15q22. In this paper we report the observation of visual disturbances with macular degeneration and angioid streaks in six patients with CDA III and discuss the apparent association between CDA III, angioid streaks and monoclonal gammopathy. We suggest that this triad forms a previously unreported syndrome.

Controversies Around Vitamin B12 in Sweden.

Over a five-year period, 1991-1995, the vitamin B12 market in Sweden increased three-fold, from approximately 2 million U.S. dollars to approximately 6 million U.S. dollars. Most prescriptions, approximately 60%, originated from primary health care. The attitudes, values and knowledge of the family physicians/general practitioners were elucidated by a questionnaire study with visuo-analogue opinion scales, evaluating 24 basic statements on problems associated with the management of vitamin B12 deficiency. The questionnaire was sent to a representative sample of 506 family physicians/general practitioners. Response rate was 74%. Dropout analysis supported the view that responders provided a representative sample of Swedish FP/GPs. Analysis of the answers was compatible with the hypothesis that the mentioned increase in Swedish B12 market reflected increased awareness in primary health care about the biochemical, pathophysiological and social problems associated with vitamin B12 deficiency.

Shifts in B12 opinions in primary health care of Sweden.

AIMS: The diagnosis and management of vitamin B12 deficiency varies between countries and within countries. The aim of the study was to map current attitudes and values behind clinical decision-making in Swedish primary health care, which has a unique B12 tradition: two patients out of three are treated with oral high-dose cyanocobalamin. Most patients with B12-associated problems are managed in primary health care by general practitioners (GPs). METHODS: The study was designed to elucidate possible opinion shifts among GPs during the period 1996-1998. GPs (n=499), stratified and randomized, received a questionnaire with 24 statements on B12-associated clinical and laboratory problems, to be evaluated by a visuo-analogue scale. RESULTS: The majority of GPs in primary health care in Sweden accepted homocysteine and methylmalonic acid (MMA) as markers for functional deficiency of vitamin B12. The evaluation of classical markers of B12 deficiency was wary and balanced. There was a consensus of the need for B12 therapy to risk groups such as patients with atrophic gastritis or previous gastric surgery. The answers also appeared to reflect an improvement of professional knowledge and competence concerning B12-associated problems among Swedish GPs between 1996 and 1998. CONCLUSIONS: The overriding conclusion was that B12-associated opinions of Swedish GPs were stable within the period studied, with marginal improvements of knowledge and competence.

Intravascular haemolysis and increased prevalence of myeloma and monoclonal gammopathy in congenital dyserythropoietic anaemia, type III.

A family with congenital dyserythropoietic anaemia type III was studied. Twenty patients and 10 of their healthy siblings were clinically examined and questioned about their medical history. Blood sampling and bone marrow aspirations were also performed. Forty-five percent of the patients reported symptoms of anaemia and 35% regularly felt weakness, fatigue, or headache. However, the majority of the patients regarded themselves as healthy. The bone marrow showed a uniform picture of erythroid hyperplasia with multinuclear erythroblasts and gigantoblasts with up to 12 nuclei. There was laboratory evidence of intravascular haemolysis and mild anaemia. We also observed a high prevalence of monoclonal gammopathy of undetermined significance (3 cases) and myeloma (1 case) among the patients.

Vitamin B12 in primary health care and geriatrics--attitudes, knowledge and competence.

OBJECTIVES: The objective of the study was to test attitudes, knowledge and competence of Swedish general practitioners and geriatricians concerning B12-associated problems in 1998. METHODS: Postal questionnaires were sent to a random sample of 485 GPs and a total sample of 613 geriatricians. The response rates were 70% in the GP group and 69% in the geriatrician group. The questionnaire contained 24 statements to be evaluated by a visuo-analogue scale. RESULTS: There were small numerical differences between the two physician groups. The geriatricians were more aware of risk groups for B12 deficiency. GPs were less categorical concerning low hit rate in the laboratory testing of clinical conclusions. There were statistical differences in both directions for statements on pitfalls in laboratory diagnostics. GPs were somewhat less prone to give risk groups prophylactic B12 therapy. CONCLUSIONS: GPs and geriatricians appeared to be familiar with the current debate on B12-associated problems, suggesting that health care quality will be unaffected by patient transfer from hospital care to primary health care.

Localization of the gene for congenital dyserythropoietic anemia type III, CDAN3, to chromosome 15q21-q25.

Congenital dyserythropoietic anemia, type III (CDA III) is a rare autosomal dominant disorder characterized by macrocytic anemia, bone marrow erythroid hyperplasia and giant multinucleate erythroblasts. We have genetically characterized a large Swedish family in which the concurrence of CDA III and myeloma or benign monoclonal gammopathy is significantly higher than expected and have found that the causative genetic defect for CDA III maps to an 11 cM interval within 15q21-q25.

Observations on two members of the Swedish family with congenital dyserythropoietic anaemia, type III.

Two affected individuals of the Swedish family with CDA, type III, in which the disease is transmitted as an autosomal dominant character, were studied. Both cases displayed features hitherto undescribed in this family but described in patients with CDA, type III, in whom the inheritance may have been as an autosomal recessive character. Such features were: (a) haemosiderinuria, (b) grossly disorganised erythroblast nuclei, (c) differences in the ultrastructural appearances of individual nuclei within the same multinucleate erythroblast and (d) intraerythroblastic inclusions resembling precipitated globin chains. In both cases the giant mononucleate erythroblasts and the multinucleate erythroblasts had total DNA contents up to 28c (1c = haploid DNA content) and 48c respectively, and some DNA synthesising bi- and multinucleate erythroblasts contained one or more nuclei which were unlabelled with 3H-thymidine. These findings are similar to those in patients with the autosomal recessive type of disease. Thus no major phenotypic differences are yet apparent between cases of CDA, type III, with different patterns of inheritance. Analysis of the surface erythrocyte proteins of the 2 Swedish CDA, type III, patients with monoclonal antibodies recognising Band 3, glycophorins A, B, C and D, Rh, CD44, CD47, CD55, CD58, CD59, Lutheran, Kell, LW and acetylcholinesterase did not reveal any gross abnormality of expression of these proteins. A slightly altered expression of blood group antigens A and H was revealed by the lectins Dolichos biflorus and Ulex europaeus and the Mr of Band 3 as judged by SDS polyacrylamide gel electrophoresis was also slightly reduced, suggesting that there may be minor alterations in the degree of N-glycosylation of some red cell membrane constituents.